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.

Choice and outcomes of rate control versus rhythm control in elderly patients with atrial fibrillation: a report from the REPOSI study / Paciullo, Francesco; Proietti, Marco; Bianconi, Vanessa; Nobili, Alessandro; Pirro, Matteo; Mannucci, Pier Mannuccio; Lip, Gregory Y H; Lupattelli, Graziana; REPOSI Investigators (Mannucci, Pm; Nobili, A; Tettamanti, M; Pasina, L; Franchi, C; Perticone, F; Salerno, F; Corrao, S; Marengoni, A; Licata, G; Violi, F; Corazza, Gr; Marcucci, M; Eldin, Tk; Di Blanca, Mpd; Lanzo, G; Astuto, S; Tettamanti, M; Ardoino, I; Cortesi, L; Prisco, D; Silvestri, E; Cenci, C; Emmi, G; Biolo, G; Guarnieri, G; Zanetti, M; Fernandes, G; Chiuch, M; Vanoli, M; Grignani, G; Casella, G; Pulixi, Ea; Bernardi, M; Bassi, Sl; Santi, L; Zaccherini, G; Mannarino, E; Lupattelli, G; Bianconi, V; Paciullo, F; Nuti, R; Valenti, R; Ruvio, M; Cappelli, S; Palazzuoli, A; Salvatore, T; Sasso, Fc; Girelli, D; Olivieri, O; Matteazzi, T; Barbagallo, M; Plances, L; Alcamo, R; Licata, G; Calvo, L; Valenti, M; Zoli, M; Arnò, R; Pasini, Fl; Capecchi, Pl; Bicchi, M; Palasciano, G; Modeo, Me; Peragine, M; Pappagallo, F; Pugliese, S; Di Gennaro, C; Postiglione, A; Barbella, Mr; De Stefano, F; Cappellini, Md; Fabio, G; Seghezzi, S; De Amicis, Mm; Mancarella, M; Mari, D; Rossi, Pd; Damanti, S; Ottolini, Bb; Bonini, G; Corazza, Gr; Miceli, E; Lenti, Mv; Padula, D; Murialdo, G; Marra, A; Cattaneo, F; Secchi, Mb; Ghelfi, D; Anastasio, L; Gnoli, SOFIA LEONCINA; Carbone, M; Davì, G; Guagnano, Mt; Sestili, S; Mancuso, G; Calipari, D; Bartone, M; Meroni, Mr; Perin, Pc; Lorenzati, B; Gruden, G; Bruno, G; Amione, C; Fornengo, P; Tassara, R; Melis, D; Rebella, L; Delitala, G; Pretti, V; Masala, Ms; Pes, C; Bolondi, L; Rasciti, L; Serio, I; Fanelli, Fr; Amoroso, A; Molfino, A; Petrillo, E; Zuccalà, G; Franceschi, F; De Marco, G; Chiara, C; Marta, S; D'Aurizio, G; Romanelli, G; Amolini, C; Chiesa, D; Marengoni, A; Picardi, A; Gentilucci, Uv; Gallo, P; Annoni, G; Corsi, M; Zazzetta, S; Bellelli, G; Szabo, H; Arturi, F; Succurro, E; Rubino, M; Sesti, G; Loria, P; Becchi, Ma; Martucci, G; Fantuzzi, A; Maurantonio, M; Serra, Mg; Bleve, Ma; Gasbarrone, L; Sajeva, Mr; Brucato, A; Ghidoni, S; Di Corato, P; Agnelli, G; Marchesini, E; Fabris, F; Carlon, M; Turatto, F; Baritusso, A; Turatto, F; Amabile, A; Omenetto, E; Scarinzi, P; Manfredini, R; Molino, C; Pala, M; Fabbian, F; Boari, B; De Giorgi, A; Paolisso, G; Rizzo, Mr; Laieta, Mt; Rini, G; Mansueto, P; Pepe, I; Borghi, C; Strocchi, E; De Sando, V; Pareo, I; Sabbà, C; Vella, Fs; Suppressa, P; Valerio, R; Agosti, P; Fontana, F; Loparco, F; Pugliese, S; Capobianco, C; Fenoglio, L; Bracco, C; Giraudo, Av; Testa, E; Serraino, C; Fargion, S; Bonara, P; Periti, G; Porzio, M; Tiraboschi, S; Peyvandi, F; Tedeschi, A; Rossio, R; Ferrari, B; Monzani, V; Savojardo, V; Folli, C; Magnini, M; Salerno, F; Conca, A; Gobbo, G; Conca, A; Pallini, G; Valenti, M; Balduini, Cl; Bertolino, G; Provini, S; Quaglia, F; Dallegri, F; Ottonello, L; Liberale, L; Chin, Ws; Carassale, L; Caporotundo, S; Traisci, G; De