Atrial fibrillation in the elderly

The prevalence of atrial fibrillation (AF) increases with age, with about one-third of patients with AF older than 80 years. Rate control is the preferable strategy using beta blockers or, if left ventricular systolic function is intact, non-dihydropyridine calcium channel blockers. A more lenient heart rate target (2DS2-VASC score greater than 2; since age over 75 years is assigned 2 points, most such patients should be anticoagulated. Of concern in ascertaining the risk:benefit ratio of anticoagulation is that the study cohorts in AF anticoagulant trials are younger than community AF patients. This chapter includes a table listing the dose reductions required for the newer direct acting oral anticoagulants (dabigatran, rivaroxaban, and apixaban). In general, clinical practitioners overestimate the fall risk in their elderly patients, denying them the benefit of anticoagulation. The HAS-BLED and HEMOR2HAGES scores can aid in determining bleeding risk at elderly age.