Elderly Patients and Atrial Fibrillation

With advancing age, the number of diagnoses increases, and patients become polymorbid and frail.

Polymorbidity is defined as the presence of ≥ 3 chronic diagnoses (or conditions following a severe disease), for example:

Arterial hypertension, diabetes mellitus, oncological disease, heart failure, peripheral arterial disease,
chronic kidney disease, rheumatoid arthritis, chronic obstructive pulmonary disease,
myocardial infarction, stroke

Frailty is a reduced physical, psychological, and functional reserve of the organism.

In clinical practice, this means that the patient tolerates any illness or stressful situation less well.
In cardiovascular diseases, it is assessed using the Clinical Frailty Scale.

Prevalence of polymorbidity and frailty in the population:

10% at age > 65 years
20% at age > 80 years

Illustration depicting elderly patients as a high-risk group for atrial fibrillation with documented ECG recording of the arrhythmia.

The prevalence of atrial fibrillation (AF) in polymorbid and frail patients is 50–75%.

Pharmacological therapy in elderly patients > 75 years is challenging because, due to cognitive dysfunction, patients may not take medications at the correct doses, resulting in the risk of overdosing or underdosing. In anticoagulation therapy for AF, this may lead to bleeding or thromboembolic events, most commonly stroke.

In patients with cognitive dysfunction, home therapy should be managed under the supervision of relatives or a caregiver.

Elderly patients and atrial fibrillation	Class
In elderly patients (>65 years) with cognitive dysfunction, pharmacological therapy should be administered under the supervision of relatives or a caregiver.	I