Atrial fibrillation: a geriatric perspective on the 2020 ESC guidelines

• Published in: European geriatric medicine Vol. 13; no. 1; pp. 5 - 18
• Main Authors: Polidori, M. Cristina, Alves, Mariana, Bahat, Gulistan, Boureau, Anne Sophie, Ozkok, Serdar, Pfister, Roman, Pilotto, Alberto, Veronese, Nicola, Bo, Mario
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.02.2022
• Subjects: Aged; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Atrial Fibrillation - therapy; Cardiology; Clinical Decision-Making; Frailty - diagnosis; Frailty - epidemiology; Frailty - therapy; Geriatric Assessment; Geriatrics/Gerontology; Humans; Internal Medicine; Medicine; Medicine & Public Health; Review; Older patients; Anticoagulation; Advanced age; Atrial fibrillation; Cognitive impairment
• ISSN: 1878-7657; 1878-7649; 1878-7657
• DOI: 10.1007/s41999-021-00537-w

Key Summary Points Aim To provide a geriatric perspective on the 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio–Thoracic Surgery (EACTS). Findings While the large majority of AF patients in real life are older, frail and cognitively impaired, these are mostly excluded from clinical trials, and physicians’ attitudes often prevail over standardized algorithms. On the basis of existing evidence, we suggest that (1) opportunistic AF screening by pulse palpation or ECG rhythm strip is cost-effective, and (2) whereas advanced chronological age by itself is not a contraindication to AF treatment, a Comprehesive Geriatric Assessment (CGA) including frailty, cognitive impairment, falls and bleeding risk may assist in clinical decision making to provide the best individualized treatment. Message The integration of CGA might positively influence clinical decision making in older patients with atrial fibrillation. Background The Task Force for the diagnosis and management of atrial fibrillation (AF) of the European Society of Cardiology (ESC) published in 2020 the updated Guidelines for the Diagnosis and Management of Atrial Fibrillation with the contribution of the European Heart Rhythm Association (EHRA) of the ESC and the European Association for Cardiothoracic Surgery (EACTS) . Methods and results In this narrative viewpoint, we approach AF from the perspective of aging medicine and try to provide the readers with information usually neglected in clinical routine, mainly due to the fact that while the large majority of AF patients in real life are older, frail and cognitively impaired, these are mostly excluded from clinical trials, and physicians’ attitudes often prevail over standardized algorithms. Conclusions On the basis of existing evidence, (1) opportunistic AF screening by pulse palpation or ECG rhythm strip is cost-effective, and (2) whereas advanced chronological age by itself is not a contraindication to AF treatment, a Comprehensive Geriatric Assessment (CGA) including frailty, cognitive impairment, falls and bleeding risk may assist in clinical decision making to provide the best individualized treatment.