Paciullo Francesco, Proietti Marco, Bianconi Vanessa, Nobili Alessandro, Pirro Matteo, Mannucci Pier Mannuccio, Lip Gregory Y H, Lupattelli Graziana
Unit of Internal Medicine, Department of Medicine, University of Perugia, Piazzale Menghini, Sant'Andrea delle Fratte, 06132, Perugia, Italy.
Section of Internal and Cardiovascular Medicine, Department of Medicine, University of Perugia, Perugia, Italy.
Drugs Aging. 2018 Apr;35(4):365-373. doi: 10.1007/s40266-018-0532-8.
Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the best management approach for non-valvular atrial fibrillation (AF) in elderly patients.
We performed an ancillary analysis from the 'Registro Politerapie SIMI' study, enrolling elderly inpatients from internal medicine and geriatric wards.
We considered patients enrolled from 2008 to 2014 with an AF diagnosis at admission, treated with a rate-control-only or rhythm-control-only strategy.
Among 1114 patients, 241 (21.6%) were managed with observation only and 122 (11%) were managed with both the rate- and rhythm-control approaches. Of the remaining 751 patients, 626 (83.4%) were managed with a rate-control-only strategy and 125 (16.6%) were managed with a rhythm-control-only strategy. Rate-control-managed patients were older (p = 0.002), had a higher Short Blessed Test (SBT; p = 0.022) and a lower Barthel Index (p = 0.047). Polypharmacy (p = 0.001), heart failure (p = 0.005) and diabetes (p = 0.016) were more prevalent among these patients. Median CHADS-VASc score was higher among rate-control-managed patients (p = 0.001). SBT [odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94-1.00, p = 0.037], diabetes (OR 0.48, 95% CI 0.26-0.87, p = 0.016) and polypharmacy (OR 0.58, 95% CI 0.34-0.99, p = 0.045) were negatively associated with a rhythm-control strategy. At follow-up, no difference was found between rate- and rhythm-control strategies for cardiovascular (CV) and all-cause deaths (6.1 vs. 5.6%, p = 0.89; and 15.9 vs. 14.1%, p = 0.70, respectively).
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.
在心率控制或节律控制策略中，关于哪种是老年患者非瓣膜性心房颤动（AF）的最佳管理方法，证据存在冲突。
我们对“Registro Politerapie SIMI”研究进行了一项辅助分析，纳入了内科和老年病房的老年住院患者。
我们纳入了2008年至2014年入院时诊断为AF且仅采用心率控制或仅采用节律控制策略治疗的患者。
在1114例患者中，241例（21.6%）仅接受观察，122例（11%）同时采用心率和节律控制方法。在其余751例患者中，626例（83.4%）仅采用心率控制策略，125例（16.6%）仅采用节律控制策略。采用心率控制的患者年龄更大（p = 0.002），简易精神状态检查表（SBT）评分更高（p = 0.022），巴氏指数更低（p = 0.047）。这些患者中多重用药（p = 0.001）、心力衰竭（p = 0.005）和糖尿病（p = 0.016）更为普遍。采用心率控制的患者CHADS-VASc评分中位数更高（p = 0.001）。SBT[比值比（OR）0.97，95%置信区间（CI）0.94 - 1.00，p = 0.037]、糖尿病（OR 0.48，95% CI 0.26 - 0.87，p = 0.016）和多重用药（OR 0.58，95% CI 0.34 - 0.99，p = 0.045）与节律控制策略呈负相关。随访时，心率控制和节律控制策略在心血管（CV）死亡和全因死亡方面无差异（分别为6.1%对5.6%，p = 0.89；15.9%对14.1%，p = 0.70）。
在患有多种合并症和多重用药的老年AF患者中，心率控制策略使用最为广泛。随访时CV死亡和全因死亡方面无明显差异。
