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Prevalence and treatment of atrial fibrillation in older adults

Prävalenz und Therapie von Vorhofflimmern bei älteren Personen

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Abstract

Background

Atrial fibrillation (AF) is the most frequent cardiac arrhythmia with an impact on morbidity and mortality found in the geriatric population.

Objective

This retrospective study is the first to investigate the prevalence, treatment and comorbidities of AF in a large cohort of older adults.

Material and methods

Older adults with AF hospitalized between 2010 and 2018. The mean age of the 10,700 AF patients in 2018 was 83.2 ± 6.4 years. The frequency of anticoagulation in older adults with AF between 2010 and 2018 was analyzed. The relationship between comorbidities and anticoagulation in 2018 was examined. Logistic regression analysis was used to identify possible predictive factors for anticoagulation.

Results

The prevalence of AF in 35,887 hospitalized older adults was 29.8% in 2018. The mean CHA2DS2VASc score was 4.4 ± 1.3 (male 3.8 ± 1.3, female 4.7 ± 1.2). From 2010 to 2018, the frequency of anticoagulation for patients with AF rose from 32.1% to 64.2%. Statistically significant differences in the examined characteristics between anticoagulated and not anticoagulated patients were found. Furthermore, there were no predictive factors for anticoagulation in multivariate logistic analysis.

Conclusion

Hospitalized older adults have an increased prevalence of AF compared to the general population. Despite the higher risk of bleeding, older adults were more frequently anticoagulated in the observation period, preferably with direct oral anticoagulants (DOACs). Patients without anticoagulation had more diagnoses and were worse in functional tests. This study suggests that the decision to give anticoagulants to older adults should be personalized.

Zusammenfassung

Hintergrund

Vorhofflimmern (VHF) ist die häufigste Arrhythmie bei geriatrischen Patienten mit Einfluss auf Morbidität und Mortalität.

Ziel der Arbeit

Diese Studie untersucht erstmals anhand einer großen Kohorte Häufigkeit, Therapie und Komorbidität von VHF bei stationären geriatrischen Patienten.

Material und Methoden

Stationäre geriatrische Patienten mit VHF zwischen 2010 und 2018. Es wurden 10.700 Patienten mit VHF aus dem Jahr 2018 im Alter von 83,2 ± 6,4 Jahren in Hinblick auf Komorbiditäten und Antikoagulation untersucht. Prädiktive Faktoren für die Antikoagulation wurden mittels logistischer Regressionsanalyse untersucht.

Ergebnisse

Die Prävalenz von VHF bei 35.887 geriatrischen stationären Patienten betrug 29,8 % im Jahr 2018. Der durchschnittliche CHA2DS2VASc score betrug 4,4 ± 1,3 (Männer 3,8 ± 1,3, Frauen 4,7 ± 1,2). Seit 2010 stieg die Häufigkeit der antikoagulierten Patienten von 32,1 % auf 64,2 % im Jahr 2018 an. Statistisch signifikante Unterschiede zwischen Patienten mit und ohne Antikoagulation konnten bei vielen untersuchten Merkmalen beobachtet werden. Anhand der logistischen Regressionsanalyse konnten jedoch keine prädiktiven Faktoren für die Antikoagulationstherapie identifiziert werden.

Schlussfolgerung

Stationäre geriatrische Patienten weisen eine deutlich höhere Prävalenz an VHF auf als die Allgemeinbevölkerung. Trotz des erhöhten Blutungsrisikos erfolgte jedoch in der Beobachtungszeit zunehmend häufiger eine Antikoagulation, vorzugsweise mit DOAKs. Patienten ohne Antikoagulation hatten mehr Diagnosen und schnitten bei den Funktionstests schlechter ab. Die Ergebnisse unserer Studie legen nahe, dass die Entscheidung für eine Antikoagulationstherapie bei älteren Patienten individualisiert erfolgen sollte.

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Acknowledgements

The present work was performed in fulfilment of the requirements for obtaining the degree “Dr. med.” by the Friedrich-Alexander University Erlangen-Nürnberg, Germany.

The authors wish to thank Dr. Roland Rupprecht for his assistance with statistical analysis and Urszula Pruchniewska PhD, Pierre Marc Paré and Jean Dumant-Liczko for their language supervision.

We are very grateful for all members providing data: Christian Ott, Christian Sänger, Roland Treiber, Edmund Goß, Florian Weber, Reiner Weisenseel, Stefan Trill, Peter Neumeier, Stephan von Clarmann, Klaus Becher, Brigitte Buchwald-Lancester, Karl-Günter Gassmann, Editha Maifarth-Bork, Robert Bütterich, Mohamed Lamine Benghebrid, Björn Johnson, Constantin Held, Antje Bräuning, Einhard Springer, Henriette Hönings, Ralf Cramer-Ebner Kathrin Tatschner, Frederike Gelpke, Wolfgang Anderer, Radu Crisan, Irina Kern, Michael Schwab, Ute Moreth, Martin Weiner, Stefan Trill, Dietmar Brückl, Ramona Ullmann, Nikolaus Netzer, Helmut Kern, Walter Swoboda, Nathalie Preiß, Ruth Herkommer, Herbert Bruckmayer, Frederike Gelpke, Roswitha Pfaffinger, Livia Hertelendy-Vogl, Jens Werner Kunze.

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Authors and Affiliations

  1. Geriatrics Center Erlangen, Department of Geriatrics and Geriatric Rehabilitation, Malteser Waldkrankenhaus St. Marien, Rathsberger Straße 57, 91054, Erlangen, Germany

    Jacek Liczko MD, Samuel Schülein & Karl-Günter Gassmann MD

  2. Geriatrics in Bavaria Database, Nürnberg, Germany

    Thomas Tümena

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  1. Jacek Liczko MD
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  2. Samuel Schülein
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  4. Karl-Günter Gassmann MD
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Correspondence to Jacek Liczko MD.

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Conflict of interest

J. Liczko, S. Schülein, T. Tümena and K.-G. Gassmann declare that they have no competing interests. K.-G. Gassmann has received lecture fees from Pfizer, Bristol-Myers Squibb, Novartis and Heel.

Ethical standards.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Liczko, J., Schülein, S., Tümena, T. et al. Prevalence and treatment of atrial fibrillation in older adults. Z Gerontol Geriat 56, 146–152 (2023). https://doi.org/10.1007/s00391-022-02017-7

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  • DOI: https://doi.org/10.1007/s00391-022-02017-7

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