151. Management of Atrial Fibrillation in Patients 75 Years and Older: JACC State-of-the-Art Review
- Author
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Annabelle Santos, Volgman, Gatha, Nair, Radmila, Lyubarova, Faisal M, Merchant, Pamela, Mason, Anne B, Curtis, Nanette K, Wenger, Neelum T, Aggarwal, James N, Kirkpatrick, and Emelia J, Benjamin
- Subjects
Vitamin K ,Alcohol Drinking ,Cost-Benefit Analysis ,Coronary Artery Disease ,Risk Assessment ,Atrial Fibrillation ,Weight Loss ,Diabetes Mellitus ,Secondary Prevention ,Humans ,Atrial Appendage ,Cognitive Dysfunction ,Exercise ,Aged ,Heart Failure ,Sleep Apnea, Obstructive ,Frailty ,Dual Anti-Platelet Therapy ,Anticoagulants ,Overweight ,Primary Prevention ,Stroke ,Hypertension ,Catheter Ablation ,Polypharmacy ,Accidental Falls ,Dementia ,Anti-Arrhythmia Agents ,Decision Making, Shared - Abstract
The prevalence of atrial fibrillation (AF) is increasing as the population ages. AF treatment-related complications also increase markedly in older adults (defined as ≥75 years of age for this review). The older AF population has a high risk of stroke, bleeding, and death. Syncope and fall-related injuries are the most common reasons for nonprescription of oral anticoagulation (OAC), and are more common in older adults when OACs are used with antiarrhythmic drugs. Digoxin may be useful for rate control, but associations with increased mortality limit its use. Beyond rate and rhythm control considerations, stroke prophylaxis is critical to AF management, and the benefits of direct OACs, compared with warfarin, extend to older adults. Invasive procedures such as AF catheter ablation, pacemaker implantation/atrioventricular junction ablation, and left atrial appendage occlusion may be useful in appropriately selected cases. However, older adults have generally been under-represented in clinical trials.
- Published
- 2021