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

Abstract

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.

Rhythm- or rate-control strategies according to 4S-AF characterization scheme and long-term outcomes in atrial fibrillation patients: the FAMo (Fibrillazione Atriale in Modena) cohort

“…Finally, the association between the specific strategy of rate or rhythm control and outcome results to be variable, depending on the population studied. While rate control was associated with a worse outcome in our study, particularly with a higher all-cause mortality, in agreement with the "Get with the Guidelines Heart Failure Registry" [53], mortality did not differ between rate and rhythm control in REPOSI [54] and ORBIT AF [55] registries.…”

Atrial Fibrillation in Older People: Concepts and Controversies

“…An ancillary analysis of the REPOSI study (146), a multi-center observational registry, did not demonstrate significant differences in the cardiovascular and all-cause mortality of older patients managed using rate and rhythm control strategies. In the study, the rate control group was older and had higher rates of polypharmacy, heart failure, and diabetes.…”

Polypharmacy in older people: lessons from 10 years of experience with the REPOSI register

“…According to the 2003 and 2012 Beers criteria on drugs that should be avoided in older people, the prevalence of patients receiving at least one inappropriate medication is relatively high, at 20 and 24%, respectively [13]. Pertaining to the drugs most frequently inappropriately prescribed even according to the available guidelines, there are proton pump inhibitors [14], non-steroidal antinflammatory drugs (NSAIDs) [15], antibiotics [16], allopurinol [17], such antithrombotic drugs as anticoagulants [18][19][20][21][22] and antiplatelets [23], and, in general, all the classes of drugs active in the central nervous system (antipsychotics, antidepressants, opioids [24][25][26][27].) A definite increase in therapeutic duplicates of psychotropic drugs and drugs for peptic ulcer is also observed at hospital discharge, although duplication increases the risk of adverse drug events and costs [28].…”