Management of Atrial Fibrillation in Patients 75 Years and Older

Volgman, Annabelle Santos; Nair, Gatha; Lyubarova, Radmila; Merchant, Faisal M.; Mason, Pamela; Curtis, Anne B.; Wenger, Nanette K.; Aggarwal, Neelum T.; Kirkpatrick, James N.; Benjamin, Emelia J.

doi:10.1016/j.jacc.2021.10.037

Cited by 54 publications

(25 citation statements)

References 100 publications

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“…Specific considerations should be made in patients with comorbidities such as atrial fibrillation [ 98 ]. A high prevalence of left ventricular hypertrophy was found in patients with non-valvular atrial fibrillation, associated with older age, hypertension, and other factors such as female gender, diabetes, and previous myocardial infarction [ 99 ].…”

Section: Clinical Practicementioning

confidence: 99%

Management of Hypertension in the Elderly and Frail Patient

Guasti

Ambrosetti²,

Ferrari

et al. 2022

Drugs Aging

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Hypertension is a frequent finding in elderly patients. Hypertension in older age can be both associated with frailty and represent a risk factor for frailty. Hypertension is recognized as a main risk factor for cardiovascular diseases such as heart failure, atrial fibrillation, and stroke and the occurrence of these diseases may provoke a decline in health status and/or worsen the degree of frailty. Blood pressure targets in hypertensive older and frail patients are not completely defined. However, specific evaluations of individual patients and their co-morbidities and assessment of domains and components of frailty, together with weighted consideration of drug use, may help in finding the appropriate therapy.

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Section: Clinical Practicementioning

confidence: 99%

Management of Hypertension in the Elderly and Frail Patient

Guasti

Ambrosetti²,

Ferrari

et al. 2022

Drugs Aging

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“…The prevalence of AF has been reported to increase with the aging progress, which leads to age as an independent risk factor of the progress and prognosis of AF [ 2 , 36 ]. At present, the diagnosis and management of AF guidelines recommend that catheter ablation should be considered in PAF and persistent AF patients for better symptom control (Class I) [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Approximately 12 million individuals will experience AF in the US by 2050 and nearly 18 million in Europe by 2060. Remarkably, the prevalence could increase to as high as 5–10% among those aged 65 years and older [ 1 , 2 ]. Meanwhile, accumulated studies have reported that the elderly population with AF has a high risk of arrhythmic burden, stroke, bleeding, and heart failure, ultimately leading to longer hospitalization and increased mortality.…”

Section: Introductionmentioning

confidence: 99%

Do Elderly Patients with Atrial Fibrillation Have Comparable Ablation Outcomes Compared to Younger Ones? Evidence from Pooled Clinical Studies

Li¹,

Zhang²,

Wu³

et al. 2022

JCM

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Background: Age is an independent risk factor of the progress and prognosis of atrial fibrillation (AF). However, ablation outcomes between elderly and younger patients with AF remain elusive. Methods: Cochrane Library, Embase, PubMed, and Web of Science were systematically searched up to 1 April 2022. Studies comparing AF ablation outcomes between elderly and younger patients and comprising outcomes of AF ablation for elderly patients were included. Trial sequential analysis (TSA) was performed to adjust for random error and lower statistical power in our meta-analysis. Subgroup analysis identified possible determinants of outcome impact for elderly patients after ablation. Moreover, linear and quadratic prediction fit plots with confidence intervals were performed, as appropriate. Results: A total of 27 studies with 113,106 AF patients were eligible. Compared with the younger group, the elderly group was significantly associated with a lower rate of freedom from AF (risk ratio [RR], 0.95; p = 0.008), as well as a higher incidence of safety outcomes (cerebrovascular events: RR, 1.64; p = 0.000; serious hemorrhage complications: RR, 1.50; p = 0.035; all-cause death: RR, 2.61; p = 0.003). Subgroup analysis and quadratic prediction fit analysis revealed the follow-up time was the potential determinant of freedom from AF for elderly patients after AF ablation. Conclusions: Our meta-analysis suggests that elderly patients may have inferior efficacy and safety outcomes to younger patients with AF ablation. Moreover, the follow-up time may be a potential determinant of outcome impact on freedom from AF for elderly patients after AF ablation.

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“…However, increased risk of bleeding during antithrombotic therapy was found with increasing age ( 29 ), resulting in challenges in management, such as anticoagulation monitoring and medication compliance, as well as the presence of comorbidities. Although elderly patients need careful treatment decisions because of biological changes and specific disease management aspects ( 29 ), they were under-represented by major cardiovascular trials and secondary cardiovascular preventive and rehabilitation programs. In the context of accelerated global aging, more researches about the evidence-based care of the elderly with AF are required.…”

Section: Discussionmentioning

confidence: 99%

Burden of atrial fibrillation and its attributable risk factors from 1990 to 2019: An analysis of the Global Burden of Disease study 2019

Xu¹,

Chen²,

Li³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundUnderstanding the pattern and trend of the atrial fibrillation (AF) burden are essential for developing effective preventive strategies. The purpose of this study was to estimate AF burdens and risk factors in 204 countries and territories between 1990 and 2019.Materials and methodsData were extracted from the Global Burden of Disease 2019, including incidence, death, disability-adjusted life-years (DALYs), and the attributable risk factors. In order to quantify changes in the age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), and age-standardized DALY rate between 1990 and 2019, the estimated annual percentage change (EAPC) was used. Also, AF burden was assessed in relation to the Socio-demographic Index (SDI).ResultsGlobally, there were 4,720,324 incident cases, 117,038 deaths and 8,393,635 DALYs in 2019. There were no significant changes in ASIR, ASDR, or age-standardized DALY rates from 1990 to 2019. Although the burden and trend of AF varied in different regions and countries, the ASIR, ASDR and age-standardized DALY rate were positively correlated with SDI. Furthermore, the burden of AF was higher in males and elderly. The age-standardized DALY rate worldwide was primarily attributable to high systolic blood pressure, followed by high body-mass index, alcohol use, smoking, diet high in sodium and lead exposure.ConclusionAF remained a major public health challenge worldwide, with substantial variation at regional and national levels. There is an urgent need to increase public awareness about AF risk factors and to bring about cost-effective interventions for AF in order to reduce its future burden.

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Management of Atrial Fibrillation in Patients 75 Years and Older

Cited by 54 publications

References 100 publications

Management of Hypertension in the Elderly and Frail Patient

Management of Hypertension in the Elderly and Frail Patient

Do Elderly Patients with Atrial Fibrillation Have Comparable Ablation Outcomes Compared to Younger Ones? Evidence from Pooled Clinical Studies

Burden of atrial fibrillation and its attributable risk factors from 1990 to 2019: An analysis of the Global Burden of Disease study 2019

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