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Atrial fibrillation in the elderly population: Challenges and management considerations

Mohammed Salih1, Osama Abdel-Hafez1, Ramzi Ibrahim1,2

  • 1Department of Internal Medicine Cardiovascular Disease St Joseph Mercy Oakland Hospital Pontiac MI USA.

Journal of Arrhythmia
|August 13, 2021
PubMed

Insights

Managing atrial fibrillation in the elderly requires an individualized approach. This review clarifies stroke prevention options, including anticoagulation and left atrial appendage occlusion, for high-risk patients.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Public Health

Background:

  • Atrial fibrillation (AF) is a significant global and national arrhythmia, affecting millions in the US, with increasing prevalence due to an aging population.
  • AF remains a major obstacle to cardiovascular health despite advancements in disease management.
  • Healthcare utilization in AF patients is a public health concern, often complicated by misconceptions in clinical decision-making.

Purpose of the Study:

  • To address misconceptions in clinical decision-making for atrial fibrillation management.
  • To clarify the risk-benefit assessment of anticoagulation strategies in high-risk patients.
  • To review second- and third-line interventions for atrial fibrillation when standard treatments are contraindicated.

Main Methods:

  • Review of current clinical practices and literature regarding atrial fibrillation management.
  • Analysis of healthcare utilization and decision-making processes in elderly AF patients.
  • Evaluation of evidence for pharmacological anticoagulation and left atrial appendage occluding devices for stroke prevention.

Main Results:

  • Misconceptions regarding anticoagulation in high-risk AF patients persist, leading to suboptimal care.
  • A skewed risk-benefit assessment often hinders the use of safe and effective anticoagulation.
  • There is often a lack of clear understanding regarding alternative interventions when standard treatments are not feasible.

Conclusions:

  • An individualized approach is crucial for managing atrial fibrillation in the elderly.
  • Physicians must consider complication risks, especially embolic stroke, and available treatment options.
  • Treatment decisions should encompass pharmacological anticoagulation and left atrial appendage occluding devices for stroke prevention.
Abstract

Keywords:
anticoagulationatrial fibrillationrate controlrhythm controlstroke

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