Comparing Rhythm vs Rate Control Strategy Among OAs With Atrial Fibrillation

Findings showed that among older adults (OAs) with atrial fibrillation (AF) use of rate control strategy was correlated with cognitive impairment, older age, and peripheral vascular disease (PVD), while visual impairment, anticoagulation, and congestive heart failure (CHF) were connected to a rhythm control strategy.

For the Systematic Assessment of Geriatric Elements-AF prospective cohort study, researchers recruited patients with AF who were aged 65 years and older with CHA₂DS₂VASc score ≥2 and eligible for anticoagulation.

Study participants were also interviewed to assess measures of health-related quality of life (HRQoL), hearing, frailty, vision, and cognitive function. Multivariable logistic regression models were utilized to determine the connection between these elements and AD treatment strategy.

Of the 1244 participants enrolled in the study, 49% were female, 85% were non-Hispanic White, and the mean age was 76 years. Rate control was used in 534 participants while rhythm control was used in 710 participants.

“Compared to participants less than 75 years of age, those aged 75 and older were more likely to be treated with a rate control strategy (age 75-84 adjusted odds ratio [aOR] 1.37 [95% CI 0.99, 1.88]; age 85+ aOR=2.05, 95% CI 1.30, 3.21),” reported study authors. “Those treated with a rate control strategy were more likely to have cognitive impairment (aOR=1.50, 95% CI 1.13, 1.99), and peripheral vascular disease (PVD) (aOR=1.82, 95% CI 1.22, 2.72) but less likely to have visual impairment (aOR 0.73 [0.55, 0.98]), CHF (aOR 0.68 [0.49, 0.94]) or receive anticoagulation (aOR 0.53, 95% CI 0.36, 0.78).”

HRQoL showed no difference between rhythm and rate control groups.

“This study suggests that certain geriatric elements may be associated with AF treatment strategies,” concluded researchers. “Further study is needed to evaluate how these decisions affect outcomes.”

Reference:
Karnik AA, Saczynski JS, Chung JJ, et al. Cognitive impairment, age, quality of life, and treatment strategy for atrial fibrillation in older adults: the SAGE-AF study. J Am Geriatr Soc. Published online June 23, 2022. doi:10.1111/jgs.17886.