Cardiology 2013 (Full reference info)

Reference Type: Journal Article
Record Number: 584Author: 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, gerontology and the 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: Geriatr Psychol Neuropsychiatr Vieil
Volume: 11
Issue: 2
Pages: 117-43
Date: Jun
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: Geriatrie et psychologie neuropsychiatrie du vieillissement
ISSN: 2115-8789 (Print)
2115-7863 (Linking)
DOI: 10.1684/pnv.2013.0407
Original Publication: Consensus d’experts de la Societe francaise de geriatrie et gerontologie et de la Societe francaise de cardiologie, sur la prise en charge de la fibrillation atriale du sujet age
Accession Number: 23803629
Keywords: Administration, Oral
Aged
Aged, 80 and over
Anticoagulants/adverse effects/*therapeutic use
Atrial Fibrillation/complications/*diagnosis/*drug therapy/mortality
*Cardiology
Cause of Death
Comorbidity
France
Geriatric Assessment
*Geriatrics
Humans
Intracranial Hemorrhages/chemically induced/prevention & control
Quality of Life
Risk Factors
*Societies, Medical
Stroke/etiology/mortality/prevention & control
Abstract: The prevalence of atrial fibrillation (AF) increase with ageing. In France AF affects between 400,000 to 660,000 people aged 75 years or more. In the elderly, AF is a major risk factor of stroke and a predictive factor for mortality. Comorbidities are frequent and worsen the prognosis of AF. They can be the cause or the consequence of AF and their management is a major therapeutic objective. Comprehensive geriatric assessment (CGA), is required to analyse both medical and psychosocial elements, and to identify co-morbidities and geriatrics syndrome as cognitive disorders, risk of falls, malnutrition, mood disorders, and lack of dependency and social isolation. The objectives of AF treatment in the elderly are to prevent AF complications, particularly stroke, and to 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 after assessing the bleeding risk using 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 very old patients with several comorbidities in ‘real life’ are necessary to evaluate tolerance of NOACs in this population. The management of AF also involves the treatment of underlying cardiomyopathy and heart rate control rather than rhythm control strategy as first-line therapy in the elderly.
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
fre
Consensus Development Conference
English Abstract
Practice Guideline
France
2013/06/28 06:00
Geriatr Psychol Neuropsychiatr Vieil. 2013 Jun;11(2):117-43. doi: 10.1684/pnv.2013.0407.
URL: http://www.ncbi.nlm.nih.gov/pubmed/23803629
Author Address: Societe francaise de geriatrie et gerontologie, France. olivier.hanon@brc.aphp.fr

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