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Updated: Mar 20, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Adherence to antithrombotic therapy guidelines improves mortality among elderly patients with atrial fibrillation:
Marco Proietti1,2, Alessandro Nobili3, Valeria Raparelli4,5
1Institute of Cardiovascular Sciences, City Hospital, University of Birmingham, Birmingham, Dudley Road, B18 7QH, UK. marco.proietti@uniroma1.it.
Insights
Adherence to European Society of Cardiology (ESC) guidelines for atrial fibrillation (AF) thromboprophylaxis in elderly patients significantly reduces all-cause and cardiovascular death risks. Improving guideline adherence is crucial for better patient outcomes.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Background:
- Atrial fibrillation (AF) poses significant risks of thromboembolism and mortality.
- Oral anticoagulation and adherence to treatment guidelines can mitigate these risks.
- This study focuses on elderly patients (≥65 years) diagnosed with AF.
Purpose of the Study:
- To evaluate if antithrombotic prophylaxis aligning with 2012 European Society of Cardiology (ESC) guidelines is associated with reduced adverse outcomes in elderly AF patients.
- To identify factors associated with non-adherence to ESC guidelines for thromboprophylaxis in this population.
Main Methods:
- Analysis of data from the prospective observational REPOSI study.
- Inclusion of inpatients aged ≥65 years discharged with an AF diagnosis in 2012 and 2014.
- Assessment of guideline adherence, over-treatment, and under-treatment rates based on ESC guidelines.
Main Results:
- Among 2535 patients, 558 (22.0%) had AF. Guideline-adherent thromboprophylaxis was observed in 40.9% of patients.
- Non-adherence was linked to increasing age, heart failure, coronary artery disease, peripheral arterial disease, and cancer.
- Guideline-adherent patients exhibited significantly lower rates of all-cause and cardiovascular death compared to non-adherent patients.
- Guideline adherence independently predicted a reduced risk of all-cause and cardiovascular deaths.
Conclusions:
- Non-adherence to ESC guidelines for thromboprophylaxis is common in elderly AF patients.
- Guideline-adherent treatment is independently associated with improved survival, reducing both all-cause and cardiovascular mortality.
- Strategies to enhance guideline adherence are essential for improving outcomes in elderly patients with AF.
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.
