AF is a disorder with high prevalence figures in the elderly.
First detected AF was reported in 18% of patients, paroxysmal AF in 28%, persistent AF in 22%, permanent AF in 29%, and in 3% of patients clinical type of AF was unknown.
In this survey, mean age was 67 years, and 26% of patients were older than 75 years. Atrial fibrillation is often secondary to coronary artery disease (CAD), heart failure, valvular heart disease (VHD), or hypertension. Especially the elderly often have underlying heart diseases, with, for example, 70% having hypertension, 41% heart failure, 40% CAD, and 29% VHD. Only 10% of the elderly have no underlying heart disease, while a quarter has three or four underlying diseases.
AF can, however, also occur as a primary condition. Patients with paroxysmal atrial fibrillation most often have no other cardiovascular disease (20%), while the relatively old group of patients with permanent atrial fibrillation is less often free from other cardiovascular diseases (7%).
Treatment of associated cardiovascular diseases in AF patients can be improved, especially in the elderly. For example, only 38% of elderly AF patients with heart failure received beta-blocker therapy, and statins were prescribed in only 40% of elderly AF patients with CAD.
In fair agreement with the guidelines, 67% of currently symptomatic patients received a rhythm control strategy. Guidelines state that rhythm control should be applied only in symptomatic patients, but was applied in 44% of patients in this survey who never experienced any symptoms.
In these patients, rate control to prevent heart failure would probably be sufficient, and may also help to avoid possible adverse effects of rhythm control.
A consequence of the high number of patients with associated cardiovascular diseases is that the vast majority of AF patients is at high risk for stroke (86%). To improve prognosis of AF patients, antithrombotic treatment and management of associated conditions should have a high priority.
Yet, the survey revealed that anticoagulation therapy (OAC) in patients with AF varied largely between hospitals. A significant proportion of patients (33%) with an indication for anticoagulation is not treated as such, which was even 40% in the elderly. Remarkably, half of the patients without an indication for anticoagulation did receive anticoagulation therapy.
Conclusion:
- Most AF patients have underlying cardiovascular diseases, especially the elderly.
- Treatment of associated cardiovascular diseases in AF patients needs a higher priority.
- In contrast with guideline recommendations, rhythm control is often applied in asymptomatic AF patients.
- Stroke prevention varied largely between hospitals, and is not strongly determined by stroke risk.
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