6533b85cfe1ef96bd12bcbca

RESEARCH PRODUCT

Adherence to antithrombotic therapy guidelines improves mortality among elderly patients with atrial fibrillation: insights from the REPOSI study

Marco ProiettiNobili AlessandroRaparelli ValeriaLaura NapoleonePier O MannucciGregory Y LipMauro TettamantiLuca PasinaCarlotta FranchiFrancesco PerticoneFrancesco SalernoCorrao SalvatoreAlessandra MarengoniGiuseppe LicataFrancesco VioliGino Roberto CorazzaMaura MarcucciDomenico PriscoElena SilvestriCaterina CenciGiacomo EmmiGianni BioloGianfranco GuarnieriMichela ZanettiGiovanni FernandesMassimo VanoliGiulia GrignaniGianluca CasellaMauro BernardiSilvia Li BassiLuca SantiGiacomo ZaccheriniElmo MannarinoGraziana LupattelliVanessa BianconiFrancesco PaciulloRanuccio NutiRoberto ValentiMartina RuvioSilvia CappelliAlberto PalazzuoliTeresa SalvatoreFerdinando Carlo SassoDomenico GirelliOliviero OlivieriThomas MatteazziMario BarbagalloLidia PlancesRoberta AlcamoLuigi CalvoMaria ValentiMarco ZoliRaffaella ArnòFranco Laghi PasiniPier Leopoldo CapecchiMaurizio BicchiGiuseppe PalascianoMaria Ester ModeoMaria PeragineFabrizio PappagalloStefania PuglieseCarla Di GennaroAlfredo PostiglioneMaria Rosaria BarbellaFrancesco De StefanoMaria Domenica CappelliniGiovanna FabioSonia SeghezziMargherita Migone De AmicisDaniela MariPaolo Dionigi RossiSarah DamantiBarbara Brignolo OttoliniSarah DamantiEmanuela MiceliMarco Vincenzo LentiDonatella PadulaGiovanni MurialdoAlessio MarraFederico CattaneoMaria Beatrice SecchiDavide GhelfiLuigi AnastasioLucia SofiaMaria CarboneGiovanni DavìMaria Teresa GuagnanoSimona SestiliGerardo MancusoDaniela CalipariMosè BartoneMaria Rachele MeroniPaolo Cavallo PerinBartolomeo LorenzatiGabriella GrudenGraziella BrunoCristina AmionePaolo FornengoRodolfo TassaraDeborah MelisLara RebellaGiuseppe DelitalaVincenzo PrettiMaristella Salvatora MasalaLuigi BolondiLeonardo RascitiIlaria SerioFilippo Rossi FanelliAntonio AmorosoAlessio MolfinoEnrico PetrilloGiuseppe ZuccalàFrancesco FranceschiGuido De MarcoCordischi ChiaraSabbatini MartaGiuseppe RomanelliClaudia AmoliniDeborah ChiesaAntonio PicardiUmberto Vespasiani GentilucciPaolo GalloGiorgio AnnoniMaurizio CorsiSara ZazzettaGiuseppe BellelliFranco ArturiElena SuccurroMariangela RubinoGiorgio SestiPaola LoriaMaria Angela BecchiGianfranco MartucciAlessandra FantuzziMauro MaurantonioGiuseppe DelitalaStefano CartaSebastiana AtzoriMaria Grazia SerraMaria Antonietta BleveLaura GasbarroneMaria Rosaria SajevaAntonio BrucatoSilvia GhidoniPaola Di CoratoGiancarlo AgnelliEmanuela MarchesiniFabrizio FabrisMichela CarlonFrancesca TurattoAldo BaritussoFrancesca TurattoRoberto ManfrediniChristian MolinoMarco PalaFabio FabbianBenedetta BoariAlfredo De GiorgiGiuseppe PaolissoMaria Rosaria RizzoMaria Teresa LaietaGiovanbattista RiniPasquale MansuetoIlenia PepeClaudio BorghiEnrico StrocchiValeria De SandoCarlo SabbàFrancesco Saverio VellaPatrizia