Management of Atrial Fibrillation in Elderly Adults

Abstract

Driven in large part by the aging of the population and the increasing prevalence of cardiovascular comorbidities associated with atrial fibrillation (AF), there is a burgeoning epidemic of AF in elderly adults. Although there is a large body of literature to guide management of people with AF, elderly adults with AF are frequently underrepresented in clinical trials. This review provides a contemporary update on management of elderly adults with AF with a particular focus on the two main clinical challenges that AF poses: stroke risk reduction and control of symptoms. The evidence to support novel AF treatment strategies in elderly adults is reviewed, including novel oral anticoagulants and left atrial appendage closure for stroke risk reduction and catheter ablation for control of symptoms.

Long‐term aspirin does not lower risk of stroke and increases bleeding risk in low‐risk atrial fibrillation ablation patients

“…DOACs (dabigatran, rivaroxaban, apixaban, and edoxaban) may present a valuable alternative therapy for low stroke risk patients. In a meta‐analysis comparing these medications (N = 42,411) to warfarin therapy (N = 29,272), it has been described that the rates of a stroke and or systemic embolism were lower in patients taking DOAC therapies when compared to warfarin (RR: 0.81 [CI 95%: 0.73; 0.91]), and lower rates of intracranial hemorrhage (ICH) (RR: 0.48 [CI95%: 0.39; 0.59]) . DOAC therapy has been known from prior studies to cause less bleeding events than warfarin, and in particular ICH (DOAC studies 0.26–0.49% and warfarin studies 0.76–0.85%, annually), which makes them a better option especially for very old adults .…”

Atrial fibrillation and medication treatment among centenarians: Are all very old patients treated the same?

“…The group of very old patients represents the fastest growing population in many countries, while atrial fibrillation (AF) is the most common chronic cardiac arrhythmia in older patients . AF represents a major risk factor for stroke, particularly in patients aged ≥75 years .…”

“…The group of very old patients represents the fastest growing population in many countries, while atrial fibrillation (AF) is the most common chronic cardiac arrhythmia in older patients. [1][2][3][4] AF represents a major risk factor for stroke, particularly in patients aged ≥75 years. 3,5 Recent data from the Screening for Atrial Fibrillation in the Elderly trial showed an AF prevalence of 6% in people aged 65-74 years, 12% in those aged 75-84 years, and 16% in those aged ≥85 years.…”

“…13 Older AF patients are at higher risk for stroke and, thus, are more likely to benefit from oral anticoagulation (OAC) than younger patients, though some studies suggest that OAC is underutilized in older patients. 4,14 A major barrier for implementation of OAC in older adults is concerns about the high bleeding risk and difficulties in controlling the international normalized ratio in the target range during warfarin treatment. 15,16 Although there is evidence of a lower AF rate and less use of anticoagulants in general for centenarians than for other populations of oldest-old, literature examining the increasing disparity between AF prevalence and prescription rates for anticoagulants with increasing age is sparse.…”

Newly Diagnosed Stroke-Associated Atrial Fibrillation: Risk of Development of Unfavorable Clinical Outcomes (The Results of the Subanalysis Cohort Study Apollo)

“…Фибрилляция предсердий (ФП) -наиболее часто встречающаяся в популяции аритмия, высоко ассо-циированная с развитием фатальных тромбоэмболи-ческих осложнений, в первую очередь -кардиоэм-болического инсульта (КЭИ) [1][2][3][4][5]. Именно инсульт сегодня и по прогнозам экспертов Всемирной орга-низации здравоохранения до 2030 останется основ-ной, после ишемической болезни сердца, причиной смерти во всем мире [6].…”