Managing atrial fibrillation in elderly people

Chronic atrial fibrillation is the commonest arrhythmia seen in clinical practice. Not only does it cause increased morbidity and mortality among affected individuals; it also adds a significant burden to healthcare costs. The prevalence of atrial fibrillation increases steadily with age (from 0.5% of those aged 50-59 years to 8.8% of those aged 80-89 years), as do the associated risks.1 Even in the absence of rheumatic heart disease, there is a sixfold increase in thromboembolic phenomena, and atrial fibrillation accounts for up to 36% of all strokes in elderly people.2 It is the commonest arrhythmia requiring admission to hospital and is the primary diagnosis in 20% of all new outpatient cardiology appointments. As the population ages so these effects will be exacerbated.

Patients who develop atrial fibrillation are likely to present to their general practitioner with palpitations, shortness of breath, and fatigue. The …