Atrial Fibrillation
Atrial fibrillation (AF) is a very common and relevant disease of the elderly (Fig. 1). Of the general population, 1%, but 10% of the 80+-year-old age group, suffer from it. In the United States alone, 2.2 million patients have AF, with an unknown number
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Relevance for Elderly Patients, Epidemiology Atrial fibrillation (AF) is a very common and relevant disease of the elderly (Fig. 1). Of the general population, 1%, but 10% of the 80+year-old age group, suffer from it. In the United States alone, 2.2 million patients have AF, with an unknown number of undiagnosed cases (which may represent another two million patients), and this figure is expected to at least double by 2050. In Europe, the number of AF patients is estimated to be around six million. Mortality of AF patients is twice that of age-matched persons without AF. The rate of stroke is increased fivefold, and 65+-year-old patients have a rate of cardiogenic thromboembolism of 4–12% per year. These numbers demonstrate that AF is one of the most important age-related diseases. Its relevance is not only underlined by these epidemiological data, but also by the fact that treatment is very successful if properly performed. The major problem of AF is thromboembolic disease originating from the heart atria, which causes strokes and peripheral occlusions (such as mesenteric or leg artery occlusions). It is accepted that 20–30% of all strokes in the
M. Wehling (*) University of Heidelberg, Maybachstr. 14, Mannheim 68169, Germany e-mail: [email protected]
elderly originate from AF. Fortunately, all studies on the major therapeutic principle, namely anticoagulation, show positive results, and this includes a sufficient number of elderly study patients. The disease is among the very few for which several studies have a dominant participation of elderly patients (>65 years) in controlled clinical trials (mean age in AFFIRM 70 years). Relating to this book, this is the only situation for which actually more data on elderly than on younger patients are available. Therapeutic effects have been clearly demonstrated, in particular in elderly patients. On average, the rate of embolic stroke as a major complication was lowered by 40–80% if anticoagulation was tested against placebo. Therefore, in a patient with AF, the question is not whether anticoagulation should be initiated, but only whether there are compelling, proven, and nonmodifiable reasons against it. Anticoagulation as embolism prophylaxis is the only indisputably beneficial therapeutic option in this context. Two additional therapeutic goals may be addressed by pharmacotherapy: – Heart rate control (ventricular rate control if tachycardia is present) – Restoration of sinus rhythm (Fig. 2) Generally, in all age groups different forms of AF are diagnosed: – Paroxysmal (rare, short episodes) – Persistent: for more than 7 days or requiring therapy to convert to sinus rhythm – Long persistent: for more than 1 year
M. Wehling (ed.), Drug Therapy for the Elderly, DOI 10.1007/978-3-7091-0912-0_9, # Springer-Verlag Wien 2013
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Incidence per 1000 person-years
Framingham (men) Framingham (women)
50
CHS (men) CHS (women)
40
Goteborg (men) Manitoba (men)
30
20
10
0 40
50
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70 Age (years)
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Fig. 1 Incidenc
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