Skip to main content
SpringerLink
Log in

Management und Therapie des Vorhofflimmerns beim geriatrischen Patienten

Management and therapy of atrial fibrillation in geriatric patients

  • CME Weiterbildung · Zertifizierte Fortbildung
  • Published:
Zeitschrift für Gerontologie und Geriatrie Aims and scope Submit manuscript

Zusammenfassung

Vorhofflimmern ist die häufigste Herzrhythmusstörung bei geriatrischen Patienten, die Prävalenz bei über 80-Jährigen beträgt etwa 10%. Patienten mit Vorhofflimmern haben ein doppelt so hohes Mortalitätsrisiko, das Risiko für einen Schlaganfall ist um den Faktor 5 erhöht. Im Gegensatz dazu stehen die aktuellen Leitlinien der Europäischen Kardiologischen Gesellschaft (ESC), die diese Patientengruppe kaum berücksichtigen. Insbesondere mangelt es an Empfehlungen zu alltäglichen Fragen in der klinischen Betreuung dieser Patientengruppe. Ziel der vorliegenden Arbeit ist, für geriatrisch tätige Kolleg(inn)en unter Aufarbeitung der spezifischen Fachliteratur die vorliegende europäische Leitlinie für dieses Patientenkollektiv zu ergänzen. Diskutiert werden die Themenbereiche Rhythmus- versus Frequenzkontrolle, Antikoagulation, Outcome und Prävention, Stürze, Compliance/Adhärenz, Polypharmazie, geriatrisches Assessment, Demenz, Pflegeheimpatienten und Frailty nach Literaturrecherche in PubMed in Hinblick auf den geriatrischen Patienten. Individuelle Aspekte sollten in die Therapiegestaltung einfließen, allerdings darf die Komplexität dieser Patienten nicht zu einer bedingungslosen Individualisierung der Therapie abseits der Leitlinien führen. Denn es gibt zahlreiche Literaturstellen, mit denen sich viele offene Fragen im Zusammenhang mit Vorhofflimmern bei geriatrischen Patienten beantworten lassen.

Abstract

Among geriatric patients, atrial fibrillation is the most common cardiac arrhythmia. In patients over 80 years of age, the prevalence rises to approximately 10%. Atrial fibrillation is associated with serious health implications, including a 2-fold increase in mortality risk and a 5-fold increase in stroke risk. In contrast to these facts, the current guidelines on the management of atrial fibrillation of the European Society of Cardiology (ESC) contain only a short paragraph on these patients. Many relevant clinical aspects go without any comment. Thus, the purpose of our paper is to discuss those special needs of geriatric patients and their physicians which are not mentioned in the guidelines of the ESC. In our review, we discuss rhythm versus rate control, oral anticoagulation, outcome, prevention, falls, adherence, polypharmacy, dementia, nursing home patients, frailty, and geriatric assessment in consideration of geriatric patients. An extended search of the literature on Pubmed served as the basis for this review. Individual aspects of each geriatric patient should be considered when managing these complex patients; however, the complexity of each case must not lead to an individualized therapy that is not in accordance with current guidelines and the literature. A large number of papers which help us to answer most of the clinical questions regarding the management of trial fibrillation in geriatric patients have already been published.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Go AS, Hylek EM, Phillips KA et al (2001) Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 285:2370–2375

    Article  PubMed  CAS  Google Scholar 

  2. Fetsch T, Bauer P, Engberding R et al (2004) Prevention of atrial fibrillation after cardioversion investigators. Prevention of atrial fibrillation after cardioversion: results of the PAFAC trial. Eur Heart J 25:1385–1394

    Article  PubMed  Google Scholar 

  3. Lloyd-Jones DM, Wang TJ, Leip EP et al (2004) Lifetime risk for development of atrial fibrillation: the Framingham Heart study. Circulation 110:1042–1046

    Article  PubMed  Google Scholar 

  4. Maisel WH, Stevenson LW (2003) Atrial fibrillation in heart failure: epidemiology, pathophysiology and rationale for therapy. Am J Cardiol 91(6A):2D–8D

    Article  PubMed  Google Scholar 

  5. Benjamin EJ, Levy D, Vaziri SM et al (1994.) Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA 271:840–844

    Article  PubMed  CAS  Google Scholar 

  6. Friberg L, Hammar N, Rosenqvist M (2010) Stroke in paroxysmal atrial fibrillation: report from the Stockholm Cohort a trial fibrillation. Eur Heart J 31:967–975

