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28:13
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Atrial fibrillation in long term care
1Cardiovascular Division, Washington University School of Medicine, St. Louis, MO 63110, USA. mrich@wustl.edu
Journal of the American Medical Directors Association
|August 15, 2012
Summary
Older adults with atrial fibrillation (AF) require careful management, balancing stroke risk with bleeding complications. Anticoagulation is generally recommended, with warfarin often preferred in long-term care settings.
Area of Science:
- Geriatrics
- Cardiology
- Pharmacology
Background:
- Increasing age is a significant risk factor for atrial fibrillation (AF) and stroke.
- AF prevalence in long-term care facilities is high (7.5%–17%), posing management challenges.
- Patients in long-term care have increased risks for stroke and bleeding complications from thromboprophylaxis.
Purpose of the Study:
- To review the diagnosis and management of atrial fibrillation in long-term care settings.
- To discuss treatment strategies balancing stroke prevention and bleeding risks in elderly AF patients.
Main Methods:
- Review of current literature on AF management in older adults.
- Discussion of rate-control, rhythm-control, and anticoagulation strategies.
- Evaluation of thromboprophylaxis options, including warfarin and newer anticoagulants.
Main Results:
- Rate-control medications and anticoagulation are suitable for minimally symptomatic AF patients.
- Cardioversion and antiarrhythmic drugs may benefit patients with persistent symptoms despite rate control.
- Catheter or surgical ablation is an option for a small subset of refractory patients.
Conclusions:
- Anticoagulation benefits in reducing stroke risk generally outweigh bleeding risks in most older adults with AF.
- Warfarin is currently preferred for stroke prophylaxis in long-term care due to limited data on newer agents.
- Increased use of newer anticoagulants is anticipated as safety and efficacy data in the elderly accumulate.
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