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