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Rate-control vs rhythm-control of atrial fibrillation in elderly patients. From new, age-oriented outcomes to a more complex management strategy

Stefano Fumagalli, Serena Boni, Simone Pupo, Marta Migliorini, Irene Marozzi, Eleonora Barghini, Flavia Sacco, Niccolò Marchionni
  • Serena Boni
    University of Florence, AOU Careggi, Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, Italy
  • Simone Pupo
    University of Florence, AOU Careggi, Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, Italy
  • Marta Migliorini
    University of Florence, AOU Careggi, Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, Italy
  • Irene Marozzi
    University of Florence, AOU Careggi, Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, Italy
  • Eleonora Barghini
    University of Florence, AOU Careggi, Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, Italy
  • Flavia Sacco
    University of Florence, AOU Careggi, Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, Italy
  • Niccolò Marchionni
    University of Florence, AOU Careggi, Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, Italy

Abstract

Atrial fibrillation (AF) is the most frequent arrhythmia in elderly people. Findings derived from clinical trials seem to demonstrate that a rate-control strategy of AF in aged patients improves prognosis if compared to a rhythm-control one. However, epidemiological studies concordantly show that the arrhythmia is associated to increased hospitalization and mortality rates. In last years, the proportion of patients admitted to hospital for AF has progressively increased; this trend is observed in subjects >75 and >85 years, while no change was found in younger cohorts. Importantly, in aged individuals, probably because of the loss of atrial activity, the increase of heart rate and the irregularity of RR intervals, AF begins a vicious cycle, leading from heart failure, through the compromise of functional and neurocognitive status, to overt disability, dementia and increased mortality. Evidence specifically aimed at clarifying the effects of arrhythmia management on outcomes characteristic of aged people is completely lacking. In the elderly, the question regarding the effects of a rate- or a rhythm-control strategy of AF should be considered as an aspect of a more complex strategy, addressed to reduce disability and hospitalizations, and to improve quality of life and survival.

Keywords

Atrial fibrillation; elderly; prognosis; rate-control; rhythm-control.

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