SuppressaRaffaella ValerioStefania PuglieseCaterina CapobiancoLuigi FenoglioChristian BraccoAlessia Valentina GiraudoElisa TestaCristina SerrainoSilvia FargionPaola BonaraGiulia PeritiMarianna PorzioFlora PeyvandiAlberto TedeschiRaffaella RossioValter MonzaniValeria SavojardoChristian FolliMaria MagniniAlessio ConcaGiulia GobboAlessio ConcaCarlo L. BalduiniGiampiera BertolinoStella ProviniFederica QuagliaFranco DallegriLuciano OttonelloLuca LiberaleWu Sheng ChinLaura CarassaleSilvia CaporotundoGiancarlo TraisciLucrezia De FeudisSilvia Di CarloNicola Lucio LiberatoAlberto BurattiTiziana TogninGiovanni Battista BianchiSabrina GiaquintoFrancesco PurrelloAntonino Di PinoSalvatore PiroRenzo RozziniLina FalangaGiuseppe MontrucchioElisabetta GrecoPietro TizzaniPaolo PetittiAntonio PerciccanteAlessia CoralliRaffaella SalmiPiergiorgio GaudenziSusanna GamberiniAndrea SempliciniLucia GottardoGianluigi VendemialeGaetano ServiddioRoberta ForlanoCesare MasalaAntonio MammarellaStefania BasiliLudovica PerriRaffaele LandolfiMassimo MontaltoAntonio MirijelloCarla ValloneMartino BellusciDonatella SettiFilippo PedrazzoliLuigina GuastiLuana CastiglioniAndrea MarescaAlessandro SquizzatoMarta MolaroMarco BertolottiChiara MussiMaria Vittoria LibbraAndrea MiceliElisa PellegriniLucia CarulliFrancesco PerticoneAngela SciacquaMichele QueroChiara BagnatoRoberto CorinaldesiRoberto De GiorgioMauro SerraValentina GrassoEugenio RuggeriAndrea SalviRoberto LeonardiChiara GrassiniIlenia MascheronaGiorgio MinelliFrancesca MalteseArmando GabrielliMassimo MattioliWilliam CapeciGiuseppe Pio MartinoSilvia MessinaRiccardi GhioSerena Favorini Anna Dal ColSalvatore MinisolaLuciano ColangeloAntonella AfeltraPamela AlemannoBenedetta MariglianoPietro CastellinoJulien BlancoLuca ZanoliMarco CattaneoPaola FracassoMaria Valentina AmorusoValter SaraccoMarisa FogliatiCarlo BussolinoVittorio DuranteGiovanna EusebiDaniela TirottaFrancesca MeteMiriam GinoAntonio CittadiniMichele ArcopintoAndrea SalzanoEmanuele BobbioAlberto Maria MarraSirico DomenicoGuido MoreoFrancesco ScopellitiFrancesca GaspariniMelissa CoccaRamirez Duque NievesMuela Molinero AlbertoAbad Requejo PedroLopez Pelaez VanessaTamargo LaraCorbella Viros XavierFormiga FrancescDiez Manglano JesusBejarano Tello EsperanzaDel Corral Behamonte EstherSevil Puras MariaManuel RomeroPinilla Llorente BlancaLopez Gonzalez Cobos CristinaVillalba Garcia M. VictoriaLopez SaezJuan BoscoSanz Baena SusanaArroyo Gallego MartaGonzalez Becerra ConcepcionFernandez Moyano AntonioMercedes Gomez HernandezManuel Poyato BorregoPacheco Cuadros RaquelPerez Rojas FlorenciaGarcia Olid BeatrizCarrascosa Garcia SaraGonzalez Cruz Cervellera AlfonsoPeinado Martinez MartaRuiz Cantero AlbertoAlbarracín Arraigosa AntonioGodoy Guerrero MontserratBarón Ramos Miguel ÁNgelMachin Jose ManuelNovo Veleiro IgnacioAlvela Suarez LucíaLopez AlfonsoRubal Bran DavidIñiguez Vazquez IriaRios Prego . Monica

