Cardiology 2013 (Full reference info)

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.
Notes: Hanon, Olivier
Assayag, Patrick
Belmin, Joel
Collet, Jean Philippe
Emeriau, Jean Paul
Fauchier, Laurent
Forette, Francoise
Friocourt, Patrick
Gentric, Armelle
Leclercq, Christophe
Komajda, Michel
Le Heuzey, Jean Yves
eng
Practice Guideline
Netherlands
2013/06/19 06:00
Arch Cardiovasc Dis. 2013 May;106(5):303-23. doi: 10.1016/j.acvd.2013.04.001. Epub 2013 May 29.
URL: http://www.ncbi.nlm.nih.gov/pubmed/23769405
Author Address: Societe francaise de geriatrie et gerontologie, Suresnes, France; AP-HP, hopital Broca, service de gerontologie, Paris, France. Olivier.hanon@brc.aphp.fr

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