PDF(Pubmed)
Abstract：
The Task Force for the diagnosis and management of atrial fibrillation (AF) of the European Society of Cardiology (ESC) published in 2020 the updated Guidelines for the Diagnosis and Management of Atrial Fibrillation with the contribution of the European Heart Rhythm Association (EHRA) of the ESC and the European Association for Cardiothoracic Surgery (EACTS).
In this narrative viewpoint, we approach AF from the perspective of aging medicine and try to provide the readers with information usually neglected in clinical routine, mainly due to the fact that while the large majority of AF patients in real life are older, frail and cognitively impaired, these are mostly excluded from clinical trials, and physicians\' attitudes often prevail over standardized algorithms.
On the basis of existing evidence, (1) opportunistic AF screening by pulse palpation or ECG rhythm strip is cost-effective, and (2) whereas advanced chronological age by itself is not a contraindication to AF treatment, a Comprehensive Geriatric Assessment (CGA) including frailty, cognitive impairment, falls and bleeding risk may assist in clinical decision making to provide the best individualized treatment.
In this narrative viewpoint, we approach AF from the perspective of aging medicine and try to provide the readers with information usually neglected in clinical routine, mainly due to the fact that while the large majority of AF patients in real life are older, frail and cognitively impaired, these are mostly excluded from clinical trials, and physicians\' attitudes often prevail over standardized algorithms.
On the basis of existing evidence, (1) opportunistic AF screening by pulse palpation or ECG rhythm strip is cost-effective, and (2) whereas advanced chronological age by itself is not a contraindication to AF treatment, a Comprehensive Geriatric Assessment (CGA) including frailty, cognitive impairment, falls and bleeding risk may assist in clinical decision making to provide the best individualized treatment.
摘要：
背景：欧洲心脏病学会（ESC）的房颤（AF）诊断和管理工作组于2020年发布了更新的房颤诊断和管理指南，该指南由ESC的欧洲心律协会（EHRA）和欧洲心胸外科协会（EACTS）提供。
结果：在这个叙述观点中，我们从衰老医学的角度来探讨房颤，并试图为读者提供临床常规中通常被忽视的信息，主要是由于这样的事实，虽然大多数的房颤患者在现实生活中年龄较大，虚弱和认知障碍，这些大多被排除在临床试验之外，和医生的态度往往胜过标准化的算法。
结论：根据现有证据，（1）通过脉搏触诊或心电图节律试纸进行机会性房颤筛查具有成本效益，和（2）尽管年龄本身并不是房颤治疗的禁忌症，包括虚弱在内的老年综合评估（CGA），认知障碍，跌倒和出血风险可能有助于临床决策,以提供最佳的个体化治疗.
结果：在这个叙述观点中，我们从衰老医学的角度来探讨房颤，并试图为读者提供临床常规中通常被忽视的信息，主要是由于这样的事实，虽然大多数的房颤患者在现实生活中年龄较大，虚弱和认知障碍，这些大多被排除在临床试验之外，和医生的态度往往胜过标准化的算法。
结论：根据现有证据，（1）通过脉搏触诊或心电图节律试纸进行机会性房颤筛查具有成本效益，和（2）尽管年龄本身并不是房颤治疗的禁忌症，包括虚弱在内的老年综合评估（CGA），认知障碍，跌倒和出血风险可能有助于临床决策,以提供最佳的个体化治疗.
