3 research outputs found
Adherence to antithrombotic therapy guidelines improves mortality among elderly patients with atrial fibrillation: insights from the REPOSI study
No full text333noneBackground: 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 â„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. KaplanâMeier 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.Proietti, M.;
Nobili, A.;
Raparelli, V.;
Napoleone, L.;
Mannucci, P.M.;
Lip, G.Y.H.;
Pasina, L.;
Franchi, C.;
Tettamanti, M.;
Eldin, T.K.;
Di Blanca, M.P.D.;
Djade, C.D.;
Ardoino, I.;
Cortesi, L.;
Marengoni, A.;
Licata, G.;
Violi, F.;
Corazza, G.R.;
Biolo, G.;
Guarnieri, G.;
Zanetti, M.;
Fernandes, G.;
Vanoli, M.;
Grignani, G.;
Casella, G.;
Bernardi, M.;
Bassi, S.L.;
Santi, L.;
Zaccherini, G.;
Mannarino, E.;
Lupattelli, G.;
Bianconi, V.;
Paciullo, F.;
Nuti, R.;
Valenti, R.;
Ruvio, M.;
Cappelli, S.;
Palazzuoli, A.;
Salvatore, T.;
Sasso, F.C.;
Girelli, D.;
Olivieri, O.;
Matteazzi, T.;
Barbagallo, M.;
Plances, L.;
Alcamo, R.;
Licata, G.;
Calvo, L.;
Valenti, M.;
Zoli, M.;
ArnĂČ, R.;
Pasini, F.L.;
Capecchi, P.L.;
Bicchi, M.;
Palasciano, G.;
Modeo, M.E.;
Peragine, M.;
Pappagallo, F.;
Di Gennaro, C.;
Postiglione, A.;
Barbella, M.R.;
De Stefano, F.;
Cappellini, M.D.;
Fabio, G.;
Seghezzi, S.;
De Amicis, M.M.;
Mari, D.;
Rossi, P.D.;
Ottolini, B.B.;
Miceli, E.;
Lenti, M.V.;
Padula, D.;
Murialdo, G.;
Marra, A.;
Cattaneo, F.;
Secchi, M.B.;
Ghelfi, D.;
Anastasio, L.;
Sofia, L.;
Carbone, M.;
Damanti, S.;
Guagnano, M.T.;
Sestili, S.;
Mancuso, G.;
Calipari, D.;
Bartone, M.;
Meroni, M.R.;
Perin, P.C.;
Lorenzati, B.;
Gruden, G.;
Bruno, G.;
Amione, C.;
Fornengo, P.;
Tassara, R.;
Melis, D.;
Rebella, L.;
Pretti, V.;
Masala, M.S.;
Bolondi, L.;
Rasciti, L.;
Serio, I.;
Fanelli, F.R.;
Amoroso, A.;
Molfino, A.;
Petrillo, E.;
ZuccalĂ , G.;
Franceschi, F.;
De Marco, G.;
Chiara, C.;
Marta, S.;
Romanelli, G.;
Amolini, C.;
Chiesa, D.;
Picardi, A.;
Gentilucci, U.V.;
Gallo, P.;
Annoni, G.;
Corsi, M.;
Zazzetta, S.;
Bellelli, G.;
Arturi, F.;
Succurro, E.;
Rubino, M.;
Sesti, G.;
Loria, P.;
Becchi, M.A.;
Martucci, G.;
Fantuzzi, A.;
Maurantonio, M.;
Carta, S.;
Atzori, S.;
Serra, M.G.;
Bleve, M.A.;
Gasbarrone, L.;
Sajeva, M.R.;
Brucato, A.;
Ghidoni, S.;
Di Corato, P.;
Agnelli, G.;
Marchesini, E.;
Fabris, F.;
Carlon, M.;
Baritusso, A.;
Manfredini, R.;
Molino, C.;
Pala, M.;
Fabbian, F.;
Boari, B.;
De Giorgi, A.;
Paolisso, G.;
Rizzo, M.R.;
Laieta, M.T.;
Rini, G.;
Mansueto, P.;
Pepe, I.;
Borghi, C.;
Strocchi, E.;
De Sando, V.;
SabbĂ , C.;
Vella, F.S.;
Turatto, F.;
Valerio, R.bg,
Capobianco, C.;
Fenoglio, L.;
Bracco, C.;
Giraudo, A.V.;
Testa, E.;
Serraino, C.;
Fargion, S.;
Bonara, P.;
Periti, G.;
Porzio, M.;
Peyvandi, F.;
Tedeschi, A.;
Rossio, R.;
Monzani, V.;
Savojardo, V.;
Folli, C.;
Magnini, M.;
Gobbo, G.;
Balduini, C.L.;
Bertolino, G.;
Provini, S.;
Quaglia, F.;
Dallegri, F.;
Ottonello, L.;
Liberale, L.;
Chin, W.S.;
Carassale, L.;
Caporotundo, S.;
