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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Use and Prescription of Direct Oral Anticoagulants in Older and Frail Patients with Atrial Fibrillation: A

Marco Proietti1,2,3, Marina Camera4,5, Maurizio Gallieni6,7

  • 1Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy.

Journal of Personalized Medicine
|March 25, 2022
PubMed

Insights

Direct oral anticoagulants have transformed atrial fibrillation care. This consensus highlights the need for comprehensive geriatric assessment to guide direct oral anticoagulant prescribing in frail, elderly patients, a high-risk group needing further study.

Area of Science:

  • Geriatrics
  • Cardiology
  • Pharmacology

Background:

  • Direct oral anticoagulants (DOACs) have revolutionized atrial fibrillation (AF) management over the past decade.
  • However, evidence regarding DOAC effectiveness and safety in the oldest and frailest populations with AF remains limited.
  • Frailty, a syndrome of reduced physiological reserves, increases vulnerability and is linked to adverse outcomes in AF patients.

Purpose of the Study:

  • To address the lack of data on DOACs in frail AF patients.
  • To propose integrating comprehensive geriatric assessment (CGA) into clinical practice.
  • To provide guidance for DOAC prescription in this high-risk subgroup.

Main Methods:

  • Multidisciplinary consensus review of existing literature.
  • Discussion on the utility of comprehensive geriatric assessment (CGA).
  • Analysis of frailty as a predictor of adverse outcomes in AF.

Main Results:

  • Significant gap in knowledge exists regarding DOACs in frail AF patients.
  • Frailty is associated with increased risk of adverse events in AF.
  • CGA can provide crucial data for personalized DOAC prescription.

Conclusions:

  • Current evidence is insufficient to guide DOAC use in frail AF patients.
  • Integrating CGA into the clinical evaluation is essential for optimizing DOAC therapy.
  • This approach will help manage the unique risks and needs of this vulnerable population.

Keywords:
DOACatrial fibrillationbleedingcardiovascular preventionfrailtyold agestroke

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