title: 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.
abstract: Atrial fibrillation (AF) is a common and serious condition in the elderly. AF affects between 600,000 and one million patients in France, two-thirds of whom are aged above 75 years. AF is a predictive factor for mortality in the elderly and a major risk factor for stroke. Co-morbidities are frequent and worsen the prognosis. The management of AF in the elderly should involve a comprehensive geriatric assessment (CGA), which analyses both medical and psychosocial elements, enabling evaluation of the patient's functional status and social situation and the identification of co-morbidities. The CGA enables the detection of "frailty" using screening tools assessing cognitive function, risk of falls, nutritional status, mood disorders, autonomy and social environment. The objectives of AF treatment in the elderly are to prevent AF complications, particularly stroke, and 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 or above after assessing the bleeding risk using the HEMORR2HAGES 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 frail patients in "real life" are necessary to evaluate tolerance of NOACs. Management of AF also involves the treatment of underlying cardiomyopathy and heart rate control rather than a rhythm-control strategy as first-line therapy for elderly patients, especially if they are paucisymptomatic. Antiarrhythmic drugs should be used carefully in elderly patients because of the frequency of metabolic abnormalities and higher risk of drug interactions and bradycardia.
authors.affiliation: Société française de gériatrie et gérontologie, Suresnes, France; AP-HP, hôpital Broca, service de gérontologie, Paris, France. Olivier.hanon@brc.aphp.fr
authors.forename: Olivier
authors.initials: O
authors.lastname: Hanon
authors.forename: Patrick
authors.initials: P
authors.lastname: Assayag
authors.forename: Joel
authors.initials: J
authors.lastname: Belmin
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Collet
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Emeriau
authors.forename: Laurent
authors.initials: L
authors.lastname: Fauchier
authors.forename: Françoise
authors.initials: F
authors.lastname: Forette
authors.forename: Patrick
authors.initials: P
authors.lastname: Friocourt
authors.forename: Armelle
authors.initials: A
authors.lastname: Gentric
authors.forename: Christophe
authors.initials: C
authors.lastname: Leclercq
authors.forename: Michel
authors.initials: M
authors.lastname: Komajda
authors.forename: Jean Yves
authors.initials: JY
authors.lastname: Le Heuzey
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D002309:Cardiology / Q000592:standards*; D015897:Comorbidity; D032921:Consensus; D004347:Drug Interactions; D005602:France; D015577:Geriatric Assessment; D005853:Geriatrics / Q000592:standards*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008875:Middle Aged; D019338:Polypharmacy; D011237:Predictive Value of Tests; D012307:Risk Factors; D012955:Societies, Medical / Q000592:standards*; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants