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[Chronic atrial fibrillation in the elderly]
E T De Carvalho Filho1, S T Miotta, A T Alves
1Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo.
Insights
Chronic atrial fibrillation (CAF) in the elderly is common, often linked to heart disease, but can also occur with thyroid issues or unknown causes. This study evaluated elderly patients with CAF to understand its various aspects.
Area of Science:
- Cardiology
- Geriatrics
Context:
- Chronic atrial fibrillation (CAF) is a prevalent condition in the elderly population.
- Understanding the diverse etiologies and clinical presentations of CAF in older adults is crucial for effective management.
Purpose:
- To comprehensively evaluate the clinical characteristics and associated conditions of chronic atrial fibrillation (CAF) in elderly patients.
- To determine the frequency of CAF in a geriatric outpatient setting and identify contributing factors.
Summary:
- A study of 49 elderly patients (average age 76.1) with CAF revealed a 4.8% prevalence in a geriatric clinic, increasing with age.
- Cardiovascular diseases (hypertension, valve disease) were common (79.6%), alongside other systemic conditions like diabetes and hyperthyroidism (16.3%).
- Electrocardiographic abnormalities (ST-T changes, left ventricular hypertrophy) and cardiomegaly were frequent; echocardiography often showed left atrial enlargement.
Impact:
- Findings highlight that CAF in the elderly is multifactorial, extending beyond cardiocirculatory diseases to include thyrotoxicosis and idiopathic cases.
- This underscores the need for thorough etiological investigation in elderly patients diagnosed with chronic atrial fibrillation.
Purpose:
To evaluate the different aspects of chronic atrial fibrillation (CAF) in elderly patients.
Methods:
Forty nine patients with CAF (18 men) aged 66 to 87 years (76.1 years on average) were studied. Their evaluation consisted of clinical examination, blood tests, electrocardiogram, chest X-Ray and echocardiogram.
Results:
The frequency of CAF in the out-patient Geriatric Clinic was 4.8% and it rose with aging. Cardiocirculatory diseases were observed in 39 (79.6%) patients: 25 (51.0%) had systemic arterial hypertension, 11 (22.4%) had mitral valve disease and six (11.2%) had aortic valve disease. Thirty patients had diseases of other systems, eight (16.3%) of whom were diabetic and seven (14.3%) had hyperthyroidism. Vascular brain disease was observed in four (8.2%) patients. Electrocardiographic changes other than CAF were observed in 41 (83.7%) patients. Changes in the ST-T segment were the more frequent, being observed in 28 (57.1%) patients, followed by left ventricular hypertrophy in 15 (30.1%). Cardiomegaly was seen in 36 (78.3%) out of 46 patients who did the chest radiography. An echocardiogram was performed in 35 patients, being found normal in seven (20.0%). In the remaining cases, the abnormality more frequently seen was the left atrial enlargement, seen in 16 (45.7%) patients. Four patients didn't show clinical, electrocardiographic, radiological or echocardiographic evidence of cardiocirculatory disease and in these, the thyroid function was normal. Digitalis therapy was used in 37 patients. Of the remaining 12, 10 had normal ventricular frequency without the use of the drug.
Conclusion:
The CAF in the elderly patient is observed not only in patients with cardiocirculatory diseases, but in thyrotoxic patients and sometimes without known etiology.