A Survey of Long‐Term Antiarrhythmic Therapy in Elderly Patients with Atrial Fibrillation

Aim: To investigate the use of long‐term antiarrhythmic (rhythm‐control [RHY] and rate‐control [RAC]) therapy for the management of atrial fibrillation (AF) in elderly patients. Method: Data were collected retrospectively from the medical records of 255 patients with AF who were ≥65 years of age and were admitted to Royal North Shore Hospital in the period 1 July 1996 to 30 June 1997. Results: Overall, 192 (75%) patients were discharged on antiarrhythmic therapy for the long‐term management of AF. Sixty‐six patients (26%) received RHY only, 90 (35%) received RAC only, 36 (14%) were prescribed the combination of RHY + RAC therapy, and 63 (25%) received no therapy. Patients ≥80 years of age were equally likely to receive longterm antiarrhythmic therapy as those >80 years (74% versus 77%, p = 0.65), but a significantly lower proportion of them received RHY only than in those >80 years (17% versus 34%, p = 0.001). The preferred option in older patients was RAC only (42% ). Cardiology patients were more likely to receive RHY ± RAC therapy (53%) than Aged Care (16%) or General Medicine patients (16%; p > 0.05). Logistic regression analysis indicated that old age and medical specialty were significant predictors for the choice of agent: patients ≥80 years were 2.2 times more likely to receive RAC only in preference to RHY only therapy than their younger counterparts (p = 0.044). Conclusion: Long‐term rhythm‐control therapy (e.g. amiodarone, sotalol) is potentially underutilised in AF patients ≥80 years of age. Reliance on the use of rate‐controlling agents such as digoxin persists in clinical practice.