Pharmacological rhythm control strategy and outcomes in the oldest atrial fibrillation patients: an analysis of the nationwide Italian START registry.
D, M., G, G., D, P., G, D.C., E, A., F, V., P, P., & D, P. (2026). Pharmacological rhythm control strategy and outcomes in the oldest atrial fibrillation patients: an analysis of the nationwide Italian START registry.. Age and ageing. https://doi.org/10.1093/ageing/afag157
D M, G G, D P, G DC, E A, F V, et al. Pharmacological rhythm control strategy and outcomes in the oldest atrial fibrillation patients: an analysis of the nationwide Italian START registry.. Age and ageing. 2026; doi: 10.1093/ageing/afag157
D M, G G, D P, et al. Pharmacological rhythm control strategy and outcomes in the oldest atrial fibrillation patients: an analysis of the nationwide Italian START registry.[J]. Age and ageing. 2026. DOI: 10.1093/ageing/afag157.
@article{d2026,
author = {Menichelli D and Gazzaniga G and Poli D and Di Carlo G and Antonucci E and Violi F and Pignatelli P and Pastori D},
title = {Pharmacological rhythm control strategy and outcomes in the oldest atrial fibrillation patients: an analysis of the nationwide Italian START registry.},
journal = {Age and ageing},
year = {2026},
doi = {10.1093/ageing/afag157},
note = {PMID: 42202280},
}
TY - JOUR AU - Menichelli D AU - Gazzaniga G AU - Poli D AU - Di Carlo G AU - Antonucci E AU - Violi F AU - Pignatelli P AU - Pastori D TI - Pharmacological rhythm control strategy and outcomes in the oldest atrial fibrillation patients: an analysis of the nationwide Italian START registry. T2 - Age and ageing PY - 2026 DO - 10.1093/ageing/afag157 AN - PMID:42202280 ER -
BACKGROUND: Evidence on antiarrhythmic drugs (AADs) in the oldest atrial fibrillation (AF) patients is limited. We investigated clinical characteristics and outcomes associated with AADs use in this population. METHODS: The oldest (age ≥ 80 years) AF patients from the nationwide START registry were included. Patients were divided into three groups: no AADs (n = 3573), class 1c-AADs (n = 207) and Amiodarone (n = 464). Factors associated with AADs were evaluated using multivariable logistic regression models. The associations between AADs and all-cause mortality were assessed using Cox proportional hazards models and cardiovascular events (CVEs) were analysed using Fine-Gray competing risk models. RESULTS: Among 4244 patients (54.9% women), the mean age was 84.8 ± 3.8 years. AADs were prescribed in 671 patients (15.8%), including amiodarone in 464 (10.9%) and 1c-AADs in 207 (4.9%). 1c-AADs use was associated with younger age and fewer comorbidities, including lower prevalence of diabetes, heart failure, chronic obstructive pulmonary disease/obstructive sleep apnoea and better functional and social status. Amiodarone use was associated with coronary artery disease and markers of frailty. Over a median follow-up of 502 (interquartile range 362-857) days, 492 deaths and 548 CVEs occurred. In unadjusted analyses, 1c-AADs were associated with lower all-cause mortality and CVEs; however, these associations were no longer significant after multivariable adjustment. Amiodarone use was not associated with clinical outcomes in either unadjusted or adjusted analyses. CONCLUSION: In the oldest AF patients, AADs use is influenced by comorbidity burden and frailty-related characteristics. AADs were not independently associated with mortality or CVEs, suggesting that pharmacological rhythm control may be reserved for selected cases in this population.