TY - JOUR
T1 - Age-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe
T2 - The EORP-AF general pilot registry (EURObservational Research Programme-Atrial Fibrillation)
AU - Fumagalli, Stefano
AU - Said, Salah A M
AU - Laroche, Cecile
AU - Gabbai, Debbie
AU - Marchionni, Niccolò
AU - Boriani, Giuseppe
AU - Maggioni, Aldo P.
AU - Popescu, Mircea Ioachim
AU - Rasmussen, Lars Hvilsted
AU - Crijns, Harry J G M
AU - Lip, Gregory Y H
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Objectives This study sought to compare age-related differences in presentation, treatment, and outcome of atrial fibrillation (AF) in a wide cohort of European subjects. Background AF is the most common sustained arrhythmia in the elderly. Methods We evaluated all patients enrolled in the EORP-AF (EURObservational Research Programme-Atrial Fibrillation) General Pilot Registry in 70 centers of 9 European countries. Results Among 3,119 subjects, 1,051 (33.7%) were age ≥75 years. Permanent AF was significantly more common in the elderly, who had a higher prevalence of hypertension, valvular diseases, chronic heart failure, coronary artery disease, renal failure, chronic obstructive pulmonary disease, and prior hemorrhagic event or a transient ischemic attack. Common diagnostic tests were underused in older subjects. Despite their higher stroke risk, the use of oral anticoagulants was significantly lower in the elderly (76.7% vs. 82.8%; p = 0.0012), whereas aspirin and clopidogrel alone or in combination were more often prescribed. Rate control was the management of choice in the older group, with electrical cardioversion and catheter ablation performed less frequently than in the younger age group. Antiarrhythmic drugs were significantly less prescribed in the elderly (29.8% vs. 41.7%; p <0.0001). At the 1-year follow-up, mortality (11.5% vs. 3.7%; p <0.0001) and the composite of stroke/transient ischemic attack, systemic thromboembolism, and/or death (13.6% vs. 4.9%; p <0.0001) were significantly higher in the ≥75 years of age cohort. Conclusions In older patients, AF is more often associated with comorbidities. Rate control is the preferred therapeutic approach. Despite a higher CHA2DS2-VASc score, the use of oral anticoagulation is suboptimal. In elderly subjects, the rate of adverse events is higher at follow-up.
AB - Objectives This study sought to compare age-related differences in presentation, treatment, and outcome of atrial fibrillation (AF) in a wide cohort of European subjects. Background AF is the most common sustained arrhythmia in the elderly. Methods We evaluated all patients enrolled in the EORP-AF (EURObservational Research Programme-Atrial Fibrillation) General Pilot Registry in 70 centers of 9 European countries. Results Among 3,119 subjects, 1,051 (33.7%) were age ≥75 years. Permanent AF was significantly more common in the elderly, who had a higher prevalence of hypertension, valvular diseases, chronic heart failure, coronary artery disease, renal failure, chronic obstructive pulmonary disease, and prior hemorrhagic event or a transient ischemic attack. Common diagnostic tests were underused in older subjects. Despite their higher stroke risk, the use of oral anticoagulants was significantly lower in the elderly (76.7% vs. 82.8%; p = 0.0012), whereas aspirin and clopidogrel alone or in combination were more often prescribed. Rate control was the management of choice in the older group, with electrical cardioversion and catheter ablation performed less frequently than in the younger age group. Antiarrhythmic drugs were significantly less prescribed in the elderly (29.8% vs. 41.7%; p <0.0001). At the 1-year follow-up, mortality (11.5% vs. 3.7%; p <0.0001) and the composite of stroke/transient ischemic attack, systemic thromboembolism, and/or death (13.6% vs. 4.9%; p <0.0001) were significantly higher in the ≥75 years of age cohort. Conclusions In older patients, AF is more often associated with comorbidities. Rate control is the preferred therapeutic approach. Despite a higher CHA2DS2-VASc score, the use of oral anticoagulation is suboptimal. In elderly subjects, the rate of adverse events is higher at follow-up.
KW - atrial fibrillation
KW - elderly
KW - oral anticoagulation
KW - registry
U2 - 10.1016/j.jacep.2015.02.019
DO - 10.1016/j.jacep.2015.02.019
M3 - Journal article
AN - SCOPUS:84944040447
SN - 2405-500X
VL - 1
SP - 326
EP - 334
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 4
ER -