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Atrial Fibrillation Undertreated in the Elderly: Presented at ACC

By Crystal Phend

ATLANTA, G.A. -- March 15, 2006 – Recommended diagnostic tests and treatments, including anticoagulation medications, are not being used in older patients with atrial fibrillation, according to results of a study presented here at the 55^th Scientific Session of the American College of Cardiology (ACC) meeting.

"This situation is evident in all the steps of the cure process, from hospitalization to the choice of diagnostic and therapeutic tools," said lead author Stefano Fumagalli, Clinical Professor, University and AOU Careggi, Florence, Italy, in his presentation on March 12^th.

Dr. Fumagalli and colleagues examined records of patients in the Euro Heart Survey on Atrial Fibrillation, a prospective observational study conducted in 35 European countries. The 5333 patients in the database all had atrial fibrillation diagnoses based on an electrocardiogram (ECG) or ECG Holter recording. Age categories were under 65, 65 to 80 years, and greater than 80 years.

Interestingly, although previous published studies report increasing incidence of atrial fibrillation with increasing age, the Euro Heart Survey found a lower incidence in the oldest patients. Those over the age of 80 had a 12.6% rate of atrial fibrillation compared to 60.2% for those 65 to 80 years old and 27.2% for those under 65.

All main diagnostic procedures except chest X-ray and thyroid function evaluation were used less as age increased, including transthoracic echocardiography and ECG Holter monitoring. Dr. Fumagalli said this was an unexpected finding since these are very common diagnostic tools.

Use of atrial fibrillation interventions showed the same significant difference with age. Electrical cardioversion and catheter ablation were performed less often in the oldest patients: 29.5%, 24.9% and 12.1% for electrocardioversion and 9.0%, 2.0%, and 1.6% for ablation. Only implantation of a permanent pacemaker increased with age.

Pharmacologic intervention showed a similar trend. Overall, 27.7% of patients under 65 received mediation compared to 23.5% of those between 65 and 80, and 12.6% of those over 80. Dr. Fumagalli said one of the most important oral anticoagulants to prevent stroke also decreased in use with increasing age, although the use of antiplatelet agents increased.

As might be expected from this treatment profile, 1 year after the atrial fibrillation episode, the complication rate was significantly higher for older patients (14.9%, 20.5% and 33.4%, respectively). "There is much to do for elderly patients," Dr. Fumagalli said.

Management of the oldest old atrial fibrillation patients seems limited by age-oriented prejudices, he added.

"Probably there is a lot of fear to treat elderly patients," he said, due to concern about co-morbidities and the like.


[Presentation title: The Oldest Old Patients Have a Lower Chance for Receiving Recommended Atrial Fibrillation Therapy. The Experience of the Euro Heart Survey on Atrial Fibrillation. Poster 946-145]

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