A survey of long-term antiarrhythmic therapy in elderly patients with atrial fibrillation

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Journal Article
Australian Journal of Hospital Pharmacy, 2001, 31 (2), pp. 93 - 97
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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 long-term 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.
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