Christopher B. Overgaard, MSc, MD
Atrial Fibrillation and Elderly Patients
Atrial fibrillation (AF) is by far the most common cardiac arrhythmia, and is most prevalent among the elderly. One large study found that 70% of all patients with AF were between 65 and 85 years of age.1 Many underlying conditions have been associated with the development of AF, including diabetes, hypertension, pulmonary disease, thyrotoxicosis, cardiomyopathy, and nonspecific conduction defects; the AF patient population is, therefore, a heterogeneous one.2 Regardless of underlying cardiac pathology, this arrhythmia is associated with a doubling of mortality and is a very significant health issue for elderly patients.
AF occurs through the propagation of random waves of intra-atrial reentry, with many macroreentrant circuits moving throughout the atrial muscle.3 This chaotic pattern results in a random irregular rhythm, a significant decrease in stroke volume and cardiac output, and the risk of thrombus formation due to atrial stasis. Systemic embolization from an atrial clot is considered to be the most devastating, albeit potentially preventable, consequence of this disease process.2
Atrial Fibrillation, Stroke, and Bleeding Risk
Elderly patients with atrial fibrillation are at a fourfold higher risk of suffering a stroke than the age-matched general population.
