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Atrial fibrillation management in older heart failure patients: a complex clinical problem

Published Online: August 20th 2018 Heart International. 2016;11(1):e41-e49
Authors: Giovanni Pulignano, Donatella Del Sindaco, Maria Denitza Tinti, Stefano Tolone, Giovanni Minardi, Antonio Lax, Massimo Uguccioni
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Abstract:
Overview

Background. Atrial fibrillation (AF) and heart failure (HF), two problems of growing prevalence as a consequence of the ageing population, are associated with high morbidity, mortality, and healthcare costs. AF and HF also share common risk factors and pathophysiologic processes such as hypertension, diabetes mellitus, ischemic heart disease, and valvular heart disease often occur together. Although elderly patients with both HF and AF are affected by worse symptoms and poorer prognosis, there is a paucity of data on appropriate management of these patients. Methods. PubMed was searched for studies on AF and older patients using the terms atrial fibrillation, elderly, heart failure, cognitive impairment, frailty, stroke, and anticoagulants. Results. The clinical picture of HF patients with AF is complex and heterogeneous with a higher prevalence of frailty, cognitive impairment, and disability. Because of the association of mental and physical impairment to non- administration of oral anticoagulants (OACs), screening for these simple variables in clinical practice may allow better strategies for intervention in this high-risk population. Since novel direct OACs (NOACs) have a more favor - able risk-benefit profile, they may be preferable to vitamin K antagonists (VKAs) in many frail elderly patients, especially those at higher risk of falls. Moreover, NOACs are simple to administer and monitor and may be associ - ated with better adherence and safety in patients with cognitive deficits and mobility impairments. Conclusions. Large multicenter longitudinal studies are needed to examine the effects of VKAs and NOACs on long-term cognitive function and frailty; future studies should include geriatric conditions.

Keywords

Atrial fibrillation, Cognitive impairments, Elderly, Frailty, Heart failure, Oral anticoagulants

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Disclosure

Financial support: This article was made possible by an unrestricted
grant from Pfizer S.r.l.

Correspondence

Giovanni Pulignano Via G. Livraghi 1 00152, Rome, Italy gipulig@yahoo.it

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