Title : Complication in the treatment of atrial fibrillation in elderly patient with comorbidities
Abstract:
Atrial fibrillation (AF) is the most common significant cardiac rhythm disorder and is also a powerful common risk factor for stroke: about 15% of all strokes in the U.S. are attributable to AF. The use of combined antiplatelet and anticoagulant therapy in patients with AF has recently come under scrutiny. It is common for patients with AF to have co-morbidities that may necessitate the use of antiplatelet therapy. However, multiple studies examining outcomes of combined antiplatelet and anticoagulant therapy in patients with indications for both have demonstrated an increased risk of major hemorrhage compared with either treatment alone; and among patients with stable coronary artery disease (CAD), in particular, combined antiplatelet and anticoagulant therapy has not been shown to reduce either AF-related stroke or cardiovascular events. AF treatment-related complications also increase markedly in older adults (defined as ≥75 years of age for this review). The older AF population has a high risk of stroke, bleeding, and death. Our patient is an 85-year-old man with a complicated past medical history. He was diagnosed with long-term persistent atrial fibrillation, 3 degree of AV block, condition after cardiac pacemaker implantation, chronic coronary disease, myocardial infarction, CABG procedure, dyslipidemia, hypertension, heart failure (NYHA III), benign prostatic hyperplasia. He had a family history of hypertension and heart attack. His symptoms of AFib have continued for many years and his cardiologist decided to keep his heart rate with oral antiarrhythmic drugs. His CHA2DS2-VASc score is 5, HAS-BLED score is 2. He is a great candidate for long term oral anticoagulant therapy. The NOAC was prescribed. His dyslipidemia is controlled with statins. Hypertension is treated by double therapy of ACE inhibitors and diuretics. Managing AFib in this elderly patient with multiple comorbidities requires a careful and individualized approach. The primary focus should be on optimizing anticoagulation with a NOAC to prevent stroke while avoiding unnecessary antiplatelet therapy to minimize bleeding risk. Regular follow-up and comprehensive management of comorbid conditions are crucial to achieving the best outcomes.
Audience Take Away Notes:
The audience will learn about treating AFib in elderly patients with comorbidities necessitates a tailored approach to optimize anticoagulation therapy while minimizing bleeding risk. The use of NOACs over warfarin and avoiding unnecessary antiplatelet therapy are key strategies. Comprehensive management of comorbid conditions, patient education, and regular follow-up are essential to improve outcomes in this vulnerable population
