A Single-Center Study on the Current Therapeutic Status and Influencing Factors of Rhythm Control versus Rate Control in Elderly Patients with Atrial Fibrillation
10.3760/cma.j.issn.0254-9026.2025.08.007
- VernacularTitle:高龄心房颤动患者节律与心室率控制治疗现状及影响因素的单中心研究
- Author:
Peng LI
1
;
Xue YU
;
Junpeng LIU
;
Ke CHAI
;
Yao JIA
;
Xue LI
;
Chen SUN
;
Huiping ZHANG
;
Lei QIU
;
Dahai HUANG
Author Information
1. 北京医院心血管内科 国家老年医学中心 中国医学科学院老年医学研究院，北京 100730
- Publication Type:Journal Article
- Keywords:
Atrial fibrillation;
Elderly;
Rhythm control;
Rate control
- From:
Chinese Journal of Geriatrics
2025;44(8):1048-1055
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the current therapeutic status of rhythm control versus rate control in elderly patients with atrial fibrillation(AF)and the related factors that may influence treatment decisions.Methods:A retrospective study was conducted on AF patients aged ≥75 years old who were hospitalized in the Healthcare Department of Beijing Hospital from January 2010 to May 2020.The patients were grouped and compared according to whether they underwent rhythm control or rate control.Multivariate logistic regression analysis was used to investigate the factors that may influence the treatment decision of rhythm control or rate control.Results:A total of 167 patients was included, with a median age of 90 years old.Among them, 21 patients(12.6%)received rhythm control, and 109 patients(65.3%)received rate control.Compared with the group not receiving rhythm control, the rhythm control group had a younger age, higher BMI, higher diastolic blood pressure, a higher proportion of multiple medication use, a lower proportion of chronic kidney disease stage 3 or above, and higher hemoglobin levels(all P<0.05). Compared with the group not receiving rate control, the rate control group had a lower proportion of paroxysmal AF, a faster resting ventricular rate, a higher proportion of smoking history, a higher proportion of multiple medication use, coronary heart disease, pacemaker treatment, chronic obstructive pulmonary disease and/or asthma, and a lower proportion of cognitive impairment(all P<0.05). Multivariate logistic regression analysis revealed that multiple drug use( OR=11.578, 95% CI: 1.341-99.993, P=0.026)was positively associated with rhythm control therapy, while chronic kidney disease stage 3 or above( OR=0.248, 95% CI: 0.063-0.968, P=0.045)was negatively associated with rhythm control therapy.For rate control therapy, multiple drug use( OR=5.056, 95% CI: 2.253-11.347, P<0.001), resting ventricular rate( OR =1.033, 95% CI: 1.005-1.062, P=0.021), and chronic obstructive pulmonary disease(COPD)and/or asthma( OR=2.739, 95% CI: 1.124-6.672, P=0.027)showed positive associations. Conclusions:The application rate of rhythm control therapy is low in elderly AF patients, and ventricular rate control is the main treatment.Complex clinical conditions are the main constraints, and it is urgent to optimize individualized strategies based on prospective studies and develop new treatment techniques to improve clinical practice.
