Atrial fibrillation living in older adults

Overview

Atrial fibrillation (AF) is a common heart condition where the upper chambers of the heart beat irregularly and often too fast. This means the heart does not pump blood as efficiently as it should, which can increase the risk of stroke and other complications. With proper treatment and lifestyle changes, most people can manage AF well.

Yes, atrial fibrillation is very common in older adults. It affects about 1 in 10 people over the age of 75. As the population ages, more people are living with AF.

AF typically affects older adults, especially those over 65. It can also occur in younger people, but it is much more common in later life. People with high blood pressure, heart disease, obesity, or a family history of AF are more likely to develop it.

Symptoms

Common symptoms

• A fluttering or racing feeling in the chest (palpitations)
• Shortness of breath, especially during activity
• Feeling tired or weak
• Dizziness or lightheadedness
• Chest discomfort or pain

Symptoms in children

• Atrial fibrillation is very rare in children. If it does occur, symptoms may be similar to adults but can include poor feeding or fatigue in infants.

Symptoms in older adults

• Older adults may have fewer obvious symptoms and instead feel vague tiredness, confusion, or shortness of breath with slight effort.
• Sometimes AF is found only during a routine check-up or when a stroke or heart failure occurs.
• Palpitations may be less noticeable in older adults, so it's important to report any new or worsening symptoms.

Causes

Main causes

• High blood pressure (the most common cause)
• Heart disease, such as coronary artery disease or heart valve problems
• Overactive thyroid (hyperthyroidism)
• Heavy alcohol use or binge drinking
• Lung diseases like chronic obstructive pulmonary disease (COPD)
• Infection or inflammation of the heart muscle (myocarditis)

Risk factors

• Age over 65
• High blood pressure
• Obesity
• Diabetes
• Sleep apnoea (pauses in breathing during sleep)
• Long-term heavy alcohol use
• Family history of AF
• Heart surgery or other heart conditions

When to see a doctor

See a doctor urgently if:

• If you have symptoms of a stroke (sudden weakness, speech problems, facial drooping) – call your local emergency number immediately.
• If you have chest pain or feel like you are going to faint – seek urgent care.

Book a routine appointment if:

• If you notice an irregular or racing heartbeat that comes and goes
• If you feel unusually tired or short of breath during everyday activities
• If you have a known heart condition and notice any change in your symptoms

Diagnosis

A doctor will start by asking about your symptoms and medical history, and checking your pulse. If AF is suspected, you will need a simple test called an electrocardiogram (ECG) to record your heart's rhythm.

Tests that may be done

• Electrocardiogram (ECG) – a quick, painless test using stickers on your chest
• Holter monitor – a portable ECG you wear for 24 to 48 hours to capture irregular rhythms
• Event recorder – a device you wear for several weeks to record heart rhythm when you have symptoms
• Echocardiogram – an ultrasound of the heart to check its structure and function
• Blood tests – to check thyroid, kidney function, and other factors

What to expect at your appointment

The diagnosis is usually straightforward. If your symptoms come and go, you may need to wear a monitor for a while. Your doctor will explain the results and what they mean for your health. You will be involved in decisions about your care.

Treatment

Treatment for atrial fibrillation aims to control the heart rate and rhythm, and to prevent stroke. Your doctor will tailor a plan based on your age, overall health, and the cause of your AF. Many people need a combination of treatments.

Self-care at home

• Reduce or avoid alcohol, especially heavy drinking
• Limit caffeine if it triggers palpitations
• Manage stress through relaxation or meditation
• Get regular, gentle exercise like walking or swimming (with your doctor's OK)
• Monitor your pulse occasionally and note any changes

Medical treatments

Medicines are the main treatment. They can help slow a fast heartbeat (rate control) or restore a normal rhythm (rhythm control). Some medicines help prevent blood clots and lower the risk of stroke – these are called anticoagulants or blood thinners. Your doctor will discuss which type is right for you and how to take them safely. Always follow your doctor's advice and do not stop medicines without talking to them.

When is surgery considered?

If medicines do not work or cause side effects, a procedure called catheter ablation may be recommended. This uses heat or cold to destroy the tiny area of heart tissue causing the irregular rhythm. Another option is a pacemaker, but this is less common for AF alone. Your doctor will explain the benefits and risks.

Living with this condition

Living with AF means paying attention to your heart but not letting it control your life. Keep your regular doctor visits, take your medicines as prescribed, and watch for symptoms. Many people with AF enjoy normal activities like travel, hobbies, and social events. Stay active and engaged.

Lifestyle tips

• Keep a healthy weight through diet and exercise
• Avoid smoking – it increases your risk of stroke and worsens AF
• Limit alcohol – no more than 1–2 drinks per day if you drink, and consider alcohol-free days
• Manage other health conditions like high blood pressure and diabetes
• Get good-quality sleep – sleep apnoea can trigger AF

Diet and exercise

A heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins can help. Reduce salt to control blood pressure. Regular moderate exercise like brisk walking, cycling, or swimming for 30 minutes most days is beneficial. Start slowly and check with your doctor before beginning a new exercise program.

Mental health and emotional wellbeing

Living with a heart condition can cause anxiety or worry. It is normal to feel concerned. Talk to your doctor if you feel low or anxious. Many people find support from family, friends, or support groups helpful. Your mental health is just as important as your physical health.

Prevention

While some risk factors like age and family history cannot be changed, you can reduce your chance of developing AF by controlling high blood pressure, maintaining a healthy weight, not smoking, limiting alcohol, and managing stress. Early treatment of other heart conditions also helps.

Vaccines

Getting recommended vaccines, such as the flu shot and pneumonia vaccine, can help prevent infections that might trigger AF in some people. Talk to your doctor about which vaccines are right for you.

Screening programmes

There is no routine screening for AF in everyone, but your doctor may check your pulse during regular visits, especially if you are over 65 or have risk factors. If you have symptoms, do not wait for a screening – see your doctor.

Complications

If left untreated

• Stroke – blood clots can form in the heart and travel to the brain
• Heart failure – the heart becomes too weak to pump blood effectively
• Poor quality of life due to ongoing symptoms like fatigue and breathlessness

Long-term outlook

With the right treatment and lifestyle changes, most people with atrial fibrillation can manage their condition well and enjoy a good quality of life. The risk of stroke can be greatly reduced with blood-thinning medicines. Work closely with your healthcare team to keep your heart healthy and stay active.

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