Gériatrie et Psychologie Neuropsychiatrie du Vieillissement


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 Volume 11, issue 2, Juin 2013


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Société française de gériatrie et gérontologie, France, Service de gérontologie, AP-HP, Hôpital Broca, Paris, France, Université Paris Descartes, Sorbonne Paris Cité, EA 4468, Paris, France, Société française de cardiologie, France, Service de cardiologie, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France, Université Paris Sud, Le Kremlin-Bicêtre, France, Service de gérontologie, AP-HP, Hôpital Charles Foix, Ivry, France, Département de cardiologie, AP-HP, Hôpital Pitié Salpêtrière, Paris, France, Université Pierre et Marie Curie, Inserm U 937, Paris, France, Centre hospitalier universitaire, Unités de médecine gériatrique, Bordeaux, France, Service de cardiologie, Hôpital Trousseau, Tours, France, Université François Rabelais, Tours, France, Service de médecine interne gériatrique, Centre hospitalier de Blois, France, Service de médecine gériatrique, Centre hospitalier universitaire, Hôpital de la Cavale Blanche, Brest, France, Université de Bretagne occidentale, EA 4636, Brest, France, Service de cardiologie et maladies vasculaires, Centre hospitalier universitaire, Rennes, France, Université de Rennes 1, CIC-IT 804, Inserm U 1099, Rennes, France, Université Pierre et Marie Curie Paris 6, Paris, France, Service de cardiologie et rythmologie, AP-HP, Hôpital européen Georges Pompidou, Paris, France, Université René Descartes, Paris, France

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 Hemorr 2hages 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,