Gosch M, Roller R E, Böhmdorfer B, Benvenuti-Falger U, Iglseder B, Lechleitner M, Sommeregger U, Dovjak P
Abteilung für Innere Medizin und Akutgeriatrie, Landeskrankenhaus Hochzirl, Zirl, Österreich.
Z Gerontol Geriatr. 2012 Jan;45(1):55-66; quiz 67-8. doi: 10.1007/s00391-011-0268-0.
Among geriatric patients, atrial fibrillation is the most common cardiac arrhythmia. In patients over 80 years of age, the prevalence rises to approximately 10%. Atrial fibrillation is associated with serious health implications, including a 2-fold increase in mortality risk and a 5-fold increase in stroke risk. In contrast to these facts, the current guidelines on the management of atrial fibrillation of the European Society of Cardiology (ESC) contain only a short paragraph on these patients. Many relevant clinical aspects go without any comment. Thus, the purpose of our paper is to discuss those special needs of geriatric patients and their physicians which are not mentioned in the guidelines of the ESC. In our review, we discuss rhythm versus rate control, oral anticoagulation, outcome, prevention, falls, adherence, polypharmacy, dementia, nursing home patients, frailty, and geriatric assessment in consideration of geriatric patients. An extended search of the literature on Pubmed served as the basis for this review. Individual aspects of each geriatric patient should be considered when managing these complex patients; however, the complexity of each case must not lead to an individualized therapy that is not in accordance with current guidelines and the literature. A large number of papers which help us to answer most of the clinical questions regarding the management of trial fibrillation in geriatric patients have already been published.
在老年患者中，心房颤动是最常见的心律失常。在80岁以上的患者中，患病率升至约10%。心房颤动与严重的健康问题相关，包括死亡风险增加两倍和中风风险增加五倍。与这些事实形成对比的是，欧洲心脏病学会（ESC）目前的心房颤动管理指南中仅用简短的一段内容提及这些患者。许多相关的临床方面未作任何评论。因此，我们本文的目的是讨论老年患者及其医生的那些在ESC指南中未提及的特殊需求。在我们的综述中，我们从老年患者的角度讨论节律控制与心率控制、口服抗凝治疗、转归、预防、跌倒、依从性、多重用药、痴呆、养老院患者、衰弱和老年评估。对PubMed上的文献进行广泛检索作为本综述的基础。在管理这些复杂患者时应考虑每位老年患者的个体情况；然而，每个病例的复杂性绝不能导致不符合当前指南和文献的个体化治疗。大量有助于我们回答有关老年患者心房颤动管理的大多数临床问题的论文已经发表。
