Pharmacological treatment of persistent atrial fibrillation in the older adult: Evidence-based practice

PURPOSE: To answer the clinical question: In adults over 65 years of age with persistent atrial fibrillation (AF), do pharmacological rhythm-control agents offer a lower risk of stroke when compared to pharmacological rate-control agents? To address whether or not rhythm control improves quality of life compared to rate control was a secondary outcome question. DATA SOURCES: Comprehensive review of pharmacological treatment of AF on stroke and quality of life outcomes; a meta-analysis of five randomized controlled trials. CONCLUSIONS: Research suggests that all AF patients should continue anticoagulant therapy long term, even if they convert to sinus rhythm. Adequate rate control or rhythm control does not appear to reduce the need for lifelong antithrombotic therapy. IMPLICATIONS FOR PRACTICE: While an individualized treatment approach to AF is essential, a strong focus in the care of the older adult with AF should be on maintaining therapeutic International Normalized Ratio (INR) levels. Improved quality of life is more dependent on reducing thromboembolic events and subsequent sequelae of stroke.