Comparative Effectiveness of Adenosine, Diltiazem, and Metoprolol in Rate Control of Supraventricular Tachyarrhythmias in Geriatric Patients: A Retrospective Cohort Study

Objective: To evaluate the comparative effectiveness of adenosine, diltiazem, and metoprolol in achieving rate control in geriatric patients presenting with supraventricular tachyarrhythmia (SVT) and to identify clinical predictors associated with treatment success. Materials and Methods: This retrospective observational cohort study was conducted in a single tertiary emergency department between January 2021 and December 2024. Patients aged ≥65 years who presented with SVT and were treated with adenosine, diltiazem, or metoprolol were included. Patients were categorized into two groups based on successful rate control (heart rate <100 bpm). Demographics, comorbidities, laboratory parameters, and hemodynamic data were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to determine the independent predictors of treatment success. Receiver operating characteristic (ROC) analysis was conducted to evaluate the prognostic performance of the identified variables. Results: A total of 167 patients were included, of whom 58 (34.7%) achieved rate control. There were no significant differences in age or sex distribution between the groups. Chronic kidney disease was significantly more prevalent in the non-rate control group (17.4% vs. 3.4%, p=0.009). Patients with successful rate control had significantly higher hemoglobin levels (13.6±2.5 vs. 12.7±2.5 g/dL, p=0.01) and glomerular filtration rates (60.7±27.3 vs. 58.7±25.5 mL/min, p=0.015). In the multivariate analysis, only hemoglobin remained an independent predictor of rate control success (odds ratio: 1.154, p=0.037). ROC analysis identified a hemoglobin cut-off of 12.9 g/dL, with a sensitivity of 62.1% and specificity of 63.9% (area under the curve: 0.622). Conclusion: Hemoglobin level is an independent predictor of successful pharmacologic rate control in geriatric patients with SVT. Personalized therapeutic strategies that incorporate hematologic status may optimize treatment outcomes in this vulnerable population. Further prospective studies are required to validate these findings.