{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T17:37:47Z","timestamp":1787593067360,"version":"build-2736575974"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Atrial fibrillation (AF) is associated with increased risks of stroke, heart failure and mortality. Rate and rhythm control are used to manage symptoms and improve quality of life, and restoration of normal sinus rhythm is also important for many, but not all, patients. AF is more prevalent in older adults, for whom AF management can be compounded by comorbidities and ongoing conditions, frailty, cognitive issues and polypharmacy. The European Society of Cardiology (ESC) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) recently updated recommendations for AF management, which may have implications for older adults in terms of overarching AF management approach, stroke and bleeding risk assessments and anticoagulation considerations. In addition, guideline recommendations and associated levels of evidence have changed for some interventions, such as left atrial appendage closure and AF ablation. In this guideline commentary, key aspects, changes and recommendations in the 2024 ESC guidelines are discussed in the context of older patients, as well as perspectives on specifically addressing the diverse ageing population in future clinical trials and practice guidelines.<\/jats:p>","DOI":"10.1093\/ageing\/afag002","type":"journal-article","created":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T12:36:54Z","timestamp":1768048614000},"source":"Crossref","is-referenced-by-count":2,"title":["Guideline commentary on the ESC\/EACTS 2024 guidelines for atrial fibrillation: a focus on managing AF in the older population"],"prefix":"10.1093","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2812-6049","authenticated-orcid":false,"given":"Riyaz A","family":"Kaba","sequence":"first","affiliation":[{"name":"Cardiovascular and Genomics Research Institute, School of Health and Medical Sciences, City St George\u2019s, University of London, St George's Hospital Medical School , London, England ,","place":["UK"]},{"name":"Cardiovascular Clinical Academic Group, St George's Hospital Medical School , London, England ,","place":["UK"]},{"name":"Department of Cardiology, Ashford and St Peter's Hospitals NHS Trust , Chertsey, England ,","place":["UK"]},{"name":"Biological Sciences, Royal Holloway University of London , Egham, England ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chakravarthi","family":"Rajkumar","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School , Brighton, England ,","place":["UK"]},{"name":"Department of Stroke Medicine, University Hospitals Sussex NHS Foundation Trust , Brighton, England ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1688-6497","authenticated-orcid":false,"given":"Francesco","family":"Mattace-Raso","sequence":"additional","affiliation":[{"name":"Geriatric Medicine, Erasmus Universiteit Rotterdam , Rotterdam, ZH ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"2026020405473351600_ref1","doi-asserted-by":"publisher","first-page":"k1453","DOI":"10.1136\/bmj.k1453","article-title":"Lifetime risk of atrial fibrillation according to optimal, borderline, or elevated levels of risk factors: cohort study based on longitudinal data from the Framingham Heart Study","volume":"361","author":"Staerk","year":"2018","journal-title":"BMJ"},{"key":"2026020405473351600_ref2","doi-asserted-by":"publisher","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"45","author":"Van Gelder","year":"2024","journal-title":"Eur Heart J"},{"key":"2026020405473351600_ref3","doi-asserted-by":"publisher","first-page":"1847","DOI":"10.1016\/j.cjca.2020.09.001","article-title":"The 2020 Canadian Cardiovascular Society\/Canadian Heart Rhythm Society Comprehensive guidelines for the Management of Atrial Fibrillation","volume":"36","author":"Andrade","year":"2020","journal-title":"Can J Cardiol"},{"key":"2026020405473351600_ref4","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1136\/bmj.39280.660567.55","article-title":"Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial","volume":"335","author":"Fitzmaurice","year":"2007","journal-title":"BMJ"},{"key":"2026020405473351600_ref5","doi-asserted-by":"publisher","first-page":"2457522","DOI":"10.1080\/07853890.2025.2457522","article-title":"Clinical outcomes of atrial fibrillation screening: a meta-analysis of randomized controlled trials","volume":"57","author":"Langen","year":"2025","journal-title":"Ann Med"},{"key":"2026020405473351600_ref6","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1136\/heartjnl-2024-325614","article-title":"AF-CARE in the elderly: complex but of increasing importance","volume":"111","author":"Van Vugt","year":"2025","journal-title":"Heart"},{"key":"2026020405473351600_ref7","doi-asserted-by":"crossref","first-page":"745","DOI":"10.7326\/0003-4819-141-10-200411160-00005","article-title":"Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation","volume":"141","author":"Fang","year":"2004","journal-title":"Ann Intern Med"},{"key":"2026020405473351600_ref8","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1007\/s41999-023-00811-z","article-title":"Anticoagulant use in older persons at risk for falls: therapeutic dilemmas-a clinical review","volume":"14","author":"Mitchell","year":"2023","journal-title":"Eur Geriatr Med"},{"key":"2026020405473351600_ref9","doi-asserted-by":"publisher","first-page":"1416","DOI":"10.1111\/jgs.14221","article-title":"Warfarin treatment and all-cause mortality in community-dwelling older adults with atrial fibrillation: a retrospective observational study","volume":"64","author":"Pilotto","year":"2016","journal-title":"J Am Geriatr Soc"},{"key":"2026020405473351600_ref10","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1001\/jamainternmed.2021.1819","article-title":"Anticoagulant use for atrial fibrillation among persons with advanced dementia at the end of life","volume":"181","author":"Ouellet","year":"2021","journal-title":"JAMA Intern Med"},{"key":"2026020405473351600_ref11","doi-asserted-by":"publisher","first-page":"509","DOI":"10.3233\/JAD-230382","article-title":"Cardiovascular risk Management for all Older Patients?","volume":"94","author":"Mattace-Raso","year":"2023","journal-title":"J Alzheimers Dis"},{"key":"2026020405473351600_ref12","doi-asserted-by":"publisher","first-page":"sfad252","DOI":"10.1093\/ckj\/sfad252","article-title":"Oral anticoagulant treatment and risk of kidney disease\u2014a nationwide, population-based cohort study","volume":"17","author":"Vestergaard","year":"2023","journal-title":"Clin Kidney J"},{"key":"2026020405473351600_ref13","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1681\/ASN.2007111207","article-title":"Dilemmas in the management of atrial fibrillation in chronic kidney disease","volume":"20","author":"Reinecke","year":"2009","journal-title":"J Am Soc Nephrol"},{"key":"2026020405473351600_ref14","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1001\/jamacardio.2024.1793","article-title":"Dose reduction of edoxaban in patients 80 years and older with atrial fibrillation: post hoc analysis of the ENGAGE AF-TIMI 48 randomized clinical trial","volume":"9","author":"Zimerman","year":"2024","journal-title":"JAMA Cardiol"},{"key":"2026020405473351600_ref15","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1161\/CIRCULATIONAHA.123.066485","article-title":"Safety of switching from a vitamin K antagonist to a non-vitamin K antagonist Oral anticoagulant in frail older patients with atrial fibrillation: results of the FRAIL-AF randomized controlled trial","volume":"149","author":"Joosten","year":"2024","journal-title":"Circulation"},{"key":"2026020405473351600_ref16","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/S0140-6736(07)61233-1","article-title":"Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham atrial fibrillation treatment of the aged study, BAFTA): a randomised controlled trial","volume":"370","author":"Mant","year":"2007","journal-title":"Lancet"},{"key":"2026020405473351600_ref17","doi-asserted-by":"publisher","first-page":"102686","DOI":"10.1016\/j.jaccas.2024.102686","article-title":"Anticoagulation in atrial fibrillation patients with renal impairment","volume":"29","author":"Parkash","year":"2024","journal-title":"JACC Case Rep"},{"key":"2026020405473351600_ref18","doi-asserted-by":"publisher","first-page":"1431","DOI":"10.1016\/j.hrthm.2015.03.028","article-title":"Association between incomplete surgical ligation of left atrial appendage and stroke and systemic embolization","volume":"12","author":"Aryana","year":"2015","journal-title":"Heart Rhythm"},{"key":"2026020405473351600_ref19","doi-asserted-by":"publisher","first-page":"1267","DOI":"10.1016\/j.hrthm.2024.01.018","article-title":"Lower rate of major bleeding in very high risk patients undergoing left atrial appendage occlusion: a propensity score-matched comparison with direct oral anticoagulant","volume":"21","author":"Magnocavallo","year":"2024","journal-title":"Heart Rhythm"},{"key":"2026020405473351600_ref20","doi-asserted-by":"publisher","first-page":"2081","DOI":"10.1056\/NEJMoa2101897","article-title":"Left atrial appendage occlusion during cardiac surgery to prevent stroke","volume":"384","author":"Whitlock","year":"2021","journal-title":"N Engl J Med"},{"key":"2026020405473351600_ref21","doi-asserted-by":"publisher","first-page":"1404","DOI":"10.31579\/2641-0419\/285","article-title":"Successful 4-year outcome following convergent ablation for longstanding persistent atrial fibrillation in an octogenarian \u2013 novel therapy for an old condition in the very elderly","volume":"3","author":"Ahmed","year":"2022","journal-title":"J Biomed Res Environ Sci"},{"key":"2026020405473351600_ref22","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14072328","article-title":"Management of atrial fibrillation in elderly patients: a whole new ballgame?","volume":"14","author":"Parrini","year":"2025","journal-title":"J Clin Med"},{"key":"2026020405473351600_ref23","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.jacep.2024.09.024","article-title":"Temporal trends in atrial fibrillation ablation in the elderly: incidence of MACE and recurrence rates","volume":"11","author":"Fusco","year":"2025","journal-title":"JACC Clin Electrophysiol"},{"key":"2026020405473351600_ref24","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1016\/j.jtcvs.2023.04.021","article-title":"Surgical ablation of atrial fibrillation is associated with improved survival compared with appendage obliteration alone: an analysis of 100,000 Medicare beneficiaries","volume":"168","author":"Mehaffey","year":"2024","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026020405473351600_ref25","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1001\/jamacardio.2015.0248","article-title":"Moving from disease-centered to patient goals-directed Care for Patients with multiple chronic conditions: patient value-based care","volume":"1","author":"Tinetti","year":"2016","journal-title":"JAMA Cardiol"},{"key":"2026020405473351600_ref26","doi-asserted-by":"publisher","first-page":"1854","DOI":"10.1001\/archinternmed.2011.424","article-title":"Health outcome prioritization as a tool for decision making among older persons with multiple chronic conditions","volume":"171","author":"Fried","year":"2011","journal-title":"Arch Intern Med"},{"key":"2026020405473351600_ref27","doi-asserted-by":"publisher","first-page":"8S","DOI":"10.1111\/j.1532-5415.1991.tb05927.x","article-title":"Impacts of geriatric evaluation and management programs on defined outcomes: overview of the evidence","volume":"39","author":"Rubenstein","year":"1991","journal-title":"J Am Geriatr Soc"}],"container-title":["Age and Ageing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/55\/1\/afag002\/66641017\/afag002.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/55\/1\/afag002\/66641017\/afag002.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T10:47:38Z","timestamp":1770202058000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ageing\/article\/doi\/10.1093\/ageing\/afag002\/8445444"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":27,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1,3]]}},"URL":"https:\/\/doi.org\/10.1093\/ageing\/afag002","relation":{},"ISSN":["0002-0729","1468-2834"],"issn-type":[{"value":"0002-0729","type":"print"},{"value":"1468-2834","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,1]]},"published":{"date-parts":[[2026,1]]},"article-number":"afag002"}}