As such , evidence was insufficient to recommend rhythm or rate control as the first-line therapy for AF in older adults .
Atrial fibrillation ( AF ) is highly prevalent in older adults and has been associated with increased morbidity and mortality .
To reduce this AF-related morbidity in older adults , antiarrhythmic drugs ( AADs ) are regularly used for rhythm control , assuming that increasing time in sinus rhythm reduces AF-related morbidity .
However , whether AADs can improve clinical outcomes in older adults remains unclear because of the increased risk for adverse drug events compared with rate control .
The aim of this study was to determine the impact of rhythm control versus rate control on clinical outcomes in older adults with AF .
Warfarin Versus Aspirin for Prevention of Cognitive Decline in Atrial Fibrillation: Randomized Controlled Trial (Birmingham Atrial Fibrillation Treatment of the Aged Study)
Background and Purpose — Atrial fibrillation is associated with decline of cognitive function . Observational evidence suggests that anticoagulation might protect against this decline . We report the first r and omized controlled trial evidence on the effect of anticoagulation on cognitive function in elderly patients with atrial fibrillation . Methods — A total of 973 patients aged ≥75 years with atrial fibrillation were recruited from primary care and r and omly assigned to warfarin ( n=488 ; target international normalized ratio , 2–3 ) or aspirin ( n=485 ; 75 mg/d ) . Neither participants nor investigators were masked to group assignment . Follow-up was for a mean of 2.7 years ( SD , 1.2 ) . Cognitive outcome was assessed using the Mini-Mental State Examination at 9- , 21- , and 33-month follow-up . Participants who had a stroke were censored from the analysis , which was by intention to treat with imputation for missing data . Results — There was no difference between mean Mini-Mental State Examination scores in people assigned to warfarin or aspirin at 9 or 21 months . At 33-month follow-up , there was a nonsignificant difference of 0.56 in favor of warfarin that decreased to 0.49 ( 95 % confidence interval , –0.01 to 0.98 ) after imputation . Conclusions — We found no evidence that anticoagulation confers clinical ly important protection over aspirin against cognitive decline as measured by the Mini-Mental State Examination in atrial fibrillation in the first 33 months of treatment other than that provided by preventing clinical stroke . Clinical Trial Registration — URL : http://www.controlled-trials.com . Unique identifier : IS RCT N89345269
As such , evidence was insufficient to recommend rhythm or rate control as the first-line therapy for AF in older adults .
Atrial fibrillation ( AF ) is highly prevalent in older adults and has been associated with increased morbidity and mortality .
To reduce this AF-related morbidity in older adults , antiarrhythmic drugs ( AADs ) are regularly used for rhythm control , assuming that increasing time in sinus rhythm reduces AF-related morbidity .
However , whether AADs can improve clinical outcomes in older adults remains unclear because of the increased risk for adverse drug events compared with rate control .
The aim of this study was to determine the impact of rhythm control versus rate control on clinical outcomes in older adults with AF .