Traisci, G.;
De Feudis, L.;
Di Carlo, S.;
Liberato, N.L.;
Buratti, A.;
Tognin, T.;
Bianchi, G.B.;
Giaquinto, S.;
Purrello, F.;
Di Pino, A.;
Piro, S.;
Conca, A.;
Falanga, L.;
Montrucchio, G.;
Greco, E.;
Tizzani, P.;
Petitti, P.;
Perciccante, A.;
Coralli, A.;
Salmi, R.;
Gaudenzi, P.;
Gamberini, S.;
Semplicini, A.;
Gottardo, L.;
Vendemiale, G.;
Serviddio, G.;
Forlano, R.;
Masala, C.;
Mammarella, A.;
Basili, S.;
Perri, L.;
Landolfi, R.;
Montalto, M.;
Mirijello, A.;
Vallone, C.;
Bellusci, M.;
Setti, D.;
Pedrazzoli, F.;
Guasti, L.;
Castiglioni, L.;
Maresca, A.;
Squizzato, A.;
Molaro, M.;
Bertolotti, M.ce,
Mussi, C.;
Libbra, M.V.;
Miceli, A.;
Pellegrini, E.;
Carulli, L.;
Sciacqua, A.;
Quero, M.;
Bagnato, C.;
Corinaldesi, R.;
De Giorgio, R.;
Serra, M.;
Grasso, V.;
Ruggeri, E.;
Salvi, A.;
Leonardi, R.;
Grassini, C.;
Mascherona, I.;
Minelli, G.;
Maltese, F.;
Gabrielli, A.;
Mattioli, M.;
Capeci, W.;
Martino, G.P.;
Messina, S.;
Ghio, R.;
Favorini, S.;
Col, A.D.;
Minisola, S.;
Colangelo, L.;
Afeltra, A.;
Alemanno, P.;
Marigliano, B.;
Castellino, P.;
Blanco, J.;
Zanoli, L.;
Cattaneo, M.;
Fracasso, P.;
Amoruso, M.V.;
Saracco, V.;
Fogliati, M.;
Bussolino, C.;
Durante, V.;
Eusebi, G.;
Tirotta, D.;
Mete, F.;
Gino, M.;
Cittadini, A.;
Arcopinto, M.;
Salzano, A.;
Bobbio, E.;
Marra, A.M.;
Sirico, D.;
Moreo, G.;
Scopelliti, F.;
Gasparini, F.;
Cocca, M.;
Nieves, R.D.;
Alberto, M.M.;
Pedro, A.R.;
Vanessa, L.P.;
Lara, T.;
Xavier, C.V.;
Francesc, F.;
Jesus, D.M.;
Esperanza, B.T.;
Behamonte Esther, D.C.;
Maria, S.P.;
Romero, M.;
Blanca, P.L.;
Cristina, L.G.-C.;
Victoria, V.G.M.;
Saez, L.;
Bosco, J.;
Susana, S.B.;
Marta, A.G.;
Concepcion, G.B.;
Antonio, F.M.;
Hernandez, M.G.;
Borrego, M.P.;
Raquel, P.C.;
Florencia, P.R.;
Beatriz, G.O.;
Sara, C.G.;
Cervellera Alfonso, G.-C.;
Marta, P.M.;
Alberto, R.C.;
Antonio, A.A.;
Montserrat, G.G.;
Miguel Ăngel, B.R.;
Manuel, M.J.;
Ignacio, N.V.;
LucĂa, A.S.;
Alfonso, L.;
David, R.B.;
Iria, I.V.;
Monica, R.P.;
On behalf of REPOSI investigatorsProietti, M.; Nobili, A.; Raparelli, V.; Napoleone, L.; Mannucci, P. M.; Lip, G. Y. H.; Pasina, L.; Franchi, C.; Tettamanti, M.; Eldin, T. K.; Di Blanca, M. P. D.; Djade, C. D.; Ardoino, I.; Cortesi, L.; Marengoni, A.; Licata, G.; Violi, F.; Corazza, G. R.; Biolo, G.; Guarnieri, G.; Zanetti, M.; Fernandes, G.; Vanoli, M.; Grignani, G.; Casella, G.; Bernardi, M.; Bassi, S. L.; Santi, L.; Zaccherini, G.; Mannarino, E.; Lupattelli, G.; Bianconi, V.; Paciullo, F.; Nuti, R.; Valenti, R.; Ruvio, M.; Cappelli, S.; Palazzuoli, A.; Salvatore, T.; Sasso, F. C.; Girelli, D.; Olivieri, O.; Matteazzi, T.; Barbagallo, M.; Plances, L.; Alcamo, R.; Licata, G.; Calvo, L.; Valenti, M.; Zoli, M.; ArnĂČ, R.; Pasini, F. L.; Capecchi, P. L.; Bicchi, M.; Palasciano, G.; Modeo, M. E.; Peragine, M.; Pappagallo, F.; Di Gennaro, C.; Postiglione, A.; Barbella, M. R.; De Stefano, F.; Cappellini, M. D.; Fabio, G.; Seghezzi, S.; De