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.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 aeyen65 years. Patients enrolled in 2012 and 2014 discharged with an AF diagnosis were analysed.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).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.

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

Marco Proietti
Membro del Collaboration Group
;
Domenico Prisco
Membro del Collaboration Group
;
Elmo Mannarino
Membro del Collaboration Group
;
Graziana Lupattelli
Membro del Collaboration Group
;
Vanessa Bianconi
Membro del Collaboration Group
;
Francesco Paciullo
Membro del Collaboration Group
;
Oliviero Olivieri
Membro del Collaboration Group
;
Maria Valenti
Membro del Collaboration Group
;
Maria Domenica Cappellini
Membro del Collaboration Group
;
Lucia Sofia
Membro del Collaboration Group
;
Maria Carbone
Membro del Collaboration Group
;
Giancarlo Agnelli
Membro del Collaboration Group
;
Emanuela Marchesini
Membro del Collaboration Group
;
Elisabetta Greco
Membro del Collaboration Group
;
Marco Bertolotti
Membro del Collaboration Group
;
Andrea Miceli
Membro del Collaboration Group
;
Elisa Pellegrini
Membro del Collaboration Group
;
Mauro Serra
Membro del Collaboration Group
;
Roberto Leonardi
Membro del Collaboration Group
;
Giorgio Minelli
Membro del Collaboration Group
;
Massimo Mattioli
Membro del Collaboration Group
;
Marco Cattaneo
Membro del Collaboration Group
;
Maria Valentina Amoruso
Membro del Collaboration Group
;
2016-01-01

Abstract

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.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 aeyen65 years. Patients enrolled in 2012 and 2014 discharged with an AF diagnosis were analysed.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).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.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11391/1538495
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