Expert consensus of the French society of geriatrics and gerontology and the French society of cardiology on the management of atrial fibrillation in elderly people

Acute cardiac disease in elder patients

“…Major risk factors in this population include age, hypertension, CHF, and valve disorders [17]. While the etiology of most cases of AF is related to these factors, there are other potential causes, including alcohol abuse, PE, emphysema, hyperthyroidism, electrolyte abnormalities, obesity, and obstructive sleep apnea [18].…”

“…The dysrhythmia may, in fact, be incidentally discovered. It is not unusual for AF to secondarily reveal itself during times of stress, such as infection, trauma, or surgery [18]. Identification of AF, in addition to ACS, is yet another reason to liberally obtain ECGs in elderly patients with nonspecific symptoms.…”

“…However, if concern exists for intracardiac thrombus, transesophageal echo is indicated. Echocardiography is not to be performed in the ED, but transesophageal echocardiography (TEE) is particularly useful prior to cardioversion and also in the evaluation of a patient with stroke of unclear etiology [18].…”

“…Aspirin can be considered in low-risk patients who are not candidates for anticoagulation; however, it is not an equivalent substitute for warfarin [23]. The BAFTA study of patients greater than 75 years of age finds that warfarin provides a 52% reduction in risk of embolism compared to aspirin [18]. Clopidogrel monotherapy is also not protective, and, when combined with aspirin, results in a higher risk of serious bleeding without much benefit.…”

“…The randomized evaluation of long-term anticoagulation therapy (RE-LY) trial evaluated more than 18,000 elderly patients and finds a 34% stroke reduction in patients taking twice a day dabigatran compared to warfarin, and also a lower chance of intracranial bleeding [18]. Dabigatran is an oral direct thrombin inhibitor, without an approved reversal agent, which is cleared renally.…”