Key result
In elderly Japanese patients with non-valvular AF, rhythm control was used in 19.6% and rate control in 36.9%, with significantly lower warfarin use in the rhythm control group (21.6% vs 28.6%, p<0.0001).
Why the study?
Data on real-world antiarrhythmic and anticoagulant therapy use in elderly AF patients were lacking.
How do rhythm and rate control strategies and anticoagulant use vary in elderly Japanese patients with non-valvular atrial fibrillation?
Observational (n=32,490)
Yes
How do rhythm and rate control strategies and anticoagulant use vary in elderly Japanese patients with non-valvular atrial fibrillation?
Absolute Event Rate: 21.6% vs 28.6%
p-value: p=<0.0001
In elderly Japanese patients with non-valvular AF, anticoagulant use is highly prevalent (92.1%), while antiarrhythmic strategy varies significantly by age, AF type, and stroke risk.
Lower warfarin use observed with rhythm control in elderly Japanese AF patients; leaves open whether this reflects selection bias or impacts outcomes.
BACKGROUND: Data on real-world antiarrhythmic and anticoagulant therapy use in elderly atrial fibrillation (AF) patients are lacking; thus, we performed a subanalysis of data from the ANAFIE registry to clarify the current management of Japanese patients aged ≥75 years with non-valvular AF. METHODS: -VASc, and HAS-BLED scores were used to estimate embolic and bleeding risk. RESULTS: Among 32,490 patients, the overall frequencies of AF by type were 42.0 % (paroxysmal), 30.1 % (persistent and long-standing persistent), and 27.9 % (permanent). Significant differences (p < 0.0001, each) in age were observed among the three groups; more patients aged 75-79 years received rhythm control (44.2 %) vs rate control (38.8 %). Patients aged ≥85 years received either rate control therapy or no antiarrhythmic agent (∼20 %, each). In the overall population, 36.9 % and 19.6 % of patients were receiving rate and rhythm control therapy, respectively; 43.4 % were not receiving antiarrhythmic therapy. The rate control group consisted mainly of patients with persistent (16.3 %) and permanent AF (38.6 %), and the rhythm control group, of patients with paroxysmal AF (79.0 %). Significantly lower embolic and bleeding risk scores and significantly higher embolic risk scores were observed in patients in the rhythm and rate control groups, respectively. In total, 92.1 % of elderly Japanese patients with AF were receiving anticoagulant therapy. The frequency of direct-acting oral anticoagulant (DOAC) use was similar (∼66 %) among the three groups. Significantly more patients in the rate control group (28.6 %) were being treated with warfarin than in the rhythm control group (21.6 %) (p < 0.0001). CONCLUSIONS: Use versus non-use and antiarrhythmic therapy varied significantly by age, stroke risk scores, type of AF, and DOAC use between subgroups.
No takes yet. Share an insight, caveat, or question.
Yuzawa et al. (2020) conducted an observational in non-valvular atrial fibrillation (n=32,490). Rhythm control therapy vs. Rate control therapy was evaluated on Warfarin use (p=<0.0001). In elderly Japanese patients with non-valvular AF, rhythm control was used in 19.6% and rate control in 36.9%, with significantly lower warfarin use in the rhythm control group (21.6% vs 28.6%, p<0.0001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: