Atrial Fibrillation (AF), the most common sustained arrhythmia, poses significant health risks to older adults.

As the global population ages, understanding the nuances of medication management in multimorbid and polymedicated older adults with AF becomes increasingly vital.

A systematic review and meta-analysis shed light on the prevalence and implications of potentially inappropriate prescribing (PIP) in this demographic, a topic of paramount importance for healthcare providers.

The Burgeoning Issue of AF in Older Adults

AF affects approximately 59.7 million people worldwide, with projections indicating a rise to 62.5 million by 2050. Notably, its prevalence increases with age, reaching 8.82% in adults over 75.

Associated with heightened risks of stroke, bleeding, and mortality, AF also leads to significant healthcare costs, often compounded by prevalent comorbidities such as heart failure, hypertension, and diabetes.

Potentially Inappropriate Prescribing: A Growing Concern

Multimorbidity in older adults with AF ranges from 38.7% to 98%, often leading to polypharmacy.

Due to age-related pharmacokinetic changes, this population is particularly susceptible to PIP, which encompasses overprescribing, misprescribing, and underprescribing.

Such practices heighten the risk of adverse drug reactions, hospitalization, and even mortality, emphasizing the need for careful medication review and management.

Insights from the Systematic Review and Meta-Analysis

The systematic review was conducted according to PRISMA guidelines and delved into published literature up to March 2023. It focused on the prevalence of PIP and its association with adverse health outcomes in older adults with AF.

The review incorporated various explicit and implicit tools to evaluate prescribing quality, acknowledging the limitations of relying solely on medications or disease-specific criteria.

Key Findings

  • Prevalence of PIP: The review revealed a significant prevalence of PIP, ranging from 8.9% to 56.5%, with a pooled prevalence of 35.2%. This highlights the critical need for regular medication review in older AF patients.
  • PIP and Adverse Outcomes: While the association between PIP and adverse health outcomes like major bleeding was noted, no significant link was found with other outcomes such as cardiovascular hospitalization or mortality.
  • Challenges in Medication Management: The review underscores the complexities in managing medications in multimorbid older adults with AF, especially considering the balance between effective stroke prevention and the risks of bleeding and other drug-related complications.

Clinical Implications

Clinical Implications - Safe Therapeutics

Holistic Care Approach

Integrated, multidisciplinary care is crucial for older adults with AF. Considering the entire medication profile and comorbid conditions, an individualized approach is essential for optimizing patient outcomes.

Regular Medication Reviews

Regular, comprehensive medication reviews can help identify PIP early, thus preventing adverse drug events and enhancing the quality of life for older adults with AF.

Patient-Centered Care

Healthcare providers must consider each patient’s unique needs and risks, balancing the benefits and risks of medications and engaging patients in shared decision-making.


This systematic review and meta-analysis bring to light the critical issue of potentially inappropriate prescribing in older adults with AF.

It underscores the need for heightened vigilance, regular medication reviews, and a patient-centered approach to managing this vulnerable population. For healthcare professionals, staying abreast of the latest research and guidelines is vital to ensure safe and effective care for older adults with AF.

Discover more about managing complex medication regimens in older adults with AF at Safe Therapeutics. Our platform offers comprehensive resources and updates tailored to the North American healthcare community, focusing on evidence-based and patient-centric approaches to care.

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