Vorhofflimmern im Alter – die geriatrische Perspektive

Was ist neu?

Was macht geriatrische Patienten besonders? Bei geriatrischen Patienten sind verschiedene Aspekte zu bedenken. Der überwiegende Teil der pharmakologischen Therapien fällt in den Bereich der Prävention, z.B. die Antikoagulation bei Vorhofflimmern. Dies bedeutet, dass wir ein bestehendes Risiko reduzieren wollen und dabei andere Risiken in Kauf nehmen. Bei alten und hochaltrigen Patienten stellt sich somit immer die Frage: Erlebt der Patient den klinischen Benefit der Therapie noch?

Frequenz- vs. Rhythmuskontrolle Als Folge der positiven Daten zur Ablation hat sich der Fokus auf die Rhythmuskontrolle gelegt. Mittel der Wahl ist die Pulmonalvenen-Isolation. Auch ältere Patienten können von einer Ablation profitieren.

Vorhofflimmern und orale Antikoagulation Die orale Antikoagulation bleibt essenzieller Bestandteil der pharmakologischen Therapie bei Vorhofflimmern. Die Behandlung geriatrischer Patienten erfordert einen individuellen Behandlungsansatz, welcher auf den aktuellen Leitlinien und ergänzenden Hilfsmitteln basieren sollte. Die Beurteilung der Funktionalität sollte in der Therapie und der Therapiezielplanung Berücksichtigung finden.

Vorhofflimmern und kognitive Beeinträchtigung Hinweise auf einen Zusammenhang zwischen Vorhofflimmern und Kognition gibt es schon länger. In einer großen prospektiven Studie mit einem langen Beobachtungszeitraum konnte in der Gruppe der Personen mit Vorhofflimmern eine Zunahme der Demenz an sich, sowie auch der Subgruppen (Mild Cognitive Impairment, Mb. Alzheimer, vaskuläre Demenz) gezeigt werden.

Abstract

Atrial fibrillation is the most common cardiac arrhythmia in older adults. As a result of the positive data on ablation, the focus has shifted to rhythm control. The method of choice is pulmonary vein isolation. Even older patients may benefit from ablation. Oral anticoagulation remains an essential component of pharmacological therapy for atrial fibrillation. Older adults require an individualised treatment approach, which should be based on current guidelines and complementary tools. The assessment of functionality should be taken into account in therapy and goal planning.

Schlüsselwörter

Alter - Vorhofflimmern - Ablation - Antikoagulation - Kognition

Keywords

older adults - atrial fibrillation - ablation - anticoagulation - cogintion

Publication History

Article published online:
27 February 2024

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