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

https://doi.org/10.4081/monaldi.2018.955

Authors

  • Stefano Fumagalli | stefano.fumagalli@unifi.it University of Florence, AOU Careggi, Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, Italy. http://orcid.org/0000-0002-6950-3875
  • 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.

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Published
2018-06-07
Info
Issue
Section
Cardiology - Original Articles
Keywords:
Atrial fibrillation, elderly, prognosis, rate-control, rhythm-control.
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  • PDF: 543
How to Cite
Fumagalli, Stefano, Serena Boni, Simone Pupo, Marta Migliorini, Irene Marozzi, Eleonora Barghini, Flavia Sacco, and Niccolò Marchionni. 2018. “Rate-Control Vs Rhythm-Control of Atrial Fibrillation in Elderly Patients. From New, Age-Oriented Outcomes to a More Complex Management Strategy”. Monaldi Archives for Chest Disease 88 (2). https://doi.org/10.4081/monaldi.2018.955.

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