Journal of the American Medical Directors Association
Original StudyRenin-Angiotensin System Inhibitors Prognostic Benefit in Older Patients with Atrial Fibrillation
Section snippets
Methods
For the study, we used a cohort of all consecutive patients aged ≥75 years diagnosed with AF between 2014 and 2017 from the health area of Vigo (Galicia, Spain), the CardioCHUVI-AF_75 registry cohort (ClinicalTrials.gov Identifier: NCT04364516).We did not apply any exclusion criteria once the diagnosis of AF was confirmed. Figure 1 shows the population flowchart. Patients were identified through administrative databases regional electronic medical records system at both the hospital and
Results
A total of 9365 patients with AF aged 75 years or older were included for statistical analysis. Baseline characteristics are summarized in Table 1. Mean age was 83.0 ± 4.9 years (range 75.0–103.0), and 60.4% of patients (n = 5657) were women. ACEi or ARBs were prescribed on 52.16% of the patients (n = 4885).
Patients on ACEi or ARB treatment were younger, but presented significantly higher cardiovascular risk and higher rates of previous coronary artery disease.
During a mean follow-up of
Discussion
Our study evaluated the prognosis benefit, in terms of survival and major cardiovascular events (HF admission, AMI, and stroke), of ACEi or ARB therapy in older patients with AF, based on a large contemporaneous registry of real-world data. According to our results, ACEi or ARB treatment is not associated with further prognostic benefit for these patients.
In contemporary AF trials, the main cause of mortality was cardiac-related etiologies (including sudden death, HF, and AMI), whereas stroke
Conclusions and Implications
ACEi or ARB therapy does not improve outcomes in terms of survival and cardiovascular outcomes in older patients with AF. Although these therapies are part of the upstream strategy, their use may not add a prognosis beneficial effect to older individuals. These results should prompt randomized clinical trials specifically designed for addressing this issue in the older patient population with AF.
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The authors declare no conflicts of interest.