Atrial fibrillation in the elderly: Therapy and prognosis characteristics

• Published in: Archives of Cardiovascular Diseases Supplements Vol. 13; no. 1; p. 97
• Main Authors: Antit, S., Hamraoui, N., Boussabeh, I., Zakhama, L., Benyoussef, S.
• Format: Journal Article
• Language: English
• Published: Elsevier Masson SAS 01.01.2021
• ISSN: 1878-6480
• DOI: 10.1016/j.acvdsp.2020.10.221

Atrial fibrillation (AF) is the most common arrhythmia in the elderly. Rate management and prevention of thromboembolic accidents are the main goal but it was challenging due to age-related physiological changes and comorbidities. This was a retrospective study, including 51 patients hospitalised for AF at the cardiology department of the Internal Security Forces Hospital–La Marsa between 2010 and 2018. The mean age of our patients was 72.4±6.97 years [64–92] with a clear female predominance. High blood pressure was the most common cardiovascular risk factor (68.5%). Dyspnea was the main symptom leading patients to consult (43.1%). Mean P-wave dispersion on electrocardiogram was 49.03±24.13ms. The cardiac echography performed showed a left atrial enlargement: mean volume was 50.26±18.86mL/m2 [22,53–103] and left ventricular ejection fraction was<50% in 19% of cases. Paroxysmal AF was predominant (60.8%). The most common etiology was arterial hypertension (39.2%). Mean score of CHA2DS2-VASc was 2.92±1.41 and HASBLED was 1.76±0.99. A rhythm control strategy was adopted in most of cases (70.6%). Amiodarone was more frequently administrated (63.9%) than electrical shock (22.2%). Anticoagulation therapy involved vitamin K antagonists (66.82%) and aspirin (30.61%). Among the patients, 13.7% have already had an ischemic stroke before AF diagnostic, but only 3.9% had thromboembolic event after treatment. Bradycardia and atrioventricular block were the main side effects related to anti-arrhythmic drugs (19.6%). Hyperthyroidism caused by amiodarone was observed in 14.8% of patients. Mortality rate was 27.47% and cardiac pathologies were the cause of 28.6% of death cases. AF in the elderly is a major health problem. The morbi-mortality is not only resulting from thromboembolic events, but also the use of pharmacological therapy for either rate, rhythm control or anticoagulation which lead to high risk of side effects and drug toxicities.