Expert consensus of the French society of geriatrics and gerontology and the French society of cardiology on the management of atrial fibrillation in elderly people

被引：11

作者：

Hanon, Olivier ^{[1
,2
,3
]}

Assayag, Patrick ^{[4
,5
]}

Belmin, Joel ^{[1
,6
,16
]}

Collet, Jean Philippe ^{[7
,8
]}

Emeriau, Jean Paul ^{[1
,9
]}

Fauchier, Laurent ^{[10
,11
]}

Forette, Francoise ^{[1
]}

Friocourt, Patrick ^{[1
]}

Gentric, Armelle ^{[1
,12
,13
]}

Leclercq, Christophe ^{[14
,15
]}

Komajda, Michel ^{[7
,16
]}

Le Heuzey, Jean Yves ^{[17
,18
]}

机构：

[1] Soc Francaise Geriatrie & Gerontol, Paris, France

[2] Hop Broca, AP HP, Serv Gerontol, Paris, France

[3] Univ Paris 05, Paris, France

[4] Hop Bicetre, AP HP, Serv Cardiol, Le Kremlin Bicetre, France

[5] Univ Paris 11, Le Kremlin Bicetre, France

[6] Hop Charles Foix, AP HP, Serv Gerontol, Ivry, France

[7] Hop La Pitie Salpetriere, AP HP, Dept Cardiol, Paris, France

[8] Univ Paris 06, INSERM, U 937, Paris, France

[9] Ctr Hosp Univ, Unites Med Geriatr, Bordeaux, France

[10] Hop Trousseau, Serv Cardiol, Tours, France

[11] Univ Tours, Tours, France

[12] Ctr Hosp Univ, Hop Cavale Blanche, Serv Med Geriatr, Brest, France

[13] Univ Bretagne Occidentale, Brest, France

[14] Ctr Hosp Univ, Serv Cardiol & Malad Vascu, Rennes, France

[15] Univ Rennes 1, CIC IT 804, INSERM U 1099, Rennes, France

[16] Univ Pierre & Marie Curie Paris 6, Paris, France

[17] Hop Europeen Georges Pompidou, AP HP, Serv Cardiol & Rythmol, Paris, France

[18] Univ Paris 05, Paris, France

来源：

GERIATRIE ET PSYCHOLOGIE NEUROPSYCHIATRIE DE VIEILLISSEMENT | 2013年 / 11卷 / 02期

关键词：

atrial fibrillation; arrhythmia; elderly; guidelines; consensus; French society of geriatrics and gerontology; French society of cardiology; EURO HEART SURVEY; CLINICAL CLASSIFICATION SCHEMES; RISK-FACTORS; BLEEDING RISK; FOLLOW-UP; RHYTHM MANAGEMENT; INTRACRANIAL HEMORRHAGE; ANTICOAGULANT TREATMENT; STROKE PREVENTION; PREDICTING STROKE;

D O I：

10.1684/pnv.2013.0407

中图分类号：

R749 [精神病学];

学科分类号：

100205 ;

摘要：

The prevalence of atrial fibrillation (AF) increase with ageing. In France AF affects between 400,000 to 660,000 people aged 75 years or more. In the elderly, AF is a major risk factor of stroke and a predictive factor for mortality. Comorbidities are frequent and worsen the prognosis of AF. They can be the cause or the consequence of AF and their management is a major therapeutic objective. Comprehensive geriatric assessment (CGA), is required to analyse both medical and psychosocial elements, and to identify co-morbidities and geriatrics syndrome as cognitive disorders, risk of falls, malnutrition, mood disorders, and lack of dependency and social isolation. The objectives of AF treatment in the elderly are to prevent AF complications, particularly stroke, and to improve quality of life. Specific precautions for treatment must be taken because of the co-morbidities and age-related changes in pharmacokinetics or pharmacodynamics. Preventing AF complications relies mainly on anticoagulant therapy. Anticoagulants are recommended in patients with AF aged >= 75 years after assessing the bleeding risk using Hemorr(2)hages or HAS-BLED scores. Novel oral anticoagulants (NOACs) are promising treatments especially due to a lower risk of intracerebral haemorrhage. However, their prescriptions should take into account renal function (creatinine clearance assessed with Cockcroft formula) and cognitive function (for adherence to treatment). Studies including very old patients with several comorbidities in 'real life' are necessary to evaluate tolerance of NOACs in this population. The management of AF also involves the treatment of underlying cardiomyopathy and heart rate control rather than rhythm control strategy as first-line therapy in the elderly,

引用

页码：117 / 143

页数：27

共 115 条

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