Atrial Fibrillation and Coronary Artery Disease in Elderly and Senile Patients: Interrelationship, Features of Clinical Presentation and Prognosis

Highlights The coexistence of atrial fibrillation and coronary artery disease in elderly and senile patients forms a complex pathophysiological continuum involving inflammation, endothelial dysfunction, and myocardial remodeling, which significantly increases the risk of adverse cardiovascular outcomes. The analysis of contemporary data demonstrates the limitations of traditional risk stratification scales in this patient population and highlights the potential of integrating biomarkers and machine learning methods for more accurate and personalized prognostic assessment. Abstract Cardiovascular diseases (CVD) have remained the leading cause of morbidity and mortality worldwide over the past decades. The increase in the prevalence of CVD is primarily associated with population aging, which is currently a global trend caused by a combination of two key processes: increased life expectancy and low birth rates. The increase in the proportion of elderly and senile patients in the population structure creates specific challenges for the healthcare system. The treatment and prevention of CVD in this group of patients is complicated by polymorbidity, polypharmacy, frequent cognitive impairments, and decreased functional status. Against this background, atrial fibrillation (AF) and coronary artery disease (CAD) occupy a special place as pathologies that significantly affect disability and mortality in the population. According to major clinical registries, CAD is detected in a significant proportion of patients with AF, and the prevalence of AF itself among patients with coronary atherosclerosis is constantly increasing. In recent years, a significant amount of data has been accumulated on the relationship between AF and CAD, their common pathogenetic mechanisms, and their impact on prognosis. This review collects and compares data on the epidemiology and mechanisms linking AF and CAD in older age groups: atrial remodeling, endothelial dysfunction, inflammatory and neurohumoral influences. Practical issues of risk stratification in this category of patients are considered, including the limitations of standard methods in very elderly patients, as well as the prospects for the clinical use of modern multimarker prognostic scales created based on machine learning and artificial intelligence.