Cardiology 2013

Notes: Hamon, Martial

Pristipino, Christian

Di Mario, Carlo

Nolan, James

Ludwig, Josef

Tubaro, Marco

Sabate, Manel

Mauri-Ferre, Josepa

Huber, Kurt

Niemela, Kari

Haude, Michael

Wijns, William

Dudek, Dariusz

Fajadet, Jean

Kiemeneij, Ferdinand

eng

Meta-Analysis

Practice Guideline

France

2013/01/29 06:00

EuroIntervention. 2013 Mar;8(11):1242-51. doi: 10.4244/EIJV8I11A192.

URL: http://www.ncbi.nlm.nih.gov/pubmed/23354100

Author Address: Recherche Clinique, Bureau 364, Centre Hospitalier Universitaire de Caen, Avenue Cote de Nacre, 14033 Caen, Normandie, France. hamon-m@chu-caen.fr

 

 

Reference Type:  Journal Article

Record Number: 596Author: Hanon, O., Assayag, P., Belmin, J., Collet, J. P., Emeriau, J. P., Fauchier, L., Forette, F., Friocourt, P., Gentric, A., Leclercq, C., Komajda, M., Le Heuzey, J. Y., French Society of, Geriatrics, Gerantology and French Society of, Cardiology

Year: 2013

Title: Expert consensus of the French Society of Geriatrics and Gerontology and the French Society of Cardiology on the management of atrial fibrillation in elderly people

Journal: Arch Cardiovasc Dis

Volume: 106

Issue: 5

Pages: 303-23

Date: May

Short Title: Expert consensus of the French Society of Geriatrics and Gerontology and the French Society of Cardiology on the management of atrial fibrillation in elderly people

Alternate Journal: Archives of cardiovascular diseases

ISSN: 1875-2128 (Electronic)

1875-2128 (Linking)

DOI: 10.1016/j.acvd.2013.04.001

Accession Number: 23769405

Keywords: Age Factors

Aged

Aged, 80 and over

Anti-Arrhythmia Agents/adverse effects

Anticoagulants/adverse effects/*therapeutic use

Atrial Fibrillation/diagnosis/epidemiology/*therapy

Cardiology/*standards

Comorbidity

Consensus

Drug Interactions

France

Geriatric Assessment

Geriatrics/*standards

Hemorrhage/chemically induced

Humans

Middle Aged

Polypharmacy

Predictive Value of Tests

Risk Factors

Societies, Medical/*standards

Stroke/epidemiology/*prevention & control

Treatment Outcome

Abstract: Atrial fibrillation (AF) is a common and serious condition in the elderly. AF affects between 600,000 and one million patients in France, two-thirds of whom are aged above 75 years. AF is a predictive factor for mortality in the elderly and a major risk factor for stroke. Co-morbidities are frequent and worsen the prognosis. The management of AF in the elderly should involve a comprehensive geriatric assessment (CGA), which analyses both medical and psychosocial elements, enabling evaluation of the patient’s functional status and social situation and the identification of co-morbidities. The CGA enables the detection of “frailty” using screening tools assessing cognitive function, risk of falls, nutritional status, mood disorders, autonomy and social environment. The objectives of AF treatment in the elderly are to prevent AF complications, particularly stroke, and improve quality of life. Specific precautions for treatment must be taken because of the co-morbidities and age-related changes in pharmacokinetics or pharmacodynamics. Preventing AF complications relies mainly on anticoagulant therapy. Anticoagulants are recommended in patients with AF aged 75 years or above after assessing the bleeding risk using the HEMORR2HAGES or HAS-BLED scores. Novel oral anticoagulants (NOACs) are promising treatments, especially due to a lower risk of intracerebral haemorrhage. However, their prescriptions should take into account renal function (creatinine clearance assessed with Cockcroft formula) and cognitive function (for adherence to treatment). Studies including frail patients in “real life” are necessary to evaluate tolerance of NOACs. Management of AF also involves the treatment of underlying cardiomyopathy and heart rate control rather than a rhythm-control strategy as first-line therapy for elderly patients, especially if they are paucisymptomatic. Antiarrhythmic drugs should be used carefully in elderly patients because of the frequency of metabolic abnormalities and higher risk of drug interactions and bradycardia.

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