Rhythm versus rate control strategies regarding anticoagulant use in elderly non-valvular atrial fibrillation patients: Subanalysis of the ANAFIE (All Nippon AF In the Elderly) Registry

Hitomi Yuzawa, Hiroshi Inoue, Takeshi Yamashita, Masaharu Akao, Hirotsugu Atarashi, Yukihiro Koretsune, Ken Okumura, Wataru Shimizu, Hiroyuki Tsutsui, Kazunori Toyoda, Atsushi Hirayama, Masahiro Yasaka, Takenori Yamaguchi, Satoshi Teramukai, Tetsuya Kimura, Jumpei Kaburagi, Atsushi Takita, Takanori Ikeda

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Abstract

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: The ANAFIE registry was a multicenter, prospective, observational study. Patients were stratified into three groups: rhythm control group, rate control group, and no antiarrhythmic group. The CHADS2, CHA2DS2-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.

Original languageEnglish
JournalJournal of Cardiology
DOIs
Publication statusAccepted/In press - Jan 1 2020

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All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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