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Older adults with atrial fibrillation often have non-specific, non-cardiac symptoms that adversely affect their quality of life, and many do not attribute their symptoms to the condition, a new study finds.

The results underscore the importance of watching for non-specific Afib symptoms and more nuanced symptom control, according to two specialists from NYU Langone Health, New York.

Study participants included older adults with Afib in Massachusetts and Georgia. They were grouped by age, from 65 to 74 years old, 75 to 84 years old, and 85 years and older. Between 2016 and 2018, participants reported their perceived Afib symptoms on a standardized questionnaire. The researchers also examined treatment strategies data using electronic medical records.

Non-specific symptoms common

​​The most commonly reported symptoms were non-specific, non-cardiac symptoms  such as fatigue, labored breathing and lightheadedness. All symptoms had a similar prevalence and impact on quality of life in all age groups, reported David D. McManus MD, from the University of Massachusetts Medical School, and colleagues. Cardiac-specific symptoms such as palpitations and irregular heartbeat were less common, although these symptoms and quality of life issues were reported more often by the youngest participants. 

What’s more, patients who report experiencing any Afib symptoms were more likely to have received rhythm compared with rate control treatment, except those aged 85 years and older.

More stoic or sicker?

The oldest participant group was less likely to report decreased quality of life. This may be because they have learned to cope with their illness or because they are sicker and attribute the symptoms to other comorbidities when compared to their younger cohort, the researchers theorized.

There will be an increased need to manage Afib symptoms as the population ages, commented geriatrician Nina L. Blachman, MD, and cardiologist Adam H. Skolnick MD, in the accompanying editorial. Afib has a prevalence of 9% among adults aged 80 to 89 years, they noted.

Silence is not golden

“Silence is not always golden; we must be vigilant and increase our index of suspicion for atrial fibrillation in older adults even in the absence of typical cardiac symptoms,” Blachman and Skolnick said.In addition, they recommended that clinicians use a validated questionnaire to discern symptom burden in known Afib patients, and that patients with non-cardiac specific symptoms such as fatigue and dizziness be screened for the condition.

The study and editorial were published in the Journal of the American Geriatrics Society.

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