    Article  PubMed  Google Scholar 

  7. Knecht S, Oelschlager C, Duning T et al (2008) A trial fibrillation in stroke-free patients is associated with memory impairment and hippocampal atrophy. Eur Heart J 29:2125–2132

    Article  PubMed  Google Scholar 

  8. Thrall G, Lane G, Caroll D et al (2006) Quality of life in patients with atrial fibrillation: a systematic review. Am J Med 119:448, e1–e19

    Article  PubMed  Google Scholar 

  9. Camm AJ, Kirchhof P, Lip GY et al (2010) Guidelines for the management of a trial fibrillation: the task force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Eur Heart J 31:2369–2429

    Article  PubMed  Google Scholar 

  10. Wheeler R, Masani ND (2011) The role of echocardiography in the management of atrial fibrillation. Eur J Echocardiogr 12:i33–i38

    Article  PubMed  Google Scholar 

  11. Wyse DG (2009) Pharmacotherapy for rhythm management in elderly patients with atrial fibrillation. J Interv Card Electrophysiol 25:25–29

    Article  PubMed  Google Scholar 

  12. Fauchier L, Grimard C, Pierre B et al (2009) Comparison of beta blocker and digoxin alone and in combination for management of patients with atrial fibrillation and heart failure. Am J Cardiol 103:248–254

    Article  PubMed  CAS  Google Scholar 

  13. Woolcott JC, Richardson KJ, Wiens MO et al (2009) Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med 169(21):1952–1960

    Article  PubMed  Google Scholar 

  14. Hohnloser SH, Crijns HJGM, Eickels M van for the ATHENA Investigators et al (2009) Effect for dronedarone on cardiovascular events in atrial fibrillation. N Engl J Med 360:668–678

    Article  PubMed  CAS  Google Scholar 

  15. Deaths doubled with dronedarone in PALLAS: FDA and EMA updates. http://www.theheart.org/article/1255799.do. Zugegriffen: 26.10.2011

  16. Vidaillet HJ (2005) Rate control vs. rhythm control in the management of atrial fibrillation in elderly persons. Am J Geriatr Cardiol 14(2):73–78

    Article  PubMed  Google Scholar 

  17. Roy D, Talajic M, Nattel S et al (2008) Rhythm control versus rate control for atrial fibrillation and heart failure. N Engl J Med 358(25):2667–2677

    Article  PubMed  CAS  Google Scholar 

  18. Waldo AL (2009) Anticoagulation: stroke prevention in patients with atrial fibrillation. Cardiol Clin 27:125–135

    Article  PubMed  Google Scholar 

  19. Mant J, Hobbs FD, Fletcher K et al (2007) Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomized controlled trial. Lancet 370:493–503

    Article  PubMed  CAS  Google Scholar 

  20. Ortiz RM, Romo E, Mesa D et al (2011) Outcomes and safety of antithrombotic treatment in patients aged over 80 years or older with nonvalvular atrial fibrillation. Am J Cardiol (Epub ahead of print)

  21. Benavente L, Calleja S, Vega V de la et al (2010) Oral anticoagulation in elderly patients as secondary prevention of cardioembolic stroke. Int Arch Med 3:8

    Article  PubMed  Google Scholar 

  22. Pugh D, Pugh J, Mead GE (2011) Attitudes of physicians regarding anticoagulation for atrial fibrillation: a systematic review. Age Ageing 0:1–9

    Google Scholar 

  23. Connolly SJ, Ezekowitz MD, Phil CHB et al (2009) Dabigatran versus Warfarin in patients with atrial fibrillation. N Engl J Med 361:1139–1150

    Article  PubMed  CAS  Google Scholar 

  24. Connolly SJ, Eikelboom J, Campbell Joyner BS et al (2011) Apixaban in patients with atrial fibrillation. N Engl J Med 364:806–817

    Article  PubMed  CAS  Google Scholar 

  25. Patel MR, Mahaffey KW, Garg J et al (2011) Rivaroxban versus Warfarin in nonvalvular atrial fibrillation. N Engl J Med 365(10):883–891

    Article  PubMed  CAS  Google Scholar 

  26. Tabereux PB, Brass LM, Concato J et al (2008) Hospital admissions for stroke among very old in the USA. Neuroepidemiology 31:93–99

    Article  Google Scholar 

  27. Saposnik G, Black S (2009) Stroke in the very elderly: hospital care, case fatality and disposition. Cerebrovasc Dis 27:537–543

