Atrial fibrillation in the elderly: a risk factor beyond stroke

Atrial fibrillation (AF) represents the most common arrhythmia worldwide and its prevalence exponentially increases with age. It is related to increased risk of ischemic stroke or systemic embolism, which determines a significant burden of morbidity and mortality, as widely documented in the literature. AF also constitutes a risk factor for other less investigated conditions, such as heart failure, pulmonary embolism, impairment in physical performance, reduced quality of life, development of disability, mood disorders and cognitive impairment up to dementia. In the elderly population, the management of AF and its complications is particularly complex due to the heterogeneity of the ageing process, the lack of specific evidence-based recommendations, as well as the high grade of comorbidity and disability characterizing the over 65 years aged people. In the present review, we aim to summarize the pieces of the most updated evidence on AF complications beyond stoke, mainly focusing on the elderly population.

New trends in drug treatment of heart failure in old age

Heart failure (HF) is a complex clinical syndrome, with high prevalence in the elderly. The World Heath Organization (WHO) predicts that by 2050 the population aged over 80 years will account around 400 million, reflecting that HF will still represent a major public health concern. Improved management of cardiovascular diseases and HF, together with the increased life expectancy explains, at least in part, the high prevalence of HF especially in the elderly. Beside the canonical therapy for HF failure, including angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers and aldosterone antagonists, new potential and promising therapies, such as sacubitril/valsartan, iron deficiency treatment and serelaxine, are emerging also in elderly HF patients. In this review we focus on the classical recommended HF therapy and the possible application of new trends in elderly.