Feudis, L; Di Carlo, S; Liberato, Nl; Buratti, A; Tognin, T; Bianchi, Gb; Giaquinto, S; Purrello, F; Di Pino, A; Piro, S; Rozzini, R; Falanga, L; Spazzini, E; Montrucchio, G; Greco, E; Tizzani, P; Petitti, P; Perciccante, A; Coralli, A; Salmi, R; Gaudenzi, P; Gamberini, S; Semplicini, A; Gottardo, L; Vendemiale, Giuseppina; Serviddio, G; Forlano, R; Masala, C; Mammarella, A; Raparelli, V; Violi, F; Basili, S; Perri, L; Landolfi, R; Montalto, M; Mirijello, A; Vallone, C; Bellusci, M; Setti, D; Pedrazzoli, F; Guasti, L; Castiglioni, L; Maresca, A; Squizzato, A; Molaro, M; Bertolotti, M; Mussi, C; Libbra, Mv; Miceli, A; Pellegrini, E; Carulli, L; Veltri, F; Perticone, F; Sciacqua, A; Quero, M; Bagnato, C; Colangelo, L; Falbo, T; De Giorgio, R; Serra, M; Grasso, V; Ruggeri, E; Ilaria, B; Salvi, A; Leonardi, R; Grassini, C; Mascherona, I; Minelli, G; Maltese, F; Damiani, Gianfranco; Capeci, W; Mattioli, M; Martino, Gp; Biondi, L; Ormas, M; Pettinari, P; Romiti, R; Corrao, S; Messina, S; Cavallaro, F; Ghio, R; Favorini, S; Col, Ad; Minisola, S; Colangelo, L; Afeltra, A; Alemanno, P; Marigliano, B; Pipita, Me; Castellino, P; Blanco, J; Zanoli, L; Cattaneo, M; Fracasso, P; Amoruso, Mv; Saracco, V; Fogliati, M; Bussolino, C; Durante, V; Eusebi, G; Tirotta, D; Mete, F; Gino, M; Cittadini, A; Vigorito, C; Arcopinto, M; Salzano, A; Bobbio, E; Sirico, D; Moreo, G; Scopelliti, F; Gasparini, F; Cocca, M; Ballestrero, A; Ferrando, F; Berra, S; Dassi, S; Nava, Mc; Graziella, B; Ghidoni, S; Amione, C; Baldassarre, S; Fragapani, S; Gruden, G; Galanti, G; Mascherini, G; Petri, C; Stefani', Loreta Anna; Girino, M; Piccinelli, V; Nasso, F; Gioffrè, V; Pasquale, M; Scattolin, G; Martinelli, S; Turrin, M; Sechi, MARIA LAURA; Catena, C; Colussi, G; Nieves, Rd; Alberto, Mm; Pedro, Ar; Vanessa, Lp; Lara, T; Xavier, Cv; Francesc, F; Jesus, Dm; Esperanza, Bt; Esther, Dcb; Maria, Sp; Romero, M; Blanca, Pl; Cristina, Lg; Victoria, Vgm; Saez, L; Bosco, J; Susana, Sb; Marta, Ag; Concepcion, Gb; Antonio, Fm; Hernandez, Mg; Borrego, Mp; Raquel, Pc; Florencia, Pr; Beatriz, Go; Sara, Cg; Alfonso, Gc; Marta, Pm; Garcia, Sc; Alberto, Rc; Antonio, Aa; Montserrat, Gg; Ángel, Brm; Manuel, Mj; Ignacio, Nv; Lucía, As; Alfonso, L; David, Rb; Iria, Iv; Monica, RP). - In: DRUGS & AGING. - ISSN 1170-229X. - ELETTRONICO. - 35:4(2018), pp. 365-373. [10.1007/s40266-018-0532-8]

Choice and outcomes of rate control versus rhythm control in elderly patients with atrial fibrillation: a report from the REPOSI study

Proietti, Marco
Secondo
;
Violi F;Fanelli FR;Amoroso A;Molfino A;Petrillo E;Masala C;Mammarella A;Raparelli V;Violi F;Basili S;Colangelo L;Minisola S
Membro del Collaboration Group
;
2018

Abstract

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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