Management of elderly patients with nonvalvular atrial fibrillation: focus on «fragile» patients


DOI: https://dx.doi.org/10.18565/therapy.2021.5.112-120

Roytberg G.E., Slastnikova I.D., Sharkhun O.O.

N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, Moscow
Abstract. The review presents data on stroke prevention, symptom reduction and cardiovascular risk reduction in atrial fibrillation (AF) in geriatric patients with fragility syndrome. The clinical benefit of prescribing anticoagulants to «fragile» patients has been demonstrated; however, in real clinical practice, anticoagulants are prescribed much less frequently and in reduced doses compared to «non-fragile» patients. To reduce symptoms associated with AF, heart rate and rhythm control strategies are discussed. To reduce the cardiovascular risk, the importance of regular assessment of the patient’s condition with ECG monitoring, renal function, geriatric status, revision of drug therapy, and identification of modifiable barriers that reduce the effectiveness/safety of therapy is emphasized. Management of «fragile» patients with AF should include a patient-oriented approach, effective management of concomitant diseases, correction of cardiometabolic factors, control of geriatric status, and regular analysis of the therapy. To develop the most optimal management of «fragile» patients with AF, it is necessary to conduct controlled randomized trials in this vulnerable patient population.
Keywords: fragility syndrome, geriatric status, elderly patients, antiarrhythmic therapy, anticoagulants, atrial fibrillation
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About the Autors

Grigori E. Roytberg, MD, professor, academician of RAS, head of the Department of therapy, general practice and nuclear medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1 Ostrovityaninova Str. Tel.: +7 (495) 251-56-84. ORCID: 0000-0003-0514-9114
Irina D. Slastnikova, PhD, associate professor of the Department of therapy, general practice and nuclear medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1 Ostrovityaninova Str. Tel.: +7 (495) 251-56-84. E-mail: slastid@mail.ru. ORCID: 0000-0002-4076-2849
Olga O. Sharkhun, MD, associate professor of the Department of therapy, general practice and nuclear medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1 Ostrovityaninova Str. Tel.: +7 (495) 251-56-84. E-mail: slastid@mail.ru. ORCID: 0000-0001-8527-4681


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