subject

Antithrombotic therapy; Atrial fibrillation; Elderly; Guidelines; Outcomes; Cardiology and Cardiovascular MedicineMaleRegistrieTime Factorsantithrombotic therapy; atrial fibrillation; elderly; guidelines; outcomesAtrial fibrillation (AF)Practice PatternsKaplan-Meier Estimate030204 cardiovascular system & hematologyGuidelineoutcomesCoronary artery disease0302 clinical medicineElderlyRisk FactorsAtrial FibrillationAntithrombotic80 and overAge Factor030212 general & internal medicineRegistriesguidelinesAntithrombotic therapy Atrial fibrillation Elderly Guidelines OutcomesPractice Patterns Physicians'OutcomeAged 80 and overFibrinolytic AgentAge FactorsAtrial fibrillationGeneral MedicineTreatment OutcomeItalyAtrial fibrillation (AF) thromboembolism antithrombotic prophylaxisPractice Guidelines as TopicCardiologyFemaleGuideline AdherenceCardiology and Cardiovascular MedicineHumanAntithrombotic therapy; Atrial fibrillation; Elderly; Guidelines; Outcomes; Age Factors; Aged; Aged 80 and over; Atrial Fibrillation; Chi-Square Distribution; Female; Fibrinolytic Agents; Guideline Adherence; Humans; Italy; Kaplan-Meier Estimate; Logistic Models; Male; Practice Patterns Physicians'; Proportional Hazards Models; Registries; Risk Assessment; Risk Factors; Thromboembolism; Time Factors; Treatment Outcome; Practice Guidelines as Topic; Cardiology and Cardiovascular Medicinemedicine.medical_specialtyLogistic ModelTime FactorSocio-culturaleLower riskRisk Assessment03 medical and health sciencesFibrinolytic AgentsInternal medicineThromboembolismmedicineHumansProportional Hazards ModelsAgedAntithrombotic therapyPhysicians'Chi-Square Distributionbusiness.industryProportional hazards modelRisk FactorSettore MED/09 - MEDICINA INTERNAGuidelinethromboembolismmedicine.diseaseAtrial fibrillationLogistic ModelsProportional Hazards Modelantithrombotic prophylaxisbusinessChi-squared distributionFibrinolytic agent

description

Background: Atrial fibrillation (AF) is associated with a substantial risk of thromboembolism and mortality, significantly reduced by oral anticoagulation. Adherence to guidelines may lower the risks for both all cause and cardiovascular (CV) deaths. Methods: Our objective was to evaluate if antithrombotic prophylaxis according to the 2012 European Society of Cardiology (ESC) guidelines is associated to a lower rate of adverse outcomes. Data were obtained from REPOSI; a prospective observational study enrolling inpatients aged ≥65 years. Patients enrolled in 2012 and 2014 discharged with an AF diagnosis were analysed. Results: Among 2535 patients, 558 (22.0 %) were discharged with a diagnosis of AF. Based on ESC guidelines, 40.9 % of patients were on guideline-adherent thromboprophylaxis, 6.8 % were overtreated, and 52.3 % were undertreated. Logistic analysis showed that increasing age (p = 0.01), heart failure (p = 0.04), coronary artery disease (p = 0.013), peripheral arterial disease (p = 0.03) and concomitant cancer (p = 0.003) were associated with non-adherence to guidelines. Specifically, undertreatment was significantly associated with increasing age (p = 0.001) and cancer (p < 0.001), and inversely associated with HF (p = 0.023). AF patients who were guideline adherent had a lower rate of both all-cause death (p = 0.007) and CV death (p = 0.024) compared to those non-adherent. Kaplan–Meier analysis showed that guideline-adherent patients had a lower cumulative risk for both all-cause (p = 0.002) and CV deaths (p = 0.011). On Cox regression analysis, guideline adherence was independently associated with a lower risk of all-cause and CV deaths (p = 0.019 and p = 0.006). Conclusions: Non-adherence to guidelines is highly prevalent among elderly AF patients, despite guideline-adherent treatment being independently associated with lower risk of all-cause and CV deaths. Efforts to improve guideline adherence would lead to better outcomes for elderly AF patients.

yearjournalcountryeditionlanguage
2016-01-01
10.1007/s00392-016-0999-4http://hdl.handle.net/10281/280989