title: Treatment of Nonagenarians With Atrial Fibrillation: Insights From the Berlin Atrial Fibrillation (BAF) Registry.
abstract: OBJECTIVE
  The objective of this study was to determine course and treatment of atrial fibrillation (AF) in nonagenarians. Incidence of AF increases with age. Due to the demographic change in the industrialized world, an increase of AF in the group of elderly and very elderly is expected in the next decades. However, only few data exist on the clinical relevance of AF in patients aged 89 years or older.
  
  
  METHODS
  Observational, mono-centric registry.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Of the 11,888 patients included in the Berlin Atrial Fibrillation (BAF) Registry, 279 patients aged 89 years or older were identified. All patients presented to our hospital with AF between January 2001 and December 2014.
  
  
  METHODS
  AF type, symptoms, comorbidities, CHA2DS2-VASc and HAS-BLED, treatment strategy, and anticoagulant treatment were assessed at baseline. A composite of stroke/transient ischemic attack (TIA), thromboembolic events, major bleeding, and death was the primary endpoint. Stroke/TIA, thromboembolic events and major bleeding, presence of AF, new onset of heart failure and change of NYHA class, and bradyarrhythmia necessitating pacemaker implantation were secondary endpoints.
  
  
  RESULTS
  Patients (age 92 ± 2.7 years, range 89-108) presented in EHRA class I in 38.4% of the cases, class II in 49.5%, class III in 10%, and class IV in 2%. Rhythm control was attempted in 37 (13.3%) of the patients. Baseline CHA2DS2-VASc and HAS-BLED were 5.0 ± 1.3 and 3.1 ± 0.9, respectively. Oral anticoagulation (OAC) was initiated in 74 (26.5 %) of the patients. Of all patients, 33 (11.8%) patients died in hospital. Of the remaining patients, 104 were followed over 13.8 ± 17.5 months with 3.5 ± 2.3 visits during follow-up. Rhythm control was attempted in 10 patients (9.6%). OAC was initiated in 37 patients (35.6 %). Fifty-nine (56.7%) patients reached the primary composite endpoint. Stroke/TIA (34.6%) and heart failure (49%) were common. Subgroup analysis revealed no significant differences in any of the endpoints between patients undergoing rhythm versus rate control and between patients under OAC compared with patients without OAC. INR at follow-up and TTR were 1.76 ± 1.0 and 29.5% ± 37.8% in patients receiving VKA.
  
  
  CONCLUSIONS
  In this real-world cohort of very elderly patients with AF, a rhythm control strategy and OAC treatment were chosen only in a minority of the cases. If OAC was initiated, most received VKAs with a poor TTR during follow-up. A high incidence of stroke/TIA was observed in patients with and without OAC. Further data are needed to define optimal treatment of AF in this particular patient group.
authors.affiliation: Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin. Electronic address: awutzler@yahoo.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Wutzler
authors.affiliation: Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin.
authors.forename: Sophie
authors.initials: S
authors.lastname: von Ulmenstein
authors.affiliation: Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin.
authors.forename: Philipp
authors.initials: P
authors.lastname: Attanasio
authors.affiliation: Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin.
authors.forename: Martin
authors.initials: M
authors.lastname: Huemer
authors.affiliation: Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin.
authors.forename: Abdul Shokor
authors.initials: AS
authors.lastname: Parwani
authors.affiliation: Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin.
authors.forename: Leif-Hendrik
authors.initials: LH
authors.lastname: Boldt
authors.affiliation: Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin.
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Haverkamp
mesh_terms: D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000503:physiopathology; D001604:Berlin; D015897:Comorbidity; D005260:Female; D006339:Heart Rate; D006785:Hospitals, University; D006801:Humans; D008297:Male; D012042:Registries
chemical_list: D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants
keywords: Atrial fibrillation; anticoagulation; elderly; nonagenarians