Increased prevalence of atrial fibrillation in the elderly population with data ≥ The prevalence of atrial fibrillation in the 80-year-old population is close to 10%, and the incidence of complications is higher in elderly patients with atrial fibrillation. Elderly patients with atrial fibrillation are at high risk for stroke, bleeding, and death, and require optimal treatment. This article mainly introduces the management strategies of the elderly, especially the elderly patients with atrial fibrillation ≥ 75 years old.
Primary and Secondary Prevention of Atrial Fibrillation p>
Associated with the onset of atrial fibrillationCardiovascular disease< /tag>and risk factors including being overweight andobesity, alcohol consumption, < /span>obstructive sleep apnea,Hypertension,diabetes, physical inactivity, coronary artery disease, heart failure andchronic kidney disease. 1. Overweight and Obesity2019 AHA/ACC/HRS Guidelines for Atrial Fibrillation First Suggest Intervention of Risk Factors to Control Atrial Fibrillation Atrial fibrillation, emphasizingBMI(BMI)>27 kg/m² Patients can benefit from weight loss. Intensive risk factor management and weight loss can reduce the burden and severity of atrial fibrillation symptoms and be beneficial in improving cardiac remodeling. 2. DrinkingDrinking is associated with new and recurrent atrial fibrillation, and the recurrence rate of atrial fibrillation is reduced after abstinence. 3. Obstructive sleep apneaRegistration data showed that patients not receiving positive pressure ventilation were significantly more The risk of progression to permanent atrial fibrillation was increased compared with patients treated with compressed ventilation. 4. HypertensionResearch shows that intensive blood pressure reduction can reduce the risk of atrial fibrillation by 26%, and in The prespecified age subgroups (<75 years, ≥75 years) were consistent. 5. DiabetesRegistration studies show that patients with diabetes have a 28% higher risk of developing atrial fibrillation than controls. Several diabetes medications have been reported to reduce the incidence of atrial fibrillation; however, the mean age of included participants was between 50-65 years. 6. Physical ActivityPhysical activity reduces AF morbidity and risk of death. Cardiovascular health studies have shown that the longer and faster the average walking distance, the lower the risk of developing atrial fibrillation in older adults. 7. Coronary artery diseaseCoronary artery disease and atrial fibrillation often coexist. Ischemia can lead to atrial enlargement and remodeling, leading to an increased risk of atrial fibrillation. Atrial fibrillation is associated with an increased risk ofmyocardial infarction, and myocardial infarction is associated with an increased risk of atrial fibrillation related. For the elderly without contraindications, the guidelines recommend anticoagulation in patients with vascular disease and atrial fibrillation. 8. Heart failureAF isHeart failureCommon causes of exacerbations. For heart failure with reduced ejection fraction (HFrEF), adherence to guideline-based pharmacotherapy is associated with a reduced risk of atrial fibrillation. 9. Chronic kidney diseaseFor the elderly, it is recommended to adjust preventive strategies for common risk factors to prevent atrial fibrillation and its complications.
Stroke Prevention
Oral anticoagulants are the cornerstone of atrial fibrillation treatment. In clinical practice, the CHA₂DS₂-VASc score should be used to determine whether patients need oral anticoagulant therapy. Patients ≥75 years of age are at higher risk for stroke and should receive oral anticoagulation regardless of other risk factors. In patients at higher risk of bleeding, modifiable risk factors for bleeding should be identified and modified. Anticoagulation therapy for elderly patients with atrial fibrillation should be individualized, and the drug of choice is not vitamin KAntagonist oral anticoagulants (NOACs), NOACs also have advantages in the anticoagulation therapy of elderly patients with atrial fibrillation. A low dose of 110 mg BID should be used in patients ≥ 80 years of age, and a dose of 110 mg BID can be considered for patients ≥ 75 years old. Factor Xa inhibitors do not require dose adjustment simply because of age. If patients aged ≥80 years have low body weight or serum creatinine ≥133 μmol/L, useapixaban should be selected at low doses. It is still controversial whether a lower INR target value can be used in the use of warfarin in elderly patients. Elderly non-valvular atrial fibrillation Chinese expert recommendations for diagnosis and treatment (2016) recommended ≥ The anticoagulation intensity of warfarin in the 75-year-old population was maintained at INR 1.6-2.5. Left atrial appendage occlusion (LAAO) is an alternative for patients who cannot tolerate oral anticoagulation or have long-term contraindications to anticoagulation. In addition, the application of LAAO in elderly patients with atrial fibrillation requires strict control of indications. Older adults are at higher risk for bleeding and ischemic events, combinedacute coronary syndrome Direct oral anticoagulant is a better choice for patients with dual antithrombotics, and clopidogrel is safer for the antiplatelet drug. Triple antithrombotic therapy is suitable for patients with very high ischemic risk, such as ST-segment elevation myocardial infarction within 1 month, stent placement in left main or complex lesions.
Rhythm control and ventricular rate control
Rhythm control and ventricular rate control are the The two main treatments for symptoms in patients with tremors. Results of a meta-analysis showed no significant difference in all-cause mortality between ventricular rate control and rhythm control, with rhythm control associated with a lower risk of stroke. my country’s latest atrial fibrillation guidelines emphasize that for symptomatic atrial fibrillation, especially those with heart failure, early rhythm control can improve symptoms, quality of life and prognosis; early rhythm control can also improve in patients with asymptomatic atrial fibrillation Prognosis. Catheter ablation is effective in older patients with atrial fibrillation, especially if symptoms persist despite medical therapy. The indications for catheter ablation of atrial fibrillation in elderly patients (≥75 years old) are the same as those in general patients. For patients with atrial fibrillation who need urgent ventricular rate control, the primary goal is to stabilize hemodynamics and improve symptoms. At the same time, the etiology of the increased ventricular rate should be further evaluated, and the selection should be based on the patient’s LVEF and hemodynamic status. suitable medication. Long-term ventricular rate control strategies include oral drug therapy and atrioventricular node ablation combined with permanent pacemaker implantation. Literature Index:1. Annabelle Santos Volgman, Gatha Nair, Radmila Lyubarova, et al. Management of Atrial Fibrillation in Patients 75 Years and Older: JACC State-of-the- Art Review. J Am Coll Cardiol. 2022 Jan, 79 (2): 166–179.2. Chinese Medical Association Cardiac Electrophysiology and Pacing Branch, Chinese Medical Doctor Association Cardiology Professional Committee, China Room Fibrillation Center Alliance Expert Working Committee on Prevention and Treatment of Atrial Fibrillation. Atrial Fibrillation: Current Understanding and Recommendations for Treatment (2021). Zhonghuaarrhythmia< /span>Journal of Science, 2022, 26(1): 15-88.3. Chinese expert advice on the diagnosis and treatment of non-valvular atrial fibrillation in the elderly (2016). Chinese Seniors J Med. 2016, 35(9): 915-928.4. Sandeep K. Goyal. Fast Five Quiz: Anticoagulation in Older Patients With Atrial Fibrillation. Medscape. Mar 09, 2022.