Recommendation ID
CG180/2
Question
Rate control drug treatment for people aged 75 and over with atrial fibrillation:- What is the comparative effectiveness of the 3 main drug classes used for rate control (beta-blockers, calcium-channel blockers and digoxin) in people aged 75 and over with atrial fibrillation in controlling symptoms, improving quality of life and reducing morbidity and mortality?
Any explanatory notes
(if applicable)
Why this is important:- Atrial fibrillation is the most common arrhythmia in people aged 75 and over, with a prevalence of more than 15%. This guideline recommends rate control of atrial fibrillation as the treatment of choice. However, there are no good-quality randomised controlled trials (RCTs) comparing the 3 main drug classes (beta-blockers, calcium-channel blockers and digoxin) used for rate control, and no studies specifically addressing people aged 75 and over. Drug treatment for rate control in people aged 75 and over with atrial fibrillation is particularly challenging because of comorbidities. For example, heart failure is prevalent in this age group but RCTs comparing beta-blockers with digoxin in people aged over 70 are of low quality.
Although these RCTs suggest no advantage of beta-blockers compared with digoxin for rate control, and an increased incidence of hospitalisations with heart failure, current guidelines propose beta-blockers as first-line therapy for rate control. Other conditions such as chronic kidney disease, ischaemic heart disease, valvular heart disease, concomitant heart conduction disorders, dementia, pulmonary disease, hypo- and hypertension and frailty might also affect the choice of drugs for this age group. Optimal treatments for people with these comorbidities are not known.
Optimising drug treatment for atrial fibrillation in this age group has the potential to reduce hospitalisations and the need for services such as GPs and specialist nurses to manage secondary symptoms, with consequent economic benefits. [new 2014]

Source guidance details

Comes from guidance
Atrial fibrillation: management
Number
CG180
Date issued
June 2014

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 13/10/2014