Guideline commentary on the ESC/EACTS 2024 guidelines for atrial fibrillation: a focus on managing AF in the older population

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.