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Atrial fibrillation in elderly – outcomes and disease management in patients ≥ 80 years presenting in an emergency departement

https://doi.org/10.1007/s00392-025-02625-4

Christian Salbach (Heidelberg)1, J. Dürr (Heidelberg)1, M. Yildirim (Heidelberg)1, B. R. Milles (Heidelberg)1, M. Biener (Heidelberg)1, M. Müller-Hennessen (Heidelberg)2, H. Hund (Heidelberg)1, H. A. Katus (Heidelberg)1, N. Frey (Heidelberg)1, E. Giannitsis (Heidelberg)1

1Universitätsklinikum Heidelberg Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie Heidelberg, Deutschland; 2Atos Praxisklinik Zentrum für Gefäßerkrankungen und Präventivmedizin Heidelberg, Deutschland

 

Background: Global population ages and prevalence of patients with atrial fibrillation (AF) rises. However, prevalence and understanding of outcomes and risk factors, in elderly AF patients remains incomplete. The current study uses data from a consecutive real-world registry and aimed to investigate prevalence, outcomes and oral anticoagulation (OAC) regimes in AF patients ≥80 years presenting in the setting of an emergency department (ED).

Methods: Data from the Heidelberg registry of atrial fibrillation (HERA-FIB), a single-center retrospective all-comer study of AF patients consecutively presenting to the ED of the University Hospital of Heidelberg from June 2009 until March 2020 was used. Data was classified by age and analyzed for outcomes and risk factors for endpoints. HERA-FIB was registered at ClinicalTrials.gov. (Identifier: NCT05995561).

Results: AF patients ≥80 years comprised 32.2% of AF cases. Herein, compared to younger patients HRs for the primary (all-cause mortality, stroke or myocardial infarction) and the secondary endpoint (plus major bleeding) were 3.09 (95%CI 2.73-3.21) for patients ≥80 years and 2.96 (95%CI 2.73-3.21). Although fewer patients ≥80 were anticoagulated (67.9% vs. 70.5%, p=0.0070), usage of OAC and non-vitamin-K-antagonists (NOAC) increased during the study period. Comparing HRs for the primary and secondary endpoints by age revealed that vitamin-K-antagonist (VKA) therapy had a significantly higher overall HR compared to NOAC therapy with 3.48 (95% CI: 3.07-3.94) for the primary endpoint and 3.23 (95% CI: 2.86-3.64) for the secondary endpoint. NOAC therapy was associated with lower HRs, 0.794 (95% CI: 0.714-0.883) and 0.794 (95%CI 0.719-0.877) for the primary and secondary endpoints, despite individual variations in statistical significance observed among patients >70 years, respectively.

Conclusions: Our data highlights elderly AF patients ≥80 years as an important and vulnerable subpopulation when presenting in the setting of an ED. In this subgroup of AF patients, evidence for optimal OAC-therapy remains conflicting.

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