Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA.
Cardiology Department, Istishari Hospital, Amman, Jordan.
Vasc Health Risk Manag. 2022 Apr 15;18:289-295. doi: 10.2147/VHRM.S360822. eCollection 2022.
Atrial fibrillation (AF) is the most common arrhythmia that is associated with high morbidity and mortality. The prevalence of AF increases with age and the elderly constitute a vulnerable cohort for higher stroke and bleeding complications.
A total of 2163 adult consecutive patients with AF in 19 hospitals and 11 outpatient clinics in Jordan were enrolled in the Jordan AF study from May 2019 to January 2021. The clinical characteristics, demographics, and risk profiles of the elderly patients (≥80 years old) were compared to the younger patients (<80 years old).
Of 2163 patients, 379 (17.5%) constituted the elderly group. The elderly group had higher prevalence of hypertension (79.9% vs 73.5%, p=0.01), lower prevalence of smoking (5.0% vs 15.2%, p<0.001) and lower body mass index (28.1 ± 5.5 kg/m vs 29.8 ± 6.2 kg/m, p<0.001) compared with younger patients. They also had more strokes or systemic emboli (25.6% vs 14.7%, p<0.001), heart failure (30.3% vs 22.9%, p=0.002), pulmonary hypertension (30.6% vs 24.8%, p=0.02), and chronic kidney disease (13.5% vs 8.3%, p=0.002). The elderly cohort had higher mean CHA2DS2-VASc (5.0 ± 1.5 vs 3.6 ± 1.8, p<0.001) and HAS-BLED scores (2.2 ± 1.1 vs 1.5 ± 1.1, p<0.001) compared to younger group. Among 370 elderly with non-valvular AF (NVAF), oral anticoagulant agents (OACs) were prescribed for 278 (84.2%) of eligible high-risk patients. Of the 1402 younger patients with NVAF, OACs were prescribed for 1133 (84.3%) of eligible patients. Direct oral anticoagulant agents (DOACs) were more frequently used in the elderly compared to the young (72.3% vs 62.3%, p<0.001).
Elderly Middle Eastern AF patients have worse baseline clinical profiles and higher risk scores compared to younger patients. The majority of the elderly were prescribed guideline directed OACs, with higher use of DOACs than the younger cohort.
The study is registered on clinicaltrials.gov (unique identifier number NCT03917992).
心房颤动（AF）是最常见的心律失常，与高发病率和死亡率相关。AF 的患病率随年龄增长而增加，老年人是中风和出血并发症风险较高的脆弱群体。
2019 年 5 月至 2021 年 1 月，在约旦的 19 家医院和 11 家门诊诊所共纳入了 2163 例连续的成年 AF 患者，这些患者参与了约旦 AF 研究。比较了年龄≥80 岁的老年患者与年龄<80 岁的年轻患者的临床特征、人口统计学和风险特征。
在 2163 例患者中，379 例（17.5%）为老年组。与年轻患者相比，老年组高血压患病率更高（79.9% vs 73.5%，p=0.01），吸烟率更低（5.0% vs 15.2%，p<0.001），体重指数（BMI）更低（28.1 ± 5.5 kg/m2 vs 29.8 ± 6.2 kg/m2，p<0.001）。此外，老年患者中风或全身性栓塞（25.6% vs 14.7%，p<0.001）、心力衰竭（30.3% vs 22.9%，p=0.002）、肺动脉高压（30.6% vs 24.8%，p=0.02）和慢性肾脏病（13.5% vs 8.3%，p=0.002）的发生率更高。与年轻组相比，老年组的平均 CHA2DS2-VASc 评分（5.0 ± 1.5 vs 3.6 ± 1.8，p<0.001）和 HAS-BLED 评分（2.2 ± 1.1 vs 1.5 ± 1.1，p<0.001）更高。在 370 例非瓣膜性心房颤动（NVAF）的老年患者中，有 278 例（84.2%）高危患者接受了口服抗凝剂（OAC）治疗。在 1402 例年轻的 NVAF 患者中，有 1133 例（84.3%）符合条件的患者接受了 OAC 治疗。与年轻患者相比，老年患者更常使用直接口服抗凝剂（DOAC）（72.3% vs 62.3%，p<0.001）。
与年轻患者相比，中东地区的老年 AF 患者基线临床特征更差，风险评分更高。大多数老年患者接受了指南推荐的 OAC 治疗，与年轻患者相比，老年患者使用 DOAC 的比例更高。
该研究在 clinicaltrials.gov 上注册（唯一标识符 NCT03917992）。
