Management of Atrial Fibrillation in Patients 75 Years and Older: JACC State-of-the-Art Review

J Am Coll Cardiol. 2022 Jan 18;79(2):166-179. doi: 10.1016/j.jacc.2021.10.037.


The prevalence of atrial fibrillation (AF) is increasing as the population ages. AF treatment-related complications also increase markedly in older adults (defined as ≥75 years of age for this review). The older AF population has a high risk of stroke, bleeding, and death. Syncope and fall-related injuries are the most common reasons for nonprescription of oral anticoagulation (OAC), and are more common in older adults when OACs are used with antiarrhythmic drugs. Digoxin may be useful for rate control, but associations with increased mortality limit its use. Beyond rate and rhythm control considerations, stroke prophylaxis is critical to AF management, and the benefits of direct OACs, compared with warfarin, extend to older adults. Invasive procedures such as AF catheter ablation, pacemaker implantation/atrioventricular junction ablation, and left atrial appendage occlusion may be useful in appropriately selected cases. However, older adults have generally been under-represented in clinical trials.

Keywords: aged; aged 80 and over; antiarrhythmic drugs; catheter ablation; frailty; left atrial appendage occlusion; oral anticoagulation; strokes.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Accidental Falls / prevention & control
  • Aged
  • Alcohol Drinking / adverse effects
  • Anti-Arrhythmia Agents / therapeutic use
  • Anticoagulants / therapeutic use
  • Atrial Appendage / surgery
  • Atrial Fibrillation / therapy*
  • Catheter Ablation
  • Cognitive Dysfunction / complications
  • Coronary Artery Disease / therapy
  • Cost-Benefit Analysis
  • Decision Making, Shared
  • Dementia / complications
  • Diabetes Mellitus / therapy
  • Dual Anti-Platelet Therapy
  • Exercise
  • Frailty
  • Heart Failure / therapy
  • Humans
  • Hypertension / therapy
  • Overweight / prevention & control
  • Polypharmacy
  • Primary Prevention
  • Risk Assessment
  • Secondary Prevention
  • Sleep Apnea, Obstructive / therapy
  • Stroke / prevention & control
  • Vitamin K / antagonists & inhibitors
  • Weight Loss


  • Anti-Arrhythmia Agents
  • Anticoagulants
  • Vitamin K