A Survey of Long‐Term Antiarrhythmic Therapy in Elderly Patients with Atrial Fibrillation

Abstract

Aim: To investigate the use of long-term antiarrhythmic (rhythm-control [RHY] and rate-control [RAC]) therapy for the management of atrial fibrillation (AF) in elderly patients. Method: Data were collected retrospectively from the medical records of255 patients with AF who were ;:::65 years of age and were admitted to Royal North Shore Hospital in the period 1 July 1996 to 30 June 1997. Results: Overall, 192 (75%) patients were discharged on antiarrhythmic therapy for the long-term management of AF. Sixty-six patients (26%) received RHY only, 90 (35%) received RAC only, 36 (14%) were prescribed the combination of RHY + RAC therapy, and 63 (25%) received no therapy.Patients ;::so years of age were equally likely to receive longterm antiarrhythmic therapy as those <SO years (74% versus 77%, p = 0.65), but a significantly lower proportion of them received RHY only than in those <SO years (17% versus 34%, p = 0.001). The preferred option in older patients was RAC only (42% ). Cardiology patients were more likely to receive RHY ± RAC therapy (53%) than Aged Care (16%) or General Medicine patients (16%; p < 0.05). Logistic regression analysis indicated that old age and medical specialty were significant predictors for the choice of agent: patients ;::so years were 2.2 times more likely to receive RAC only in preference to RHY only therapy than their younger counterparts (p = 0.044). Conclusion: Long-term rhythm-control therapy (e.g. amiodarone, sotalol) is potentially underutilised in AF patients INTRODUCTIONAtrial fibrillation (AF) is the most commonly encountered cardiac arrhythmia in clinical practice. It is most prevalent in the elderly and is estimated to occur in approximately 12% of people over 75 years of age. 1 The most alarming consequence of AF is cardioembo1ic stroke, particularly in the elderly population over SO years of age, where more than one-third of all strokes can be directly attributed to AF. 2 Stroke prevention is a major objective in the management of AF, and recent attention has focused on the use of antithrombotic therapy.2· 3 Although warfarin has been shown to effectively and safely reduce the relative risk of stroke in AF, 4 · 9 evidence suggests suboptimal use in the target elderly population for fear of bleeding. 10 12The most effective way to prevent stroke in this setting, as well as avoid the dilemma of whether to anticoagulate an elderly patient, is to optimise the manage-

Are interventions recommended by pharmacists during Home Medicines Review evidence‐based?

“…Although these management issues may appear to be of limited significance they are integral to risk prevention and management, and require that attention be devoted to necessary communication and documentation so as to ensure that appropriate follow‐up occurs. Pharmacists also recommended a high number of medication changes: recommendations for initiating new medicines were the most common among these changes, highlighting that the under‐prescription of medicines is increasingly being recognized as a problem in older people [17,50,51]. The use of non‐drug therapy was the least (1.6%) commonly recommended action reported to the GP.…”

Identifying Temporal Changes to the Prescribing of Anti‐Arrhythmics for Atrial Fibrillation

“…An Australian clinical audit, conducted at a large Sydney teaching hospital (n = 255), which investigated antiarrhythmic use in AF, highlighted that the elderly were less likely to receive long-term anti-arrhythmics, and that digoxin was over used as a rate control drug. 6 Historically, digoxin has been a drug of choice for AF but its inability to revert, prevent, or effectively control AF particularly on exercise, renders its main use to cases of AF accompanied by heart failure.…”