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. © 2018, Springer International Publishing AG, part of Springer Nature.
Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation: A Report from the REPOSI Study
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; Sofia L; 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 G; 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 G; 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; Marra AM ;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 L; Girino M; Piccinelli V; Nasso F; Gioffrè V; Pasquale M; Scattolin G; Martinelli S; Turrin M; Sechi L; 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.
2018
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. © 2018, Springer International Publishing AG, part of Springer Nature.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11588/721212
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Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2021-2023 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande. La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.