Chen Michael A
Cardiology, Harborview Medical Center, University of Washington School of Medicine, 325 9th Avenue, Box 359748, Seattle, WA 98104, USA.
Clin Geriatr Med. 2016 May;32(2):315-29. doi: 10.1016/j.cger.2016.01.001.
Older adults with atrial fibrillation often have multiple comorbid conditions, including common geriatric syndromes. Pharmacologic therapy, whether for rate control or rhythm control, can result in complications related to polypharmacy in patients who are often on multiple medications for other conditions. Because of uncertainty about the relative risks and benefits of rate versus rhythm control (including antiarrhythmic or ablation therapy), anticoagulation, and procedural treatments (eg, ablation, left atrial appendage closure, pacemaker placement) in older patients with multimorbidity, shared decision-making is essential. However, this may be challenging in patients with cognitive dysfunction, high fall risk, or advanced comorbidity.
患有心房颤动的老年人通常有多种合并症，包括常见的老年综合征。药物治疗，无论是用于心率控制还是节律控制，都可能在经常因其他疾病而服用多种药物的患者中导致与多重用药相关的并发症。由于在患有多种疾病的老年患者中，心率控制与节律控制（包括抗心律失常或消融治疗）、抗凝以及程序性治疗（如消融、左心耳封堵、起搏器植入）的相对风险和益处存在不确定性，共同决策至关重要。然而，这对于认知功能障碍、跌倒风险高或合并症晚期的患者可能具有挑战性。
