OUT-OF-HOSPITAL PHARMACOLOGICAL CARDIOVERSION OF RECENT-ONSET ATRIAL-FIBRILLATION IN ELDERLY PATIENTS - EXPERIENCE OF A MOBILE CORONARY-CARE UNIT IN FLORENCE, ITALY

Background: Out-of-hospital treatment of recent-onset atrial fibrillat ion can avoid the costs of hospital admission, but its effectiveness a nd safety in elderly patients (those >70 years old) has not been inves tigated. Methods: The outcome of domiciliary treatment of recent-onset atrial fibrillation was compared in 743 consecutive patients (337 age d >70 years (45.3%), 406 aged <70 years) who were attended in Florence , Italy, by a mobile coronary care unit between November 1979 and Dece mber 1990. Results: Sinus rhythm was restored in 318 (140>70 years, 17 8<70 years) out of 743 patients (42.7%). The success rate was not sign ificantly different between the two groups, being 41.5% in the older i ndividuals and 43.8% in the younger ones. The cardioversion rate was l ower in patients with secondary atrial fibrillation than in those with lone atrial fibrillation, but the difference was statistically signif icant only in younger patients. Side-effects of pharmacological treatm ent did not differ in the two groups. Hospital admission was necessary for 115 patients (34.1%) aged >70 years and 145 (35.6%) aged <70 year s. In both groups the rate of hospital admission was higher among pati ents with coronary heart disease. Conclusions: In patients aged >70 ye ars the cardioversion rate and the need for hospital admission were no t significantly different from those in younger patients, despite a hi gher prevalence of organic heart disease.