Retrospective Analysis of Atrial Fibrillation Treatment in Octogenarians and Nonagenarians

Background:
Elderly patients diagnosed with atrial fibrillation are often underrepresented in clinical trials, complicating effective treatment approaches. This study examines the use of oral anticoagulation (OAC) and the choice between rhythm-control and rate-control strategies in octogenarians and nonagenarians with atrial fibrillation.

Methods:
The study included 397 patients with a mean age of 85 years (range: 82-90) diagnosed with atrial fibrillation. Data were collected at hospital admission, including demographics, medical history, and clinical presentations. Patients underwent blood sampling, ECG, and transthoracic echocardiography. Follow-up tracked hospital readmissions due to atrial fibrillation over an average of 7.5 years.

Results:
Among included patients 283 (71.3%) were octogenarians and 66.2% were female. Mean CHA2DS2-VASc score was 5.1 ± 1.4; mean HAS-BLED score was 1.6 ± 0.7. The percentage of patients receiving OAC increased from 41.6% (165 patients) to 82.1% (326 patients). 83.4% of those anticoagulated were on new oral anticoagulants (NOACs), primarily Apixaban (44.9%). 53.7% received reduced doses, with 41.8% of reductions deemed inappropriate. 17.9% were not prescribed OAC, primarily due to concerns about falls (33.8%) and gastrointestinal bleeding (8.5%). At discharge, a rhythm-control strategy was employed in 51.1% of patients, with higher prevalence in octogenarians (59.7%) compared to nonagenarians (29.8%). Follow-up indicated a shift towards rate-control therapy, particularly in nonagenarians, where only 20.8% continued with rhythm-control. During follow-up, 28.5% developed congestive heart failure, 35% experienced significant bradycardia, and 20.2% were readmitted for atrial fibrillation management.

Conclusion:
The study highlights a positive trend in the prescription of OAC, especially NOACs, in elderly patients over the past decade, with instances of underdosing. Initial preferences for rhythm-control strategies diminished over time, particularly in nonagenarians. Further research is needed to evaluate the long-term impacts of these treatment strategies in older adults with atrial fibrillation.