[Management and therapy of atrial fibrillation in geriatric patients].

Abteilung für Innere Medizin und Akutgeriatrie, Landeskrankenhaus Hochzirl, Zirl, Österreich.
Zeitschrift für Gerontologie + Geriatrie (Impact Factor: 0.81). 01/2012; 45(1):55-66; quiz 67-8.
Source: PubMed


Among geriatric patients, atrial fibrillation is the most common cardiac arrhythmia. In patients over 80 years of age, the prevalence rises to approximately 10%. Atrial fibrillation is associated with serious health implications, including a 2-fold increase in mortality risk and a 5-fold increase in stroke risk. In contrast to these facts, the current guidelines on the management of atrial fibrillation of the European Society of Cardiology (ESC) contain only a short paragraph on these patients. Many relevant clinical aspects go without any comment. Thus, the purpose of our paper is to discuss those special needs of geriatric patients and their physicians which are not mentioned in the guidelines of the ESC. In our review, we discuss rhythm versus rate control, oral anticoagulation, outcome, prevention, falls, adherence, polypharmacy, dementia, nursing home patients, frailty, and geriatric assessment in consideration of geriatric patients. An extended search of the literature on Pubmed served as the basis for this review. Individual aspects of each geriatric patient should be considered when managing these complex patients; however, the complexity of each case must not lead to an individualized therapy that is not in accordance with current guidelines and the literature. A large number of papers which help us to answer most of the clinical questions regarding the management of trial fibrillation in geriatric patients have already been published.

18 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Digitalis und Theophyllin gehören zu den ältesten Medikamenten in der Behandlung von Herz-Lungen-Erkrankungen. Trotz der langen Tradition ist die Evidenz widersprüchlich, teils eher negativ. Besonders groß ist das Spannungsfeld in der Geriatrie. Einerseits haben beide Substanzen noch einen Stellenwert, insbesondere in fortgeschrittenen Stadien der Erkrankungen bzw. als symptomatische Therapie, andererseits werden sie auf Listen als potenziell ungeeignete Medikamente für den älteren Patienten geführt. Der vorliegende Beitrag beleuchtet die aktuelle Datenlage zu beiden Substanzen auf Basis der aktuellen Literatur.
    No preview · Article · Jul 2013 · Zeitschrift für Gerontologie + Geriatrie
  • [Show abstract] [Hide abstract]
    ABSTRACT: Digitalis and theophylline are some of the oldest drugs used to treat cardiopulmonary diseases. Despite a long history, the evidence for both drugs is still inconsistent, in parts negative. In this context, geriatric medicine represents a special area of conflict. On the one hand, both drugs may play a role in the treatment of advanced heart failure and chronic obstructive pulmonary disease, particularly in the treatment of symptoms. On the other hand, both drugs are often listed as potentially inappropriate medications for the elderly. This paper discusses the evidence for both drugs based on the current literature.
    No preview · Article · Jun 2013 · Zeitschrift für Gerontologie + Geriatrie
  • [Show abstract] [Hide abstract]
    ABSTRACT: Pharmacotherapy for end-of-life patients with multimorbidity is a major challenge. Estimating prognosis can be much more difficult when compared to patients suffering from cancer alone. Nevertheless, it is crucial in order to prescribe in the context of the following determining factors: disease, co-morbidities, functional status, life expectancy and therapy goals. Since such patients are prone to adverse drug reactions, inappropriate prescriptions should be avoided, since evidence concerning the benefits or risks for various drugs used is as yet inadequate. Several tools can be of help to improve pharmacotherapy for this vulnerable group of patients.
    No preview · Article · Apr 2014 · Wiener Medizinische Wochenschrift