Key result
Patients 80 and older face independent arrhythmia risk but remain critically underrepresented in clinical trials.
Why the study?
Patients ≥80 years of age are under-represented in clinical trials, creating critical evidence gaps to guide the effective and safe treatment of arrhythmias despite their unique clinical and therapeutic challenges.
Warrants caution extrapolating arrhythmia trial data to patients ≥80 years; leaves open optimal management pending dedicated inclusive trials.
Advances in medical care have led to an increase in the number of octogenarians and even older patients, forming an important and unique patient subgroup. It is clear that advancing age is an independent risk factor for the development of most arrhythmias, causing substantial morbidity and mortality. Patients ≥80 years of age have significant structural and electrical remodeling of cardiac tissue; accrue competing comorbidities; react differently to drug therapy; and may experience falls, frailty, and cognitive impairment, presenting significant therapeutic challenges. Unfortunately, very old patients are under-represented in clinical trials, leading to critical gaps in evidence to guide effective and safe treatment of arrhythmias. In this state-of-the-art review, we examine the pathophysiology of aging and arrhythmias and then present the available evidence on age-specific management of the most common arrhythmias, including drugs, catheter ablation, and cardiac implantable electronic devices.
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Curtis et al. (2018) conducted a review in Arrhythmias. Age-specific management (drugs, catheter ablation, cardiac implantable electronic devices) was evaluated. Advancing age (≥80 years) is an independent risk factor for arrhythmias, but these patients are under-represented in clinical trials, leading to critical gaps in evidence for their management.
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