Abstract

Background: Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the best management approach for non-valvular atrial fibrillation (AF) in elderly patients. Design: We performed an ancillary analysis from the ‘Registro Politerapie SIMI’ study, enrolling elderly inpatients from internal medicine and geriatric wards. Methods: We considered patients enrolled from 2008 to 2014 with an AF diagnosis at admission, treated with a rate-control-only or rhythm-control-only strategy. Results: Among 1114 patients, 241 (21.6%) were managed with observation only and 122 (11%) were managed with both the rate- and rhythm-control approaches. Of the remaining 751 patients, 626 (83.4%) were managed with a rate-control-only strategy and 125 (16.6%) were managed with a rhythm-control-only strategy. Rate-control-managed patients were older (p = 0.002), had a higher Short Blessed Test (SBT; p = 0.022) and a lower Barthel Index (p = 0.047). Polypharmacy (p = 0.001), heart failure (p = 0.005) and diabetes (p = 0.016) were more prevalent among these patients. Median CHA2DS2-VASc score was higher among rate-control-managed patients (p = 0.001). SBT [odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94–1.00, p = 0.037], diabetes (OR 0.48, 95% CI 0.26–0.87, p = 0.016) and polypharmacy (OR 0.58, 95% CI 0.34–0.99, p = 0.045) were negatively associated with a rhythm-control strategy. At follow-up, no difference was found between rate- and rhythm-control strategies for cardiovascular (CV) and all-cause deaths (6.1 vs. 5.6%, p = 0.89; and 15.9 vs. 14.1%, p = 0.70, respectively). Conclusion: A rate-control strategy is the most widely used among elderly AF patients with multiple comorbidities and polypharmacy. No differences were evident in CV death and all-cause death at follow-up.

Original languageEnglish
Pages (from-to)365-373
Number of pages9
JournalDrugs and Aging
Volume35
Issue number5
DOIs
Publication statusPublished - 2018

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Atrial Fibrillation
Polypharmacy
Odds Ratio
Confidence Intervals
Cause of Death
Internal Medicine
Geriatrics
Comorbidity
Inpatients
Heart Failure
Observation

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Pharmacology (medical)

Cite this

Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation : A Report from the REPOSI Study. / REPOSI investigators.

In: Drugs and Aging, Vol. 35, No. 5, 2018, p. 365-373.

Research output: Contribution to journalArticle

@article{29497c88d75146e8b01df1a311321b37,
title = "Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation: A Report from the REPOSI Study",
abstract = "Background: Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the best management approach for non-valvular atrial fibrillation (AF) in elderly patients. Design: We performed an ancillary analysis from the ‘Registro Politerapie SIMI’ study, enrolling elderly inpatients from internal medicine and geriatric wards. Methods: We considered patients enrolled from 2008 to 2014 with an AF diagnosis at admission, treated with a rate-control-only or rhythm-control-only strategy. Results: Among 1114 patients, 241 (21.6{\%}) were managed with observation only and 122 (11{\%}) were managed with both the rate- and rhythm-control approaches. Of the remaining 751 patients, 626 (83.4{\%}) were managed with a rate-control-only strategy and 125 (16.6{\%}) were managed with a rhythm-control-only strategy. Rate-control-managed patients were older (p = 0.002), had a higher Short Blessed Test (SBT; p = 0.022) and a lower Barthel Index (p = 0.047). Polypharmacy (p = 0.001), heart failure (p = 0.005) and diabetes (p = 0.016) were more prevalent among these patients. Median CHA2DS2-VASc score was higher among rate-control-managed patients (p = 0.001). SBT [odds ratio (OR) 0.97, 95{\%} confidence interval (CI) 0.94–1.00, p = 0.037], diabetes (OR 0.48, 95{\%} CI 0.26–0.87, p = 0.016) and polypharmacy (OR 0.58, 95{\%} CI 0.34–0.99, p = 0.045) were negatively associated with a rhythm-control strategy. At follow-up, no difference was found between rate- and rhythm-control strategies for cardiovascular (CV) and all-cause deaths (6.1 vs. 5.6{\%}, p = 0.89; and 15.9 vs. 14.1{\%}, p = 0.70, respectively). Conclusion: A rate-control strategy is the most widely used among elderly AF patients with multiple comorbidities and polypharmacy. No differences were evident in CV death and all-cause death at follow-up.",
author = "{REPOSI investigators} and Francesco Paciullo and Marco Proietti and Vanessa Bianconi and Alessandro Nobili and Matteo Pirro and Mannucci, {Pier Mannuccio} and Lip, {Gregory Y.H.} and Graziana Lupattelli and Mannucci, {Pier Mannuccio} and Alessandro Nobili and Mauro Tettamanti and Luca Pasina and Carlotta Franchi and Francesco Perticone and Francesco Salerno and Salvatore Corrao and Alessandra Marengoni and Giuseppe Licata and Francesco Violi and Corazza, {Gino Roberto} and Maura Marcucci and Mauro Tettamanti and Mauro Bernardi and Cappellini, {Maria Domenica} and Giovanna Fabio and {de Amicis}, {Margherita Migone} and Daniela Mari and Rossi, {Paolo Dionigi} and Corazza, {Gino Roberto} and Emanuela Miceli and Giovanni Murialdo and Maria Carbone and Rizzo, {Maria Rosaria} and Christian Bracco and Silvia Fargion and Flora Peyvandi and Alberto Tedeschi and Valter Monzani and Valeria Savojardo and Christian Folli and Francesco Salerno and Balduini, {Carlo L.} and Giampiera Bertolino and Bianchi, {Giovanni Battista} and Gianluigi Vendemiale and Antonio Mirijello and Chiara Mussi and Michele Arcopinto and Marra, {Alberto Maria} and Alberto Ballestrero",
year = "2018",
doi = "10.1007/s40266-018-0532-8",
language = "English",
volume = "35",
pages = "365--373",
journal = "Drugs and Aging",
issn = "1170-229X",
publisher = "Springer International Publishing",
number = "5",

}

TY - JOUR

T1 - Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation

T2 - A Report from the REPOSI Study

AU - REPOSI investigators

AU - Paciullo, Francesco

AU - Proietti, Marco

AU - Bianconi, Vanessa

AU - Nobili, Alessandro

AU - Pirro, Matteo

AU - Mannucci, Pier Mannuccio

AU - Lip, Gregory Y.H.

