Minerva Medica 2021 Apr 09

DOI: 10.23736/S0026-4806.21.07525-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Evidence and uncertainties in the management of atrial fibrillation in older persons

Paolo ALBONI ¹, Mario BO ¹, Stefano FUMAGALLI ¹, Francesco VETTA ¹, Gianluca ISAIA ², Enrico BRUNETTI ² ✉, Samuele BALDASSERONI ¹, Alessandro BOCCANELLI ¹, Giovambattista DESIDERI ¹, Niccolò MARCHIONNI ¹, Renzo ROZZINI ¹, Pierfranco TERROSU ¹, Andrea UNGAR ¹, Giovanni ZITO ¹

¹ SICGe Società Italiana di Cardiologia Geriatrica, Florence, Italy; ² Section of Geriatrics, Department of Medical Sciences, Città della Salute e della Scienza Molinette Hospital, University of Turin, Turin, Italy

INTRODUCTION: Atrial fibrillation (AF) is the most common cardiac sustained arrhythmia, whose incidence and prevalence increase with age, representing a significant burden for health services in western countries. Older people contribute to the vast majority of patients affected from AF.
EVIDENCE ACQUISITION: Although oral anticoagulant therapy represents the cornerstone for the prevention of ischemic stroke and its disabling consequences, several other interventions - including left atrial appendage occlusion (LAAO), catheter ablation (CA) of AF, and rhythm control strategy (RCS) - have proved to be potentially effective in reducing the incidence of AF-associated clinical complications. Scientific literature focused on the three items will be discussed.
EVIDENCE SYNTHESIS: Practical treatment of older AF patients is presented, including approach and management of patients with geriatric syndromes, selection of the most appropriate individualized drug treatment, clinical indications and potential clinical benefit of LAAO and CA in selected older AF patients.
CONCLUSIONS: Older people carry the greatest burden of AF in real world practice. Within a shared decision making process, the patient centered approach need to be put in the context of a comprehensive assessment, in order to gain maximal net clinical benefit and avoid futility or harm.

KEY WORDS: Atrial fibrillation; Older patients; Oral anticoagulants; Left atrial appendage occlusion; AF catheter ablation