Amicis, M. M.; Mari, D.; Rossi, P. D.; Ottolini, B. B.; Miceli, E.; Lenti, M. V.; Padula, D.; Murialdo, G.; Marra, A.; Cattaneo, F.; Secchi, M. B.; Ghelfi, D.; Anastasio, L.; Sofia, L.; Carbone, M.; Damanti, S.; Guagnano, M. T.; Sestili, S.; Mancuso, G.; Calipari, D.; Bartone, M.; Meroni, M. R.; Perin, P. C.; Lorenzati, B.; Gruden, G.; Bruno, G.; Amione, C.; Fornengo, P.; Tassara, R.; Melis, D.; Rebella, L.; Pretti, V.; Masala, M. S.; Bolondi, L.; Rasciti, L.; Serio, I.; Fanelli, F. R.; Amoroso, A.; Molfino, A.; Petrillo, E.; ZuccalĂ , G.; Franceschi, F.; De Marco, G.; Chiara, C.; Marta, S.; Romanelli, G.; Amolini, C.; Chiesa, D.; Picardi, A.; Gentilucci, U. V.; Gallo, P.; Annoni, G.; Corsi, M.; Zazzetta, S.; Bellelli, G.; Arturi, F.; Succurro, E.; Rubino, M.; Sesti, G.; Loria, P.; Becchi, M. A.; Martucci, G.; Fantuzzi, A.; Maurantonio, M.; Carta, S.; Atzori, S.; Serra, M. G.; Bleve, M. A.; Gasbarrone, L.; Sajeva, M. R.; Brucato, A.; Ghidoni, S.; Di Corato, P.; Agnelli, G.; Marchesini, E.; Fabris, F.; Carlon, M.; Baritusso, A.; Manfredini, R.; Molino, C.; Pala, M.; Fabbian, F.; Boari, B.; De Giorgi, A.; Paolisso, G.; Rizzo, M. R.; Laieta, M. T.; Rini, G.; Mansueto, P.; Pepe, I.; Borghi, C.; Strocchi, E.; De Sando, V.; SabbĂ , C.; Vella, F. S.; Turatto, F.; Valerio, ; R., Bg; Capobianco, C.; Fenoglio, L.; Bracco, C.; Giraudo, A. V.; Testa, E.; Serraino, C.; Fargion, S.; Bonara, P.; Periti, G.; Porzio, M.; Peyvandi, F.; Tedeschi, A.; Rossio, R.; Monzani, V.; Savojardo, V.; Folli, C.; Magnini, M.; Gobbo, G.; Balduini, C. L.; Bertolino, G.; Provini, S.; Quaglia, F.; Dallegri, F.; Ottonello, L.; Liberale, L.; Chin, W. S.; Carassale, L.; Caporotundo, S.; Traisci, G.; De Feudis, L.; Di Carlo, S.; Liberato, N. L.; Buratti, A.; Tognin, T.; Bianchi, G. B.; Giaquinto, S.; Purrello, F.; Di Pino, A.; Piro, S.; Conca, A.; Falanga, L.; Montrucchio, G.; Greco, E.; Tizzani, P.; Petitti, P.; Perciccante, A.; Coralli, A.; Salmi, R.; Gaudenzi, P.; Gamberini, S.; Semplicini, A.; Gottardo, L.; Vendemiale, G.; Serviddio, G.; Forlano, R.; Masala, C.; Mammarella, A.; Basili, S.; Perri, L.; Landolfi, R.; Montalto, M.; Mirijello, A.; Vallone, C.; Bellusci, M.; Setti, D.; Pedrazzoli, F.; Guasti, Luigina; Castiglioni, L.; Maresca, ANDREA MARIA; Squizzato, Alessandro; Molaro, M.; Bertolotti, ; M., Ce; Mussi, C.; Libbra, M. V.; Miceli, A.; Pellegrini, E.; Carulli, L.; Sciacqua, A.; Quero, M.; Bagnato, C.; Corinaldesi, R.; De Giorgio, R.; Serra, M.; Grasso, V.; Ruggeri, E.; Salvi, A.; Leonardi, R.; Grassini, C.; Mascherona, I.; Minelli, G.; Maltese, F.; Gabrielli, A.; Mattioli, M.; Capeci, W.; Martino, G. P.; Messina, S.; Ghio, R.; Favorini, S.; Col, A. D.; Minisola, S.; Colangelo, L.; Afeltra, A.; Alemanno, P.; Marigliano, B.; Castellino, P.; Blanco, J.; Zanoli, L.; Cattaneo, M.; Fracasso, P.; Amoruso, M. V.; Saracco, V.; Fogliati, M.; Bussolino, C.; Durante, V.; Eusebi, G.; Tirotta, D.; Mete, F.; Gino, M.; Cittadini, A.; Arcopinto, M.; Salzano, A.; Bobbio, E.; Marra, A. M.; Sirico, D.; Moreo, G.; Scopelliti, F.; Gasparini, F.; Cocca, M.; Nieves, R. D.; Alberto, M. M.; Pedro, A. R.; Vanessa, L. P.; Lara, T.; Xavier, C. V.; Francesc, F.; Jesus, D. M.; Esperanza, B. T.; Behamonte