Management of atrial fibrillation in older patients

There has been a rapid growth in the elderly population and atrial fibrillation (AF) is the most common sustained cardiac arrhythmia among older patients. There is considerable diversity in the management of AF and different treatment regimens have been proposed. These treatments are influenced by multiple factors. However there is no information available on the management of AF in very elderly patients. Most evidence is based upon research in younger people which cannot be extrapolated to older patients.

The study was a prospective assessment of patients over 77 years admitted to a district general hospital. New onset AF was defined as AF of less than 3 months duration and chronic AF was defined as AF for more than 3 months. The electrocardiograms of all patients were reviewed following admission and patients were included provided they had AF on admission or during their hospital stay.

Over the six months 783 patients were admitted and of those 153 patients had AF (20%). The mean age was 85.2 years and in 33% of patients AF was the primary cause for admission. New onset AF was noted in 35% of patients and 65% had chronic AF. Intermittent AF was noted in 10% and no patient met the criteria for lone AF. Most patients presented with multiple medical problems averaging nearly five pathologies per patient. Though 41% of patient received thromboprophylaxis, most had inappropriate dosage thus highlighting the problems surrounding less rigid patient selection or inadequate monitoring. Twentysix percent of patients died during their hospital stay but no deaths were recorded in patients who reverted to sinus rhythm.

Elderly patients with AF are a diverse group with limited treatment options due to delayed hospital admission and multiple pathology. Chemical cardioversion is safe in the short term and those who cardiovert have better prognosis. Awareness is required for adequate dosage and monitoring of antithrombotic medications.