Zathar Zafraan, Karunatilleke Anne, Fawzy Ameenathul M, Lip Gregory Y H
Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.
Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
Front Med (Lausanne). 2019 Aug 8;6:175. doi: 10.3389/fmed.2019.00175. eCollection 2019.
Atrial fibrillation (AF) is the commonest cardiac rhythm abnormality and has a significant disease burden. Amongst its devastating complications is stroke, the risk of which increases with age. The stroke risk in an older person with AF is therefore tremendous, and oral-anticoagulation (OAC) therapy is central to minimizing this risk. The presence of age-associated factors such as frailty and multi-morbidities add complexity to OAC prescription decisions in older patients and often, OAC is needlessly withheld from them despite a lack of evidence to support this practice. Generally, this is driven by an over-estimation of the bleeding risk. This review article provides an overview of the concepts and controversies in managing AF in older people, with respect to the existing evidence and current practice. A literature search was conducted on Pubmed and Cochrane using keywords, and relevant articles published by the 1st of May 2019 were included. The article will shed light on common misconceptions that appear to serve as rationale for precluding OAC and focus on clinical considerations that may aid OAC prescription decisions where appropriate, to optimize AF management using an integrated, multi-disciplinary care approach. This is crucial for all patients, particularly older individuals who are most vulnerable to the deleterious consequences of this condition.
心房颤动（AF）是最常见的心律失常，具有重大的疾病负担。其严重并发症之一是中风，中风风险会随着年龄增长而增加。因此，老年房颤患者的中风风险极大，口服抗凝（OAC）治疗对于将这种风险降至最低至关重要。诸如虚弱和多种疾病等与年龄相关的因素增加了老年患者OAC处方决策的复杂性，而且尽管缺乏支持这种做法的证据，但老年患者往往被不必要地停用OAC。一般来说，这是由于对出血风险的高估所致。这篇综述文章根据现有证据和当前实践，概述了老年房颤管理中的概念和争议。使用关键词在PubMed和Cochrane上进行了文献检索，并纳入了截至2019年5月1日发表的相关文章。本文将阐明那些似乎作为排除OAC理由的常见误解，并重点关注在适当情况下可能有助于OAC处方决策的临床考量因素，以采用综合、多学科护理方法优化房颤管理。这对所有患者都至关重要，尤其是那些最易受这种疾病有害后果影响的老年人。
