AF-CARE in the Elderly: Implications of the 2024 ESC Guideline on the Management of Atrial Fibrillation in Older Patients

BACKGROUND: It is anticipated that demographic trends will result in a notable increase in the number of elderly and geriatric patients globally. Concurrently, atrial fibrillation exhibits a pronounced age-dependent prevalence, thereby anticipating a substantial increase in the number of elderly atrial fibrillation patients. In this context, we have examined the recently published European Society of Cardiology (ESC) guidelines on the management of atrial fibrillation from 2024, analyzing their recommendations and implications for atrial fibrillation management in elderly patients, and critically summarized the recent recommendations. SUMMARY: In summary, it can be stated that the guideline makes age-dependent recommendations in some areas. Such recommendations can be found in particular for the indication for anticoagulation and for switching anticoagulation therapy from VKA to DOAC, or for atrial fibrillation screening. When it comes to rhythm control and catheter ablation, however, there are few age-specific recommendations and the particularities and heterogeneities of this patient group tend to be underrepresented in the guidelines. KEY MESSAGES: Tailored recommendations for elderly patients can be found in the ESC guidelines on the management of atrial fibrillation for atrial fibrillation screening and anticoagulation. In particular, the recommendations on rhythm control and catheter ablation lack specific recommendations for older patients.