Drugs & Aging

, Volume 30, Issue 8, pp 593–601 | Cite as

Atrial Fibrillation in the Elderly

  • Teerapat Nantsupawat
  • Kenneth Nugent
  • Arintaya PhrommintikulEmail author
Therapy in Practice


Atrial fibrillation (AF) is the most common arrhythmia in older adults with a prevalence of 9 % in adults aged 80 years or older. AF patients have a five times greater risk of developing stroke than the general population. Using anticoagulants for stroke prevention in the elderly becomes a challenge because both stroke and bleeding complications increase with age. CHA2DS2-VASc and HAS-BLED scores are currently used as stroke and bleeding risk evaluations. When the HAS-BLED score is 3 or higher, caution and efforts to correct reversible risk factors are advised. Regardless of the HAS-BLED score, warfarin or novel oral anticoagulants are a IIa recommendation for CHA2DS2-VASc of 1, except for a score of 1 for females, and a IA recommendation for the score of 2 or higher. Aspirin is no longer recommended for AF thromboprophylaxis. In an elderly patient, lenient rate control is preferred over rhythm control owing to fewer adverse drugs effects and hospitalizations. When rhythm control is needed, dronedarone is a new antiarrhythmic drug that can be considered in patients who have paroxysmal AF and no history of heart failure. Although less efficacious than amiodarone, dronedarone has a fewer thyroid, neurologic, dermatologic, and ocular side effects than amiodarone.


Atrial Fibrillation Warfarin International Normalize Ratio Dabigatran Rivaroxaban 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Financial/nonfinancial disclosures

The authors have reported to Drugs and Aging that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.


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Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Teerapat Nantsupawat
    • 1
  • Kenneth Nugent
    • 1
  • Arintaya Phrommintikul
    • 2
    Email author
  1. 1.Department of Internal MedicineTexas Tech University Health Sciences CenterLubbockUSA
  2. 2.Division of Cardiology, Department of Internal Medicine, Faculty of MedicineChiang Mai UniversityChiang MaiThailand

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