title: Atrial fibrillation, stroke, and quality of life.
abstract: Contemporary management of atrial fibrillation imposes many challenges, particularly in the setting of our aging population. In addition to well-recognized consequences, such as stroke and mortality, emerging evidence relates atrial fibrillation to elevated risk of dementia, posing further therapeutic challenges. As the incidence of atrial fibrillation rises with age, the balance of controlling stroke risk and limiting major hemorrhage on anticoagulation has become increasingly critical in elderly patients. Appreciation of more extensive risk factors has made it possible to identify patients at very low risk of thromboembolism and higher risk of bleeding. However, practice guidelines in the United States and abroad have occasionally divergent viewpoints regarding how to best manage patients in various risk strata. Options for stroke prevention have expanded with novel antithrombotics and promising mechanical alternatives to anticoagulation, which may be at least as effective in preventing stroke without increasing bleeding risk. Catheter ablation has demonstrated impressive success at preventing atrial fibrillation recurrence in selected patients, and has the potential to further improve outcomes. In addition, the role of antiplatelet medications in patients deemed unsuitable for anticoagulation has been better clarified, although novel agents require further study to assess their impact on thromboembolism. High-bleeding risks associated with the concomitant use of multiple antithrombotics remains a major obstacle in patients with indications for both antiplatelet and anticoagulant therapy.
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute.|Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Mount Sinai School of Medicine, New York, New York.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Chinitz
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute.|Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Mount Sinai School of Medicine, New York, New York.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Castellano
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute.|Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Mount Sinai School of Medicine, New York, New York.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Kovacic
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute.|Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Mount Sinai School of Medicine, New York, New York.|Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D003704:Dementia / Q000209:etiology / Q000517:prevention & control; D005060:Europe; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D019934:International Normalized Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control*; D014481:United States
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors