Skip to main content
Erschienen in: Zeitschrift für Gerontologie und Geriatrie 2/2023

28.01.2022 | Original Contributions

Prevalence and treatment of atrial fibrillation in older adults

verfasst von: Jacek Liczko, MD, Samuel Schülein, Thomas Tümena, Karl-Günter Gassmann, MD

Erschienen in: Zeitschrift für Gerontologie und Geriatrie | Ausgabe 2/2023

Einloggen, um Zugang zu erhalten

Abstract

Background

Atrial fibrillation (AF) is the most frequent cardiac arrhythmia with an impact on morbidity and mortality found in the geriatric population.

Objective

This retrospective study is the first to investigate the prevalence, treatment and comorbidities of AF in a large cohort of older adults.

Material and methods

Older adults with AF hospitalized between 2010 and 2018. The mean age of the 10,700 AF patients in 2018 was 83.2 ± 6.4 years. The frequency of anticoagulation in older adults with AF between 2010 and 2018 was analyzed. The relationship between comorbidities and anticoagulation in 2018 was examined. Logistic regression analysis was used to identify possible predictive factors for anticoagulation.

Results

The prevalence of AF in 35,887 hospitalized older adults was 29.8% in 2018. The mean CHA2DS2VASc score was 4.4 ± 1.3 (male 3.8 ± 1.3, female 4.7 ± 1.2). From 2010 to 2018, the frequency of anticoagulation for patients with AF rose from 32.1% to 64.2%. Statistically significant differences in the examined characteristics between anticoagulated and not anticoagulated patients were found. Furthermore, there were no predictive factors for anticoagulation in multivariate logistic analysis.

Conclusion

Hospitalized older adults have an increased prevalence of AF compared to the general population. Despite the higher risk of bleeding, older adults were more frequently anticoagulated in the observation period, preferably with direct oral anticoagulants (DOACs). Patients without anticoagulation had more diagnoses and were worse in functional tests. This study suggests that the decision to give anticoagulants to older adults should be personalized.
Literatur
1.
Zurück zum Zitat Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ et al (2014) Worldwide epidemiology of atrial fibrillation: a global burden of disease 2010 study. Circulation 129(8):837–847CrossRefPubMed Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ et al (2014) Worldwide epidemiology of atrial fibrillation: a global burden of disease 2010 study. Circulation 129(8):837–847CrossRefPubMed
2.
Zurück zum Zitat Lloyd-Jones DM, Wang TJ, Leip EP, Larson MG, Levy D, Vasan RS et al (2004) Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation 110(9):1042–1046CrossRefPubMed Lloyd-Jones DM, Wang TJ, Leip EP, Larson MG, Levy D, Vasan RS et al (2004) Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation 110(9):1042–1046CrossRefPubMed
3.
Zurück zum Zitat Stefansdottir H, Aspelund T, Gudnason V, Arnar DO (2011) Trends in the incidence and prevalence of atrial fibrillation in Iceland and future projections. Europace 13(8):1110–1117CrossRefPubMed Stefansdottir H, Aspelund T, Gudnason V, Arnar DO (2011) Trends in the incidence and prevalence of atrial fibrillation in Iceland and future projections. Europace 13(8):1110–1117CrossRefPubMed
4.
Zurück zum Zitat Benjamin EJ, Wolf PA, D’Agostino RB, Silbershatz H, Kannel WB, Levy D (1998) Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 98(10):946–952CrossRefPubMed Benjamin EJ, Wolf PA, D’Agostino RB, Silbershatz H, Kannel WB, Levy D (1998) Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 98(10):946–952CrossRefPubMed
5.
Zurück zum Zitat Stewart S, Hart CL, Hole DJ, McMurray JJ (2002) A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. Am J Med 113(5):359–364CrossRefPubMed Stewart S, Hart CL, Hole DJ, McMurray JJ (2002) A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. Am J Med 113(5):359–364CrossRefPubMed
6.
Zurück zum Zitat Andersson T, Magnuson A, Bryngelsson IL, Frøbert O, Henriksson KM, Edvardsson N et al (2013) All-cause mortality in 272,186 patients hospitalized with incident atrial fibrillation 1995–2008: a Swedish nationwide long-term case-control study. Eur Heart J 34(14):1061–1067CrossRefPubMedPubMedCentral Andersson T, Magnuson A, Bryngelsson IL, Frøbert O, Henriksson KM, Edvardsson N et al (2013) All-cause mortality in 272,186 patients hospitalized with incident atrial fibrillation 1995–2008: a Swedish nationwide long-term case-control study. Eur Heart J 34(14):1061–1067CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Kishore A, Vail A, Majid A, Dawson J, Lees KR, Tyrrell PJ et al (2014) Detection of atrial fibrillation after ischemic stroke or transient ischemic attack: a systematic review and meta-analysis. Stroke 45(2):520–526CrossRefPubMed Kishore A, Vail A, Majid A, Dawson J, Lees KR, Tyrrell PJ et al (2014) Detection of atrial fibrillation after ischemic stroke or transient ischemic attack: a systematic review and meta-analysis. Stroke 45(2):520–526CrossRefPubMed
8.
Zurück zum Zitat Hart RG, Pearce LA, Aguilar MI (2007) Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 146(12):857–867CrossRefPubMed Hart RG, Pearce LA, Aguilar MI (2007) Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 146(12):857–867CrossRefPubMed
9.
Zurück zum Zitat Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD et al (2014) Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 383(9921):955–962CrossRefPubMed Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD et al (2014) Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 383(9921):955–962CrossRefPubMed
10.
Zurück zum Zitat Friberg L, Rosenqvist M, Lip GY (2012) Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish atrial fibrillation cohort study. Eur Heart J 33(12):1500–1510CrossRefPubMed Friberg L, Rosenqvist M, Lip GY (2012) Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish atrial fibrillation cohort study. Eur Heart J 33(12):1500–1510CrossRefPubMed
11.
Zurück zum Zitat Trögner J, Tümena T, Schramm A, Heinrich R, Sieber C, BDAT-Gruppe G (2006) Geriatrics in Bavaria-database (GiB-DAT): basic data analysis of geriatric rehabilitation in Bavaria and analysis of inter-clinic variability (part II). Z Gerontol Geriatr 39(2):134–142CrossRefPubMed Trögner J, Tümena T, Schramm A, Heinrich R, Sieber C, BDAT-Gruppe G (2006) Geriatrics in Bavaria-database (GiB-DAT): basic data analysis of geriatric rehabilitation in Bavaria and analysis of inter-clinic variability (part II). Z Gerontol Geriatr 39(2):134–142CrossRefPubMed
12.
Zurück zum Zitat Trögner J, Tümena T, Schramm A, Heinrich R, Sieber C, BDAT-Gruppe G (2006) Geriatrics in Bavaria-database (GiB-DAT): conception, structure and results of implementation (part I). Z Gerontol Geriatr 39(2):126–133CrossRefPubMed Trögner J, Tümena T, Schramm A, Heinrich R, Sieber C, BDAT-Gruppe G (2006) Geriatrics in Bavaria-database (GiB-DAT): conception, structure and results of implementation (part I). Z Gerontol Geriatr 39(2):126–133CrossRefPubMed
13.
Zurück zum Zitat Gaßmann KG, Tümena T, Schlee S, Garner C, Kieslich B, Kraft J et al (2012) Implementation and results of a geriatric medication database. Z Gerontol Geriatr 45(6):455–461CrossRefPubMed Gaßmann KG, Tümena T, Schlee S, Garner C, Kieslich B, Kraft J et al (2012) Implementation and results of a geriatric medication database. Z Gerontol Geriatr 45(6):455–461CrossRefPubMed
14.
Zurück zum Zitat Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S (2014) Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol 6:213–220CrossRefPubMedPubMedCentral Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S (2014) Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol 6:213–220CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Kannel WB, Abbott RD, Savage DD, McNamara PM (1982) Epidemiologic features of chronic atrial fibrillation: the Framingham study. N Engl J Med 306(17):1018–1022CrossRefPubMed Kannel WB, Abbott RD, Savage DD, McNamara PM (1982) Epidemiologic features of chronic atrial fibrillation: the Framingham study. N Engl J Med 306(17):1018–1022CrossRefPubMed
16.
Zurück zum Zitat Marinigh R, Lip GY, Fiotti N, Giansante C, Lane DA (2010) Age as a risk factor for stroke in atrial fibrillation patients: implications for thromboprophylaxis. J Am Coll Cardiol 56(11):827–837CrossRefPubMed Marinigh R, Lip GY, Fiotti N, Giansante C, Lane DA (2010) Age as a risk factor for stroke in atrial fibrillation patients: implications for thromboprophylaxis. J Am Coll Cardiol 56(11):827–837CrossRefPubMed
17.
Zurück zum Zitat Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al (2016) 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg 50(5):e1–e88CrossRefPubMed Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al (2016) 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg 50(5):e1–e88CrossRefPubMed
18.
Zurück zum Zitat Lip GY, Laroche C, Ioachim PM, Rasmussen LH, Vitali-Serdoz L, Petrescu L et al (2014) Prognosis and treatment of atrial fibrillation patients by European cardiologists: one year follow-up of the EURobservational research programme-atrial fibrillation general registry pilot phase (EORP-AF pilot registry). Eur Heart J 35(47):3365–3376CrossRefPubMed Lip GY, Laroche C, Ioachim PM, Rasmussen LH, Vitali-Serdoz L, Petrescu L et al (2014) Prognosis and treatment of atrial fibrillation patients by European cardiologists: one year follow-up of the EURobservational research programme-atrial fibrillation general registry pilot phase (EORP-AF pilot registry). Eur Heart J 35(47):3365–3376CrossRefPubMed
19.
Zurück zum Zitat Hart RG, Pearce LA, Aguilar MI (2007) Adjusted-dose warfarin versus aspirin for preventing stroke in patients with atrial fibrillation. Ann Intern Med 147(8):590–592CrossRefPubMed Hart RG, Pearce LA, Aguilar MI (2007) Adjusted-dose warfarin versus aspirin for preventing stroke in patients with atrial fibrillation. Ann Intern Med 147(8):590–592CrossRefPubMed
20.
Zurück zum Zitat Connolly SJ, Eikelboom J, Joyner C, Diener HC, Hart R, Golitsyn S et al (2011) Apixaban in patients with atrial fibrillation. N Engl J Med 364(9):806–817CrossRefPubMed Connolly SJ, Eikelboom J, Joyner C, Diener HC, Hart R, Golitsyn S et al (2011) Apixaban in patients with atrial fibrillation. N Engl J Med 364(9):806–817CrossRefPubMed
21.
Zurück zum Zitat Mant J, Hobbs FD, Fletcher K, Roalfe A, Fitzmaurice D, Lip GY et al (2007) Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham atrial fibrillation treatment of the aged study, BAFTA): a randomised controlled trial. Lancet 370(9586):493–503CrossRefPubMed Mant J, Hobbs FD, Fletcher K, Roalfe A, Fitzmaurice D, Lip GY et al (2007) Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham atrial fibrillation treatment of the aged study, BAFTA): a randomised controlled trial. Lancet 370(9586):493–503CrossRefPubMed
22.
Zurück zum Zitat Diener HC, Eikelboom J, Connolly SJ, Joyner CD, Hart RG, Lip GY et al (2012) Apixaban versus aspirin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a predefined subgroup analysis from AVERROES, a randomised trial. Lancet Neurol 11(3):225–231CrossRefPubMed Diener HC, Eikelboom J, Connolly SJ, Joyner CD, Hart RG, Lip GY et al (2012) Apixaban versus aspirin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a predefined subgroup analysis from AVERROES, a randomised trial. Lancet Neurol 11(3):225–231CrossRefPubMed
23.
Zurück zum Zitat Mazzaglia G, Filippi A, Alacqua M, Cowell W, Shakespeare A, Mantovani LG et al (2010) A national survey of the management of atrial fibrillation with antithrombotic drugs in Italian primary care. Thromb Haemost 103(5):968–975CrossRefPubMed Mazzaglia G, Filippi A, Alacqua M, Cowell W, Shakespeare A, Mantovani LG et al (2010) A national survey of the management of atrial fibrillation with antithrombotic drugs in Italian primary care. Thromb Haemost 103(5):968–975CrossRefPubMed
24.
Zurück zum Zitat Donzé J, Clair C, Hug B, Rodondi N, Waeber G, Cornuz J et al (2012) Risk of falls and major bleeds in patients on oral anticoagulation therapy. Am J Med 125(8):773–778CrossRefPubMed Donzé J, Clair C, Hug B, Rodondi N, Waeber G, Cornuz J et al (2012) Risk of falls and major bleeds in patients on oral anticoagulation therapy. Am J Med 125(8):773–778CrossRefPubMed
25.
Zurück zum Zitat Pugh D, Pugh J, Mead GE (2011) Attitudes of physicians regarding anticoagulation for atrial fibrillation: a systematic review. Age Ageing 40(6):675–683CrossRefPubMed Pugh D, Pugh J, Mead GE (2011) Attitudes of physicians regarding anticoagulation for atrial fibrillation: a systematic review. Age Ageing 40(6):675–683CrossRefPubMed
26.
Zurück zum Zitat Oqab Z, Pournazari P, Sheldon RS (2018) What is the impact of frailty on prescription of anticoagulation in elderly patients with atrial fibrillation? A systematic review and meta-analysis. J Atr Fibrillation 10(6):1870CrossRefPubMedPubMedCentral Oqab Z, Pournazari P, Sheldon RS (2018) What is the impact of frailty on prescription of anticoagulation in elderly patients with atrial fibrillation? A systematic review and meta-analysis. J Atr Fibrillation 10(6):1870CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Wilkinson C, Todd O, Clegg A, Gale CP, Hall M (2019) Management of atrial fibrillation for older people with frailty: a systematic review and meta-analysis. Age Ageing 48(2):196–203CrossRefPubMed Wilkinson C, Todd O, Clegg A, Gale CP, Hall M (2019) Management of atrial fibrillation for older people with frailty: a systematic review and meta-analysis. Age Ageing 48(2):196–203CrossRefPubMed
Metadaten
Titel
Prevalence and treatment of atrial fibrillation in older adults
verfasst von
Jacek Liczko, MD
Samuel Schülein
Thomas Tümena
Karl-Günter Gassmann, MD
Publikationsdatum
28.01.2022
Verlag
Springer Medizin
Erschienen in
Zeitschrift für Gerontologie und Geriatrie / Ausgabe 2/2023
Print ISSN: 0948-6704
Elektronische ISSN: 1435-1269
DOI
https://doi.org/10.1007/s00391-022-02017-7

Weitere Artikel der Ausgabe 2/2023

Zeitschrift für Gerontologie und Geriatrie 2/2023 Zur Ausgabe

Mitteilungen der DGGG

Mitteilungen der DGGG

Mitteilungen des BV Geriatrie

Mitteilungen des BV Geriatrie