The role of geriatricians in the atrial fibrillation management teams

Abstract

The world's aging population is increasing, making it essential and complex to manage multimorbid older adults. According to United Nations statistics, people aged 65 years or older will rise from 761 million in 2021 to 1.6 billion in 2050. The number of people aged 80 years or older is growing even faster.¹ Due to the need to evaluate patients holistically and monitor them from a single source, geriatric medicine has gained importance all over the world. Geriatricians use an exclusive assessment method, the Comprehensive Geriatric Assessment (CGA), to evaluate not only systemic medical diseases and pharmacologic agents of the patients but also functionality, gait, mood, cognitive impairment, and nutritional status. This multidimensional holistic approach enables healthcare providers to identify medical and social problems and meet the sophisticated needs of older adults.

One of the major systemic medical conditions frequently encountered in older adults is atrial fibrillation (AF). In Europe, in 2010, around 9 million individuals older than 55 years had AF, and it is estimated to jump to 14 million by 2060.² AF prevalence gets higher with age, and it is an important issue in all specialties to prevent ischemic stroke because of a major cause of functionality and independence loss. AF screening, recognition, and management require multidisciplinary coordination. Therefore, AF has particular importance for geriatricians' clinical practice. Geriatricians also follow and implement the European Society of Cardiology guidelines into clinical practice as the most reliable source, updated in 2020.³ Integrated management of patients was suggested in the guideline.

On the other hand, it should be kept in mind that some geriatric syndromes, such as falls, polypharmacy, malnutrition, and dementia, which may pose a risk in prescribing anticoagulant drugs, may make AF management more difficult in older adults. In addition, healthcare professionals should be aware that managing older patients with AF and one of those geriatric syndromes needs a special, holistic geriatric perspective. It is important to consider the risk of falls, chronic medical conditions (such as chronic liver or kidney disease), and the routine use of drugs to prevent unwanted drug–drug interactions or drug–disease interactions. It is also challenging to maintain the international normalized ratio (INR) therapeutic range in bed-bound patients on warfarin. Therefore, individual treatment and provision plans should be organized considering these situations. However, geriatricians have not been defined as a part of the integrated AF management team in fig. 11 in the 2020 AF guideline.³ We believe geriatricians should be one of the top priorities in AF management. Additionally, it is important to raise awareness and specialization in the geriatric population among healthcare professionals. A multidisciplinary integrated care approach (such as nurse-led care in addition to usual specialist care) is reported to be associated with reduced cardiovascular hospitalization and all-cause mortality.⁴ The integration of geriatricians, geriatric cardiologists, geriatric nurses, and geriatric pharmacy specialists into multidisciplinary AF teams supports patient adherence and treatment follow-up, and helps prevent side effects.

We would like to emphasize the importance of including geriatricians in the management team, alongside general practitioners and cardiologists, in the upcoming revised and updated AF diagnosis and management guidelines. We believe that this approach will raise awareness and enhance the quality of AF management.

EAB and ATI drafted and critically revised the manuscript. ME and IHK conducted the literature search and assisted with the draft. All authors contributed to and approved the final manuscript.

The authors have no conflicts of interest to declare.

None.