    Article  PubMed  Google Scholar 

  28. Kammersgrd LP, Jörgensen HS, Reith J et al (2004) Short- and long-term prognosis for very old stroke patients. The Copenhagen Stroke study. Age Ageing 33:149–154

    Article  Google Scholar 

  29. Deplanque D, Leys D, Parnetti L et al (2004) Stroke prevention atrial fibrillation: reasons leading to an inappropriate management. Main results of the SAFE II study. Br J Clin Pharmacol 57(6):798–806

    Article  PubMed  Google Scholar 

  30. Fang MC, Go AS, Hylek EM et al (2006) Age and risk of Warfarin-associated hemorrhage: the Anticoagulation and Risk Factors in Atrial Fibrillation study. JAGS 54:1231–1236

    Article  Google Scholar 

  31. Gage BF, Birman-Deych E, Kerzner R et al (2005) Incidence of intracranial hemorrhage in patients with atrial fibrillation who are prone to fall. Am J Med 118:612–617

    Article  PubMed  Google Scholar 

  32. Man-Son-Hing M, Nichol G, Lau A et al (1999) Choosing antithrombotic therapy for elderly patients with atrial fibrillation. Who are at risk for falls. Arch Intern Med 159:677–685

    Article  PubMed  CAS  Google Scholar 

  33. Sellers MB, Newby LK (2011) Atrial fibrillation, anticoagulation, fall risk, and outcomes in elderly patients. Am Heart J 161:241–246

    Article  PubMed  Google Scholar 

  34. Dossett LA, Riesel JN, Griffin MR et al (2011) Prevalence and implications of preinjury Warfarin use. Arch Surg 146(5):565–570

    Article  PubMed  Google Scholar 

  35. Balkrishnan R (1998) Predictors of medication adherence in the elderly. Clin Ther 20:764–771

    Article  PubMed  CAS  Google Scholar 

  36. Coons SJ, Shehan SL, Martin SS et al (1994) Predictors of medication noncompliance in a sample of older adults. Clin Ther 16:110–117

    PubMed  CAS  Google Scholar 

  37. Bardel A, Wallander MA, Svärdsudd K (2007) Factors associated with adherence to drug therapy: a population-based study. Eur J Pharmacol 63:307–314

    Article  Google Scholar 

  38. Schüz B, Marx C, Wurm S et al (2011) Medication beliefs predict medication adherence in older adults with multiple illnesses. J Psychosom Res 70:179–187

    Article  PubMed  Google Scholar 

  39. Garner JB (2010) Problems of nonadherence in cardiology and proposals to improve oucome. Am J Cardiol 105:1495–1501

    Article  PubMed  Google Scholar 

  40. Kneeland PP, Fang MC (2010) Current issues in patient adherence and persistence: focus on anticoagulants for the treatment and prevention of thomboembolism. Patient Prefer Adherence 4:51–60

    PubMed  Google Scholar 

  41. Kimmel SE, Chen Z, Price M et al (2007) The influence of patient adherence on anticoagulation control with warfarin. Arch Intern Med 167:229–235

    Article  PubMed  CAS  Google Scholar 

  42. Platt AB, Localio R, Brensinger CM et al (2008) Risk factors for nonadherence to warfarin: results from the IN-RANGE study. Pharmacoepidemiol Drug Saf 17(9):853–860

    Article  PubMed  Google Scholar 

  43. Platt AB, Localio R, Brensinger CM et al (2010) Can we predict daily adherence to warfarin? Results from the IN-RANGE study. Chest 137(4):883–889

    Article  PubMed  Google Scholar 

  44. Glasheen JJ, Fugit RV, Prochazka AV (2005) The risk of overanticoagulation with antidiotic use in outpatients on stable warfarin regimens. J Gen Intern Med 20:653–656

    Article  PubMed  Google Scholar 

  45. Shorr RI, Ray WA, Daugherty JR et al (1993) Concurrent use of non-steroidal anti-inflammatory drugs and oral anticoagulants places elderly persons at high risk for hemorrhagic peptic ulcer disease. Arch Intern Med 153:1665–1670

    Article  PubMed  CAS  Google Scholar 

  46. Behr S (2010) Risk of intracerebral hemorrhage associated with phenprocoumon exposure: a nested case-control study in a large population-based German database. Pharmacoepidemiol Drug Saf 19:722–730

    Article  PubMed  Google Scholar 

  47. Laine L, Smith R, Min K et al (2006) Systematic review: the lower gastrointestinal adverse effects of non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther 24:751–767