Esther, D. C.; Maria, S. P.; Romero, M.; Blanca, P. L.; Cristina, L. G. C.; Victoria, V. G. M.; Saez, L.; Bosco, J.; Susana, S. B.; Marta, A. G.; Concepcion, G. B.; Antonio, F. M.; Hernandez, M. G.; Borrego, M. P.; Raquel, P. C.; Florencia, P. R.; Beatriz, G. O.; Sara, C. G.; Cervellera Alfonso, G. C.; Marta, P. M.; Alberto, R. C.; Antonio, A. A.; Montserrat, G. G.; Miguel Ăngel, B. R.; Manuel, M. J.; Ignacio, N. V.; LucĂa, A. S.; Alfonso, L.; David, R. B.; Iria, I. V.; Monica, R. P.; On behalf of REPOSI, Investigator
Adherence to antithrombotic therapy guidelines improves mortality among elderly patients with atrial fibrillation: insights from the REPOSI study
No full textBackground: 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 6565 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\u2013Meier 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
Appropriateness of antiplatelet therapy for primary and secondary cardio- and cerebrovascular prevention in acutely hospitalized older people
No full textAims: Antiplatelet therapy is recommended for the secondary prevention of cardio- and cerebrovascular disease, but for primary prevention it is advised only in patients at very high risk. With this background, this study aims to assess the appropriateness of antiplatelet therapy in acutely hospitalized older people according to their risk profile. Methods: Data were obtained from the REPOSI register held in Italian and Spanish internal medicine and geriatric wards in 2012 and 2014. Hospitalized patients aged 6565 assessable at discharge were selected. Appropriateness of the antiplatelet therapy was evaluated according to their primary or secondary cardiovascular prevention profiles. Results: Of 2535 enrolled patients, 2199 were assessable at discharge. Overall 959 (43.6%, 95% CI 41.5\u201345.7) were prescribed an antiplatelet drug, aspirin being the most frequently chosen. Among patients prescribed for primary prevention, just over half were inappropriately prescribed (52.1%), being mainly overprescribed (155/209 patients, 74.2%). On the other hand, there was also a high rate of inappropriate underprescription in the context of secondary prevention (222/726 patients, 30.6%, 95% CI 27.3\u201334.0%). Conclusions: This study carried out in acutely hospitalized older people shows a high degree of inappropriate prescription among patients prescribed with antiplatelets for primary prevention, mainly due to overprescription. Further, a large proportion of patients who had had overt cardio- or cerebrovascular disease were underprescribed, in spite of the established benefits of antiplatelet drugs in the context of secondary prevention