AU - Lupattelli, Graziana

AU - Mannucci, Pier Mannuccio

AU - Nobili, Alessandro

AU - Tettamanti, Mauro

AU - Pasina, Luca

AU - Franchi, Carlotta

AU - Perticone, Francesco

AU - Salerno, Francesco

AU - Corrao, Salvatore

AU - Marengoni, Alessandra

AU - Licata, Giuseppe

AU - Violi, Francesco

AU - Corazza, Gino Roberto

AU - Marcucci, Maura

AU - Tettamanti, Mauro

AU - Bernardi, Mauro

AU - Cappellini, Maria Domenica

AU - Fabio, Giovanna

AU - de Amicis, Margherita Migone

AU - Mari, Daniela

AU - Rossi, Paolo Dionigi

AU - Corazza, Gino Roberto

AU - Miceli, Emanuela

AU - Murialdo, Giovanni

AU - Carbone, Maria

AU - Rizzo, Maria Rosaria

AU - Bracco, Christian

AU - Fargion, Silvia

AU - Peyvandi, Flora

AU - Tedeschi, Alberto

AU - Monzani, Valter

AU - Savojardo, Valeria

AU - Folli, Christian

AU - Salerno, Francesco

AU - Balduini, Carlo L.

AU - Bertolino, Giampiera

AU - Bianchi, Giovanni Battista

AU - Vendemiale, Gianluigi

AU - Mirijello, Antonio

AU - Mussi, Chiara

AU - Arcopinto, Michele

AU - Marra, Alberto Maria

AU - Ballestrero, Alberto

PY - 2018

Y1 - 2018

N2 - Background: Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the best management approach for non-valvular atrial fibrillation (AF) in elderly patients. Design: We performed an ancillary analysis from the ‘Registro Politerapie SIMI’ study, enrolling elderly inpatients from internal medicine and geriatric wards. Methods: We considered patients enrolled from 2008 to 2014 with an AF diagnosis at admission, treated with a rate-control-only or rhythm-control-only strategy. Results: Among 1114 patients, 241 (21.6%) were managed with observation only and 122 (11%) were managed with both the rate- and rhythm-control approaches. Of the remaining 751 patients, 626 (83.4%) were managed with a rate-control-only strategy and 125 (16.6%) were managed with a rhythm-control-only strategy. Rate-control-managed patients were older (p = 0.002), had a higher Short Blessed Test (SBT; p = 0.022) and a lower Barthel Index (p = 0.047). Polypharmacy (p = 0.001), heart failure (p = 0.005) and diabetes (p = 0.016) were more prevalent among these patients. Median CHA2DS2-VASc score was higher among rate-control-managed patients (p = 0.001). SBT [odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94–1.00, p = 0.037], diabetes (OR 0.48, 95% CI 0.26–0.87, p = 0.016) and polypharmacy (OR 0.58, 95% CI 0.34–0.99, p = 0.045) were negatively associated with a rhythm-control strategy. At follow-up, no difference was found between rate- and rhythm-control strategies for cardiovascular (CV) and all-cause deaths (6.1 vs. 5.6%, p = 0.89; and 15.9 vs. 14.1%, p = 0.70, respectively). Conclusion: A rate-control strategy is the most widely used among elderly AF patients with multiple comorbidities and polypharmacy. No differences were evident in CV death and all-cause death at follow-up.

AB - Background: Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the best management approach for non-valvular atrial fibrillation (AF) in elderly patients. Design: We performed an ancillary analysis from the ‘Registro Politerapie SIMI’ study, enrolling elderly inpatients from internal medicine and geriatric wards. Methods: We considered patients enrolled from 2008 to 2014 with an AF diagnosis at admission, treated with a rate-control-only or rhythm-control-only strategy. Results: Among 1114 patients, 241 (21.6%) were managed with observation only and 122 (11%) were managed with both the rate- and rhythm-control approaches. Of the remaining 751 patients, 626 (83.4%) were managed with a rate-control-only strategy and 125 (16.6%) were managed with a rhythm-control-only strategy. Rate-control-managed patients were older (p = 0.002), had a higher Short Blessed Test (SBT; p = 0.022) and a lower Barthel Index (p = 0.047). Polypharmacy (p = 0.001), heart failure (p = 0.005) and diabetes (p = 0.016) were more prevalent among these patients. Median CHA2DS2-VASc score was higher among rate-control-managed patients (p = 0.001). SBT [odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94–1.00, p = 0.037], diabetes (OR 0.48, 95% CI 0.26–0.87, p = 0.016) and polypharmacy (OR 0.58, 95% CI 0.34–0.99, p = 0.045) were negatively associated with a rhythm-control strategy. At follow-up, no difference was found between rate- and rhythm-control strategies for cardiovascular (CV) and all-cause deaths (6.1 vs. 5.6%, p = 0.89; and 15.9 vs. 14.1%, p = 0.70, respectively). Conclusion: A rate-control strategy is the most widely used among elderly AF patients with multiple comorbidities and polypharmacy. No differences were evident in CV death and all-cause death at follow-up.

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