    Article  PubMed  CAS  Google Scholar 

  48. Hanlon JT et al (1992) A method for assessing drug therapy appropriateness. J Clin Epidemiol 45(10):1045–1051

    Article  PubMed  CAS  Google Scholar 

  49. Gallagher P et al (2008) STOPP (Screening tool of older person’s prescriptions) and START (Screening tool to alert doctors to right treatment). Consensus validation. Int J Clin Pharmacol Ther 46(2):72–83

    PubMed  CAS  Google Scholar 

  50. Bunch TJ, Weiss JP, Crandell BG et al (2010) Atrial fibrillation is independently associated with senile, vascular, and Alzheimer’s dementia. Heart Rhythm 74(4):433–437

    Article  Google Scholar 

  51. Dublin S, Andrson ML, Haneuse SJ et al (2011) Atrial fibrillation and risk of dementia: a prospective cohort study. JAGS 59:1369–1375

    Article  Google Scholar 

  52. Flaker GC, Pogue J, Yusuf S et al (2010) Cognitive function and anticoagulation control in patients with atrial fibrillation. Circ Cardiovasc Qual Outcomes 3:277–283

    Article  PubMed  Google Scholar 

  53. Jacobs LG, Billett HH, Freeman K et al (2009) Anticoagulation for stroke prevention in elderly patients with atrial fibrillation, including those with falls and/or early stage dementia: a single center, retrospective, observational study. Am J Geriatr Pharamcother 7(3):159–166

    Article  Google Scholar 

  54. McCormick D, Gurwitz JH, Goldberg RJ et al (2001) Prevalence and quality of warfarin use for patients with atrial fibrillation in the long-term care setting. Arch Intern Med 161:2458–2463

    Article  PubMed  CAS  Google Scholar 

  55. Gurwitz JH, Field TS, Radford MJ et al (2007) The safety of warfarin therapy in the nursing home setting. Am J Med 120:539–544

    Article  PubMed  CAS  Google Scholar 

  56. Papaioannou A, Kennedy CC, Campbell G et al (2010) A team-based approach to warfarin management in long term care: a feasibility study of the MEDeINR electronic decision support system. BMC Geriatr 10:38

    PubMed  Google Scholar 

  57. Folstein MF, Folstein SE, McHugh PR et al (1975) „Mini-mental state“: a practical method for grading the cognitive status of patients for the clinicians. J Psychiatr Res 12:189–198

    Article  PubMed  CAS  Google Scholar 

  58. Yesavage JA, Brink TL, Rose TL et al (1982) Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 17:37–49

    Article  PubMed  Google Scholar 

  59. American Geriatrics Society (2001) Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc 49:664

    Article  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Abteilung für Innere Medizin und Akutgeriatrie, Landeskrankenhaus Hochzirl, Hochzirl 1, 6170, Zirl, Österreich

    M. Gosch MAS, U. Benvenuti-Falger & M. Lechleitner

  2. Universitätsklinik für Innere Medizin, Graz, Österreich

    R.E. Roller

  3. Anstaltsapotheke, Krankenhaus Hietzing mit Neurologischen Zentrum Rosenhügel, Wien, Österreich

    B. Böhmdorfer

  4. Universitätsklinik für Geriatrie, Christian-Doppler-Klinik und PMU Salzburg, Salzburg, Österreich

    B. Iglseder

  5. Abteilung für Akutgeriatrie, Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel, Wien, Österreich

    U. Sommeregger

  6. Abteilung für Akutgeriatrie/Remobilisation, Landeskrankenhaus Gmunden, Gmunden, Österreich

    P. Dovjak

  7. Arbeitsgruppe „Polypharmazie und Pharmakotherapie im Alter“, Österreichischen Gesellschaft für Geriatrie und Gerontologie, Wien, Österreich

    M. Gosch MAS, R.E. Roller, B. Böhmdorfer, U. Benvenuti-Falger, B. Iglseder, M. Lechleitner, U. Sommeregger & P. Dovjak

Authors
  1. M. Gosch MAS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R.E. Roller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Böhmdorfer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. U. Benvenuti-Falger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. B. Iglseder
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Lechleitner
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. U. Sommeregger
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. P. Dovjak
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Gosch MAS.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gosch, M., Roller, R., Böhmdorfer, B. et al. Management und Therapie des Vorhofflimmerns beim geriatrischen Patienten. Z Gerontol Geriat 45, 55–68 (2012). https://doi.org/10.1007/s00391-011-0268-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00391-011-0268-0

Schlüsselwörter

Keywords

Search

Navigation