Journal of the American Medical Directors Association
ReviewAtrial Fibrillation in Long Term Care
Section snippets
Symptoms and Signs
Although no studies have specifically examined symptoms and signs of AF in NH residents, clinical experience reveals that manifestations of AF are highly variable. Many patients are asymptomatic or minimally symptomatic. Others describe palpitations, fatigue, impaired exercise tolerance, shortness of breath, or chest discomfort. Acute or worsening heart failure is common in older patients with AF and rapid ventricular response rates, and an associated small to moderate rise in cardiac biomarker
Management
The primary objectives of therapy for AF are to alleviate symptoms and to reduce the risk of thromboembolism. The most common questions that arise in managing older adults with AF are whether to attempt to maintain sinus rhythm and whether to prescribe anticoagulation.
Recommendations
Given that NH residents comprise an extremely heterogeneous population, management of AF (indeed, of all conditions) must first and foremost be individualized, taking into consideration prevalent comorbidities, overall health and functional status, prognosis, goals of care, and personal preferences. In patients with adequate cognitive function, it is appropriate to discuss the risks and benefits of the various therapeutic options in accordance with the process of shared decision-making.
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Heart failure and cognitive dysfunction
2015, International Journal of CardiologyCitation Excerpt :Mild hyponatremia is associated with impaired cognition [129,130]. Atrial fibrillation, including paroxysmal atrial fibrillation, have been shown to be strongly related to cognitive and functional decline independent of whether or not the person has had a stroke [131–135]. Atrial fibrillation is associated with reduced brain volume [136] and hippocampal atrophy [137].
Mild cognitive impairment-a treatable condition
2014, Journal of the American Medical Directors AssociationShared decision making with anticoagulants
2017, Australian Journal of PharmacyFall risk and anticoagulation for atrial fibrillation in the elderly: A delicate balance
2017, Cleveland Clinic Journal of Medicine
The author has no conflicts of interest relating to this article.