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Updates in antiarrhythmic therapy for atrial fibrillation in geriatric patients
Cassandra Ehrlich1, Laura V Tsu
1Banner Boswell Medical Center, Sun City, Arizona, USA.
Insights
Elderly patients require careful consideration for antiarrhythmic therapy due to increased susceptibility to adverse effects. Pharmacists are vital in monitoring and educating geriatric patients on these medications for atrial fibrillation management.
Area of Science:
- Geriatric Pharmacology
- Cardiology
- Clinical Pharmacy
Background:
- Atrial fibrillation (A fib) incidence rises with age, necessitating understanding of antiarrhythmic drug use in the elderly.
- Geriatric patients face unique challenges with antiarrhythmic medications due to physiological changes and comorbidities.
Purpose of the Study:
- To review current evidence on antiarrhythmic therapy for atrial fibrillation in the geriatric population.
- To highlight monitoring parameters and clinical considerations for antiarrhythmic drug use in older adults.
Main Methods:
- Conducted a PubMed search for English-language articles from 1990 to August 2014.
- Utilized keywords including specific antiarrhythmic drugs, atrial fibrillation, and geriatric/elderly terms.
- Assessed original studies, reviews, and guidelines, including reference list evaluations.
Main Results:
- The aging population experiences a higher incidence of atrial fibrillation, increasing the need for effective antiarrhythmic strategies.
- This review focuses on the literature concerning high-risk antiarrhythmic medications in the elderly.
- Key considerations include specific monitoring parameters and clinical management tailored to geriatric patients.
Conclusions:
- Elderly individuals are more prone to adverse effects from antiarrhythmic drugs due to reduced drug clearance, metabolism, and potential drug interactions.
- Comorbidities and polypharmacy in geriatric patients significantly influence antiarrhythmic therapy outcomes.
- Pharmacists play a crucial role in a multidisciplinary approach to monitor patients and provide education on antiarrhythmic therapy.
Objective:
To provide a review of the current evidence for the use of antiarrhythmic therapy in the geriatric population.
Data Sources:
A PubMed search of articles in the English language published from 1990 through August 2014 was performed using a combination of the following words: amiodarone, antiarrhythmic, atrial fibrillation, dofetilide, dronedarone, elderly, flecainide, geriatric, propafenone, sotalol.
Study Selection/Data Extraction:
Relevant original studies, review articles, and guidelines were assessed for use of antiarrhythmic therapy to manage atrial fibrillation (A fib) in the elderly. References from the above literature were also evaluated and included based on their relevance.
Data Synthesis:
The incidence of A fib increases as the population ages, which creates an increased need for clinicians to understand the place of antiarrhythmic therapy in management of A fib. This article provides a review of the current literature regarding this high-risk class of medications in the elderly population, with a focus on monitoring parameters and clinical considerations in the geriatric population.
Conclusion:
Elderly patients are more susceptible to the adverse effects of antiarrhythmic medications as a result of multiple factors, including decreased clearance and metabolism of medications as well as interactions caused by comorbid conditions and medications. Pharmacists can play a key role in a multidisciplinary team to monitor and educate patients on their antiarrhythmic therapy.
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