Special problems with antiarrhythmic drugs in the elderly: safety, tolerability, and efficacy.
With advancing age, atrial fibrillation is increasingly likely to indicate underlying cardiovascular disease and risk. An understanding of this is particularly important in the elderly patient, where likely triggers to atrial fibrillation and the influence of other pathologies on the safety and efficacy of proposed treatments will all contribute to optimal care of these patients. It is not yet clear whether rate control or cardioversion to sinus rhythm is the best strategy for the generality of patients with atrial fibrillation, and still less so for individuals. Age and comorbidity add complexities to this decision, which should inform the choice of drugs to be used. Further uncertainties arise from a literature that has often excluded elderly patients and derived its conclusions about mode of drug action from studies undertaken during sinus rhythm rather than atrial fibrillation. Despite these difficulties the careful evaluation of elderly patients with atrial fibrillation and their involvement in relevant choices should ensure optimum treatment for the individual.
Dayer
Mark
M
Cardiovascular Medicine Registry, the Whittington Hospital, London N19 5NF, United Kingdom.
Hardman
Suzanna M C
SM
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D002121:Calcium Channel Blockers / Q000008:administration & dosage*; D018849:Controlled Clinical Trials as Topic; D004077:Digoxin / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D002121:Calcium Channel Blockers; D004077:Digoxin