心房颤动：2020 ESC 指南的老年医学视角。
Atrial fibrillation: a geriatric perspective on the 2020 ESC guidelines.
机构信息
Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Cologne Excellence Cluster On Cellular Stress-Responses in Aging-Associated Diseases (CECAD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
出版信息
Eur Geriatr Med. 2022 Feb;13(1):5-18. doi: 10.1007/s41999-021-00537-w. Epub 2021 Nov 2.
BACKGROUND
The Task Force for the diagnosis and management of atrial fibrillation (AF) of the European Society of Cardiology (ESC) published in 2020 the updated Guidelines for the Diagnosis and Management of Atrial Fibrillation with the contribution of the European Heart Rhythm Association (EHRA) of the ESC and the European Association for Cardiothoracic Surgery (EACTS).
METHODS AND RESULTS
In this narrative viewpoint, we approach AF from the perspective of aging medicine and try to provide the readers with information usually neglected in clinical routine, mainly due to the fact that while the large majority of AF patients in real life are older, frail and cognitively impaired, these are mostly excluded from clinical trials, and physicians' attitudes often prevail over standardized algorithms.
CONCLUSIONS
On the basis of existing evidence, (1) opportunistic AF screening by pulse palpation or ECG rhythm strip is cost-effective, and (2) whereas advanced chronological age by itself is not a contraindication to AF treatment, a Comprehensive Geriatric Assessment (CGA) including frailty, cognitive impairment, falls and bleeding risk may assist in clinical decision making to provide the best individualized treatment.
背景
欧洲心脏病学会（ESC）的心房颤动（AF）诊断和管理工作组于 2020 年发布了经过更新的《心房颤动诊断和管理指南》，该指南得到了欧洲心律协会（EHRA）和欧洲心胸外科学会（EACTS）的贡献。
方法和结果
在这个叙述性观点中，我们从老年医学的角度来探讨 AF，并尝试为读者提供通常在临床常规中被忽视的信息，主要是因为在现实生活中，大多数 AF 患者年龄较大、身体虚弱且认知受损，但这些患者大多被排除在临床试验之外，而且医生的态度往往优先于标准化算法。
结论
基于现有证据，（1）通过脉搏触诊或心电图节律带进行机会性 AF 筛查具有成本效益，（2）虽然先进的年龄本身不是 AF 治疗的禁忌症，但包括虚弱、认知障碍、跌倒和出血风险的综合老年评估（CGA）可能有助于临床决策，以提供最佳的个体化治疗。
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