Adequacy of ESC atrial fibrillation guidelines in the elderly population: Analysis of practices from an internal medicine department

Abstract

BackgroundAtrial fibrillation (AF) is a particularly prevalent and challenging to manage disease in the elderly. This study aims to evaluate the adequacy of ESC guidelines for the management of AF in a clinical setting with an aged population. MethodsRetrospective study of 212 hospitalizations with a diagnosis of AF. Patients admitted to the unit from January to June of 2012 were eligible for the study; their clinical status, underlying morbidities, and AF treatments were assessed. ResultsThe mean age of the study population was 78.6±10.2 years old; more than 90% of the cases were≥65 years old. Permanent AF was the most frequent form of the disease (66.0%), followed by paroxysmal AF (24.1%). Infection was the leading reason for hospitalization (39.2% of cases); AF (or flutter) was the reason for hospitalization in 15.6% of cases. Rate and/or rhythm control therapy was administered in 40.6% of cases at the emergency department and in 75.0% of cases at discharge; amiodarone was the most used drug in all clinical scenarios. At admission, anticoagulation therapy was not being used in 64.1% of cases; at discharge (57.2%). The main reason for non-anticoagulation was HAS-BLED≥3 (60%); in 23.5% of the cases there was no explicit reason for non-anticoagulation. ConclusionThe elderly population with AF presents some distinctive characteristics that the current ESC guidelines do not consistently address. There is a need to develop guidelines tailored to the elderly population, allowing the use of validated, systematic treatment approaches in this highly relevant population.