Effective atrial fibrillation (AFib) management for older adults involves assessing potential risk factors and considering procedures or medications to restore a typical heart rhythm.

Atrial fibrillation (AFib) is a common heart rhythm disorder that becomes more frequent with age.

Despite this, many older people with AFib remain undiagnosed or undertreated.

This article explores treatment options for AFib in older individuals. It also discusses AFib symptoms, potential complications, and the overall outlook for managing the condition.

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AFib is the most common arrhythmia (irregular heart rhythm) in older adults, particularly those ages 65 years and older.

According to a 2015 article, around 10% of individuals in their 80s have AFib, while approximately 70% of those with AFib fall within the age range of 65-85 years.

Most people with AFib, especially older adults, likely have underlying conditions, such as:

While AFib itself is generally not life threatening, it can significantly increase the risk of serious cardiovascular events such as stroke and heart failure.

There are three classification categories for treating AFib in older people.

Rate control

The most common treatment option for older adults with A-fib is often rate control. This approach focuses on managing the heart rate to a target range of 80-110 beats per minute (BPM) at rest to improve symptoms such as palpitations and shortness of breath.

Healthcare professionals may prescribe medications such as beta-blockers or calcium channel blockers to help reduce heart rate and regulate rhythm in older adults with AFib.

Rhythm control

The goal of rhythm control is to restore and maintain a person’s typical heart rhythm. However, studies have shown higher rates of adverse events in older adults with antiarrhythmic drugs. Rhythm control is also typically less effective when there has been longstanding AFib, which is more likely in older adults.

In some cases, healthcare professionals may consider antiarrhythmic medications such as amiodarone or interventions such as cardioversion or catheter ablation.

Prevention of thromboembolic events

Older adults with AFib have an increased risk of stroke due to blood clots forming in the atria of the heart.

Healthcare professionals often prescribe blood thinners (anticoagulants), such as warfarin, or direct oral anticoagulants, such as apixaban or dabigatran, to prevent blood clots and reduce stroke risk.

Read more about medications for AFib.

Not everyone with AFib experiences symptoms. However, for those who do, the most common symptoms include:

AFib increases the risk of stroke in older adults. It accounts for around 25% of all strokes in those over ages 40 years, making their risk five times higher than individuals without AFib.

AFib can also lead to other complications, such as heart failure.

Some research also shows that AFib can lead to cognitive decline. A 2023 study found that AFib was associated with a 45% greater risk of mild cognitive impairment. The study states this could be partly due to the cardiovascular risk factors and other conditions associated with AFib.

The outlook for older adults with AFib is generally positive with proper management.

One 2020 study analyzing participants surviving to ages 70 or older found that the mortality rate of participants with AFib was twice as high as those without. The study also notes that those who received a diagnosis of AFib through initial screening had a 29% increase in mortality risk compared to participants without AFib.

This suggests that early intervention can improve outcomes.

With appropriate treatment, which may include lifestyle changes, medication, and regular doctor visits, older adults with AFib can improve their quality of life and reduce the risk of complications such as stroke and heart failure.

The following are answers to some questions people frequently ask about treating atrial fibrillation in older people.

What should you not do if you have atrial fibrillation?

People with AFib should avoid certain triggers, such as alcohol, stress, anxiety, and smoking. It is important for individuals with AFib to manage underlying health conditions such as high blood pressure and diabetes and not to ignore symptoms such as palpitations or shortness of breath.

What is the life expectancy of someone diagnosed with atrial fibrillation?

While AFib has associations with increased mortality, individual life expectancy varies depending on age, overall health, and other medical conditions.

Untreated AFib can lead to complications such as stroke and heart failure, impacting lifespan. However, with proper management and treatment, many older people with AFib can live long and fulfilling lives.

What is the first-line treatment for atrial fibrillation in older people?

Rate control is often the first-line treatment for older people with AFib. It focuses on managing the person’s heart rate rather than restoring their usual sinus rhythm. Doctors often prescribe medications, such as beta-blockers or calcium channel blockers, to regulate the heart rate and improve symptoms.

However, treatment typically depends on individual situations. Treating AFib in older adults involves sharing decision-making with a healthcare professional who can discuss the risks and benefits of various treatment options.

Treating AFib in older adults requires a personalized approach that considers age, other health conditions, symptoms, and individual preferences.

Treatment options may include anticoagulation to reduce the risk of stroke, controlling the ventricular rate response, or attempting to maintain sinus rhythm through drug or non-drug therapies.

Early intervention and prompt treatment are crucial for improving outcomes in older people with AFib.