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

Drugs Aging. 2018 Apr;35(4):365-373. doi: 10.1007/s40266-018-0532-8.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Arrhythmia Agents / therapeutic use
  • Atrial Fibrillation / drug therapy*
  • Atrial Fibrillation / epidemiology
  • Atrial Fibrillation / physiopathology
  • Comorbidity
  • Diabetes Mellitus / drug therapy
  • Diabetes Mellitus / epidemiology
  • Female
  • Heart Failure / drug therapy
  • Heart Failure / epidemiology
  • Heart Rate / drug effects
  • Hospitalization
  • Humans
  • Male
  • Odds Ratio
  • Polypharmacy
  • Prevalence

Substances

  • Anti-Arrhythmia Agents