Adherence to antithrombotic therapy guidelines improves mortality among elderly patients with atrial fibrillation: insights from the REPOSI study

Background: 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 ≥65years. 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&nbsp