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.
Titolo: | Adherence to antithrombotic therapy guidelines improves mortality among elderly patients with atrial fibrillation: insights from the REPOSI study | |
Autore/i: | Proietti M.; Nobili A.; Raparelli V.; Napoleone L.; Mannucci P. M.; Lip G. Y. H.; Pasina L.; Franchi C.; Tettamanti M.; Eldin T. K.; Di Blanca M. P. D.; Djade C. D.; Ardoino I.; Cortesi L.; Marengoni A.; Licata G.; Violi F.; Corazza G. R.; Biolo G.; Guarnieri G.; Zanetti M.; Fernandes G.; Vanoli M.; Grignani G.; Casella G.; Bernardi M.; Bassi S. L.; Santi L.; Zaccherini G.; Mannarino E.; Lupattelli G.; Bianconi V.; Paciullo F.; Nuti R.; Valenti R.; Ruvio M.; Cappelli S.; Palazzuoli A.; Salvatore T.; Sasso F. C.; Girelli D.; Olivieri O.; Matteazzi T.; Barbagallo M.; Plances L.; Alcamo R.; Licata G.; Calvo L.; Valenti M.; Zoli M.; Arno R.; Pasini F. L.; Capecchi P. L.; Bicchi M.; Palasciano G.; Modeo M. E.; Peragine M.; Pappagallo F.; Di Gennaro C.; Postiglione A.; Barbella M. R.; De Stefano F.; Cappellini M. D.; Fabio G.; Seghezzi S.; De Amicis M. M.; Mari D.; Rossi P. D.; Ottolini B. B.; Miceli E.; Lenti M. V.; Padula D.; Murialdo G.; Marra A.; Cattaneo F.; Secchi M. B.; Ghelfi D.; Anastasio L.; Sofia L.; Carbone M.; Damanti S.; Guagnano M. T.; Sestili S.; Mancuso G.; Calipari D.; Bartone M.; Meroni M. R.; Perin P. C.; Lorenzati B.; Gruden G.; Bruno G.; Amione C.; Fornengo P.; Tassara R.; Melis D.; Rebella L.; Pretti V.; Masala M. S.; Bolondi L.; Rasciti L.; Serio I.; Fanelli F. R.; Amoroso A.; Molfino A.; Petrillo E.; Zuccala G.; Franceschi F.; De Marco G.; Chiara C.; Marta S.; Romanelli G.; Amolini C.; Chiesa D.; Picardi A.; Gentilucci U. V.; Gallo P.; Annoni G.; Corsi M.; Zazzetta S.; Bellelli G.; Arturi F.; Succurro E.; Rubino M.; Sesti G.; Loria P.; Becchi M. A.; Martucci G.; Fantuzzi A.; Maurantonio M.; Carta S.; Atzori S.; Serra M. G.; Bleve M. A.; Gasbarrone L.; Sajeva M. R.; Brucato A.; Ghidoni S.; Di Corato P.; Agnelli G.; Marchesini E.; Fabris F.; Carlon M.; Baritusso A.; Manfredini R.; Molino C.; Pala M.; Fabbian F.; Boari B.; De Giorgi A.; Paolisso G.; Rizzo M. R.; Laieta M. T.; Rini G.; Mansueto P.; Pepe I.; Borghi C.; Strocchi E.; De Sando V.; Sabba C.; Vella F. S.; Turatto F.; Valerio R.; Capobianco C.; Fenoglio L.; Bracco C.; Giraudo A. V.; Testa E.; Serraino C.; Fargion S.; Bonara P.; Periti G.; Porzio M.; Peyvandi F.; Tedeschi A.; Rossio R.; Monzani V.; Savojardo V.; Folli C.; Magnini M.; Gobbo G.; Balduini C. L.; Bertolino G.; Provini S.; Quaglia F.; Dallegri F.; Ottonello L.; Liberale L.; Chin W. S.; Carassale L.; Caporotundo S.; Traisci G.; De Feudis L.; Di Carlo S.; Liberato N. L.; Buratti A.; Tognin T.; Bianchi G. B.; Giaquinto S.; Purrello F.; Di Pino A.; Piro S.; Conca A.; Falanga L.; Montrucchio G.; Greco E.; Tizzani P.; Petitti P.; Perciccante A.; Coralli A.; Salmi R.; Gaudenzi P.; Gamberini S.; Semplicini A.; Gottardo L.; Vendemiale G.; Serviddio G.; Forlano R.; Masala C.; Mammarella A.; Basili S.; Perri L.; Landolfi R.; Montalto M.; Mirijello A.; Vallone C.; Bellusci M.; Setti D.; Pedrazzoli F.; Guasti L.; Castiglioni L.; Maresca A.; Squizzato A.; Molaro M.; Bertolotti M.; Mussi C.; Libbra M. V.; Miceli A.; Pellegrini E.; Carulli L.; Sciacqua A.; Quero M.; Bagnato C.; Corinaldesi R.; De Giorgio R.; Serra M.; Grasso V.; Ruggeri E.; Salvi A.; Leonardi R.; Grassini C.; Mascherona I.; Minelli G.; Maltese F.; Gabrielli A.; Mattioli M.; Capeci W.; Martino G. P.; Messina S.; Ghio R.; Favorini S.; Col A. D.; Minisola S.; Colangelo L.; Afeltra A.; Alemanno P.; Marigliano B.; Castellino P.; Blanco J.; Zanoli L.; Cattaneo M.; Fracasso P.; Amoruso M. V.; Saracco V.; Fogliati M.; Bussolino C.; Durante V.; Eusebi G.; Tirotta D.; Mete F.; Gino M.; Cittadini A.; Arcopinto M.; Salzano A.; Bobbio E.; Marra A. M.; Sirico D.; Moreo G.; Scopelliti F.; Gasparini F.; Cocca M.; Nieves R. D.; Alberto M. M.; Pedro A. R.; Vanessa L. P.; Lara T.; Xavier C. V.; Francesc F.; Jesus D. M.; Esperanza B. T.; Behamonte Esther D. C.; Maria S. P.; Romero M.; Blanca P. L.; Cristina L. G. -C.; Victoria V. G. M.; Saez L.; Bosco J.; Susana S. B.; Marta A. G.; Concepcion G. B.; Antonio F. M.; Hernandez M. G.; Borrego M. P.; Raquel P. C.; Florencia P. R.; Beatriz G. O.; Sara C. G.; Cervellera Alfonso G. -C.; Marta P. M.; Alberto R. C.; Antonio A. A.; Montserrat G. G.; Miguel Angel B. R.; Manuel M. J.; Ignacio N. V.; Lucia A. S.; Alfonso L.; David R. B.; Iria I. V.; Monica R. P.; On behalf of REPOSI investigators | |
Autore/i Unibo: | ||
Anno: | 2016 | |
Rivista: | ||
Digital Object Identifier (DOI): | http://dx.doi.org/10.1007/s00392-016-0999-4 | |
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. | |
Data stato definitivo: | 2021-01-28T15:58:08Z | |
Appare nelle tipologie: | 1.01 Articolo in rivista |