Atrial Fibrillation in Older People: Concepts and Controversies

Zathar, Zafraan; Karunatilleke, Anne; Fawzy, A M; Lip, Gregory Y.H.

doi:10.3389/fmed.2019.00175

Cited by 65 publications

(68 citation statements)

References 155 publications

(162 reference statements)

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“…in case of paroxysmal atrial fibrillation). However, such initially cryptogenic stroke patients are younger and have less comorbidities compared to the standard cardioembolic stroke patients [ 18 ]. The exclusion of such patients as it was done by the MR-CLEAN investigators might therefore explain the reported baseline imbalances in their subgroup analysis [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Relationship between stroke etiology and collateral status in anterior circulation large vessel occlusion

et al. 2020

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Background and purpose Clinical outcome after mechanical thrombectomy (MT) for large vessel occlusion (LVO) stroke is influenced by the intracerebral collateral status. We tested the hypothesis that patients with preexisting ipsilateral extracranial carotid artery stenosis (CAS) would have a better collateral status compared to non-CAS patients. Additionally, we evaluated MT-related adverse events and outcome for both groups. Methods Over a 7-year period, we identified all consecutive anterior circulation MT patients (excluding extracranial carotid artery occlusion and dissection). Patients were grouped into those with CAS ≥ 50% according to the NASCET criteria and those without significant carotid stenosis (non-CAS). Collateral status was rated on pre-treatment CT- or MR-angiography according to the Tan Score. Furthermore, we assessed postinterventional infarct size, adverse events and functional outcome at 90 days. Results We studied 281 LVO stroke patients, comprising 46 (16.4%) with underlying CAS ≥ 50%. Compared to non-CAS stroke patients (n = 235), patients with CAS-related stroke more often had favorable collaterals (76.1% vs. 46.0%). Recanalization rates were comparable between both groups. LVO stroke patients with underlying CAS more frequently had adverse events after MT (19.6% vs. 6.4%). Preexisting CAS was an independent predictor for favorable collateral status in multivariable models (Odds ratio: 3.3, p = 0.002), but post-interventional infarct size and functional 90-day outcome were not different between CAS and non-CAS patients. Conclusions Preexisting CAS ≥ 50% was associated with better collateral status in LVO stroke patients. However, functional 90-day outcome was independent from CAS, which could be related to a higher rate of adverse events.

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Section: Discussionmentioning

confidence: 99%

Relationship between stroke etiology and collateral status in anterior circulation large vessel occlusion

et al. 2020

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“…[7][8][9][10] The prevalence of FS increases with age and may significantly affect both treatment success and the ultimate outcomes of AF. 11 It is estimated at 7-12% of the elderly population. Between the ages of 56 and 74, FS is diagnosed in 3.9% of patients, but in patients aged over 85, this proportion increases to 25%.…”

Section: Introductionmentioning

confidence: 99%

<p>Assessment of Frailty and Occurrence of Anxiety and Depression in Elderly Patients with Atrial Fibrillation</p>

Uchmanowicz¹,

Lomper²,

Gros³

et al. 2020

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Purpose: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its incidence increases with age. The elderly population is commonly affected by frailty syndrome (FS). FS syndrome along with anxiety and depressive symptoms are prevalent among elderly patients with AF. It is unclear whether depression contributes to AF or vice versa. The purpose of this study was to assess correlations between FS and the occurrence of anxiety and depression symptoms in a group of elderly patients with AF. Patients and Methods: This cross-sectional study included 100 elderly patients (69 females, 31 males, mean age: 70.27 years) with AF. Standardized research instruments were used including the Tilburg Frailty Indicator (TFI) to assess FS, and two questionnaires to assess depression including the Geriatric Depression Scale (GDS), and the Hospital Anxiety Depression Scale (HADS). Results: Mild FS was found in 38% and moderate FS in 29% of patients. Based on GDS scores, depression symptoms were found in 51% of patients' sample. Based on HADS scores, 20% of patients were found to have anxiety symptoms, and 28% revealed depression symptoms. Single-factor analysis demonstrated a significant positive correlation between HADS anxiety symptoms (r=0.492), HADS depression symptoms (r=0.696), and GDS score (r=0.673) on the one hand, and overall TFI frailty score on the other. Multiple-factor analysis identified overall GDS score, education, and lack of bleeding as significant independent predictors of TFI scores (p<0.05). Conclusion: FS is common in the population of elderly patients with AF. We found evidence for the association between symptoms of anxiety and depression and the incidence of FS in this group of patients. Due to the risk of consequences which may in part be irreversible, screening for FS is recommended.

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“…In our study, we identified frailty syndrome in 34.2% of patients, and more often among the women. 17,18 Many authors have undertaken research whose aim was to assess the factors that affect the effectiveness of electrical cardioversion. Among the factors that influence the effectiveness of cardioversion are the elimination of the cause of arrhythmias, the duration of arrhythmia, age, obesity, mitral valve defects, left atrial enlargement, number of previous relapses, atrial conduction disturbances and a higher heart rate.…”

Section: Discussionmentioning

confidence: 99%

<p>Modified Frailty as a Novel Factor in Predicting the Maintenance of the Sinus Rhythm After Electrical Cardioversion of Atrial Fibrillation in the Elderly Population</p>

Młynarska¹,

Młynarski²,

Marcisz³

et al. 2020

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Introduction: Frailty is a common geriatric syndrome that causes an elevated risk of catastrophic declines in the health and function among older adultswe hypothesized that frailty may be related to the maintenance of sinus rhythm after cardioversion. Methods: The study sample was a group of 199 consecutive patients over 60 (average age 71.41 ± 6.99; 40.2% women) with AF who were hospitalized in order to perform electrical cardioversion. The Tilburg Frailty Indicator (TFI) was used to assess frailty before cardioversion. The six-month visit after the electrical cardioversion was a follow-up. The follow-up period for the maintenance of sinus rhythm after electrical cardioversion was 180 ± 14 days. Results: Patients in whom cardioversion was effective had a statistically significantly lower severity of frailty syndrome (3.44 ± 1.83 vs 5.87 ± 1.12; p=0.000) and its components: physical components (2.14 ± 1.33 vs 3.62 ± 1.05 p=0.000); emotional components (0.92 ± 0.79 vs 1.29 ± 0.86 p=0.037) and social components (0.37 ± 0.56 vs 0.96 ± 0.46; p=0.000) compared to those patients in which cardioversion was ineffective. In the logistic regression, frailty (OR: 0.65, 95% CI:0.5010-0.8330; p=0.000) was observed to be an independent predictor for maintaining sinus rhythm. Conclusion: Frailty is a novel, independent factor that can be used to predict the effectiveness of electrical cardioversion and the maintenance of sinus rhythm in the elderly population. Modifying the level of recognition in the Tilburg Frailty Indicator to a 4 improved the prediction of the effectiveness of electrical cardioversion as well as the maintenance of sinus rhythm.

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Atrial Fibrillation in Older People: Concepts and Controversies

Cited by 65 publications

References 155 publications

Relationship between stroke etiology and collateral status in anterior circulation large vessel occlusion

Relationship between stroke etiology and collateral status in anterior circulation large vessel occlusion

<p>Assessment of Frailty and Occurrence of Anxiety and Depression in Elderly Patients with Atrial Fibrillation</p>

<p>Modified Frailty as a Novel Factor in Predicting the Maintenance of the Sinus Rhythm After Electrical Cardioversion of Atrial Fibrillation in the Elderly Population</p>

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