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Clin Res Cardiol. 2016 Nov;105(11):912-920. Epub 2016 May 31.

Adherence to antithrombotic therapy guidelines improves mortality among elderly patients with atrial fibrillation: insights from the REPOSI study.

Author information

1
Institute of Cardiovascular Sciences, City Hospital, University of Birmingham, Birmingham, Dudley Road, B18 7QH, UK. marco.proietti@uniroma1.it.
2
Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Rome, Italy. marco.proietti@uniroma1.it.
3
Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
4
Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Rome, Italy.
5
Department of Experimental Medicine, Sapienza-University of Rome, Rome, Italy.
6
IRCCS Fondazione Cà Granda, A. Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy.
7
Institute of Cardiovascular Sciences, City Hospital, University of Birmingham, Birmingham, Dudley Road, B18 7QH, UK. g.y.h.lip@bham.ac.uk.
8
Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. g.y.h.lip@bham.ac.uk.

Abstract

BACKGROUND:

Atrial fibrillation (AF) is associated with a substantial risk of thromboembolism and mortality, significantly reduced by oral anticoagulation. Adherence to guidelines may lower the risks for both all cause and cardiovascular (CV) deaths.

METHODS:

Our objective was to evaluate if antithrombotic prophylaxis according to the 2012 European Society of Cardiology (ESC) guidelines is associated to a lower rate of adverse outcomes. Data were obtained from REPOSI; a prospective observational study enrolling inpatients aged ≥65 years. Patients enrolled in 2012 and 2014 discharged with an AF diagnosis were analysed.

RESULTS:

Among 2535 patients, 558 (22.0 %) were discharged with a diagnosis of AF. Based on ESC guidelines, 40.9 % of patients were on guideline-adherent thromboprophylaxis, 6.8 % were overtreated, and 52.3 % were undertreated. Logistic analysis showed that increasing age (p = 0.01), heart failure (p = 0.04), coronary artery disease (p = 0.013), peripheral arterial disease (p = 0.03) and concomitant cancer (p = 0.003) were associated with non-adherence to guidelines. Specifically, undertreatment was significantly associated with increasing age (p = 0.001) and cancer (p < 0.001), and inversely associated with HF (p = 0.023). AF patients who were guideline adherent had a lower rate of both all-cause death (p = 0.007) and CV death (p = 0.024) compared to those non-adherent. Kaplan-Meier analysis showed that guideline-adherent patients had a lower cumulative risk for both all-cause (p = 0.002) and CV deaths (p = 0.011). On Cox regression analysis, guideline adherence was independently associated with a lower risk of all-cause and CV deaths (p = 0.019 and p = 0.006).

CONCLUSIONS:

Non-adherence to guidelines is highly prevalent among elderly AF patients, despite guideline-adherent treatment being independently associated with lower risk of all-cause and CV deaths. Efforts to improve guideline adherence would lead to better outcomes for elderly AF patients.

KEYWORDS:

Antithrombotic therapy; Atrial fibrillation; Elderly; Guidelines; Outcomes

PMID:
27245329
DOI:
10.1007/s00392-016-0999-4
[Indexed for MEDLINE]

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