Age-Related Differences in Presentation, Treatment, and Outcome of Patients With€Atrial Fibrillation in Europe

Fro Flo Ne xD Bo Ca Ca su en Gm Gr Ind OBJECTIVES This study sought to compare age-related differences in presentation, treatment, and outcome of atrial fibrillation (AF) in a wide cohort of European subjects. BACKGROUND AF is the most common sustained arrhythmia in the elderly. METHODS We evaluated all patients enrolled in the EORP-AF (EURObservational Research Programme-Atrial Fibrillation) General Pilot Registry in 70 centers of 9 European countries. RESULTS Among 3,119 subjects, 1,051 (33.7%) were age $75 years. Permanent AF was significantly more common in the elderly, who had a higher prevalence of hypertension, valvular diseases, chronic heart failure, coronary artery disease, renal failure, chronic obstructive pulmonary disease, and prior hemorrhagic event or a transient ischemic attack. Common diagnostic tests were underused in older subjects. Despite their higher stroke risk, the use of oral anticoagulants was significantly lower in the elderly (76.7% vs. 82.8%; p 1⁄4 0.0012), whereas aspirin and clopidogrel alone or in combination were more often prescribed. Rate control was the management of choice in the older group, with electrical cardioversion and catheter ablation performed less frequently than in the younger age group. Antiarrhythmic drugs were significantly less prescribed in the elderly (29.8% vs. 41.7%; p < 0.0001). At the 1-year follow-up, mortality (11.5% vs. 3.7%; p < 0.0001) and the composite of stroke/transient ischemic attack, systemic thromboembolism, and/or death (13.6% vs. 4.9%; p < 0.0001) were significantly higher in the $75 years of age cohort. CONCLUSIONS In older patients, AF is more often associated with comorbidities. Rate control is the preferred therapeutic approach. Despite a higher CHA2DS2-VASc score, the use of oral anticoagulation is suboptimal. In elderly subjects, the rate of adverse events is higher at follow-up. (J Am Coll Cardiol EP 2015;1:326–34) © 2015 by the American College of Cardiology Foundation. m the *Division of Geriatric Cardiology and Medicine, Department of Experimental and Clinical Medicine, University of rence and AOU Careggi, Florence, Italy; yDepartment of Cardiology, Hospital Group Twente, Almelo-Hengelo, Hengelo, the therlands; zEURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France; epartment of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola Malpighi University Hospital, logna, Italy; kCounty Emergency Hospital, Oradea, Romania; {Aalborg University Hospital, Aalborg, Denmark; #Department of rdiology, Maastricht University Medical Center, Maastricht, the Netherlands; and the **University of Birmingham, Center for rdiovascular Sciences, City Hospital, Birmingham, United Kingdom. At the time of the registry, the following companies were pporting the EURObservational Research Programme: Abbott Vascular International, Amgen, Bayer Pharma AG, Boston Scitific International, The Bristol-Myers Squibb and Pfizer Alliance, Boehringer Ingelheim, The Alliance Daiichi Sankyo Europe bH and Eli Lilly and Company, Menarini International Operations, Merck & Co. International, Novartis Pharma, Sanofi-Aventis oup, and SERVIER. Dr. Fumagalli held lectures for BMS/Pfizer; and was an investigator for a study sponsored by A. Menarini ustrie Farmaceutiche Riunite. Dr. Boriani received a small speakers fee (less than V1,200) from Boehringer, Medtronic Inc., AB BR E V I A T I O N S