?Afib in declining 85 year old

  1. Patient has been ordered external monitor for afib (30d)...she is 85 years old, not tech savvy, and is struggling with keeping the appliance attached. Has hx of prev CVA, is in fair health. Multiple comorbid conditions (NIDDM, CHF, multiple falls etc). Stroke clinic now says maybe an implanted device to monitor for afib. Says it can be under the skin for 3 years. I get the need to know for afib as it impacts meds, blood thinner risk vs reward. How far do you go down this road?
  2. Visit NutmeggeRN profile page

    About NutmeggeRN, BSN, RN

    Joined: Dec '11; Posts: 3,510; Likes: 7,653

    9 Comments

  3. by   Susie2310
    It depends on the patient's wishes, and it is a personal decision for the patient. Elderly people usually include their close family members in decisions about their care. One's own thoughts as a nurse in regard to the types of care elderly patients with co-morbidities/previous medical history (even if significant) should or should not receive are irrelevant. The patient/their representative has the right to be informed by their physician of their medical problem/diagnosis, treatment options and risks and benefits along with likely treatment outcomes, and then the decision is theirs to make. Some elderly people wish to continue to receive treatment (just as other demographics do), and some don't. We must respect the patient's wishes.
    Last edit by Susie2310 on May 2
  4. by   NutmeggeRN
    it is my mom, I'm not looking for medical advice, just thoughts on such a procedure at this point in her life...
  5. by   cardiacfreak
    Are you talking about a loop recorder? If she is frequently falling I would be very concerned with a anti-coagulant, so next question if it is afib are you going to treat or not?

    Myself, if I am 85 just leave it alone....no loop recorder, no anti-coagulant, no holter monitor, etc...

    With that being said,I have taken care of many 80y/o people who were getting pacemakers implanted, heart caths, CABG procedures.
  6. by   NutmeggeRN
    Quote from cardiacfreak
    Are you talking about a loop recorder? If she is frequently falling I would be very concerned with a anti-coagulant, so next question if it is afib are you going to treat or not?

    Myself, if I am 85 just leave it alone....no loop recorder, no anti-coagulant, no holter monitor, etc...

    With that being said,I have taken care of many 80y/o people who were getting pacemakers implanted, heart caths, CABG procedures.
    She had an EKG that shows afib, stroke clininc (she had a small one last year) with no paresis, has referred her back to PCP to discuss meds...they are not inclined to use coumadin due to bleed risk/need for INRs. My mom is def a fall risk so we are weighing the risk benefit of no blood thinner/some blood thinner and the resulting risk of the big stroke. My mom is really not excited about any more meds or changes. Not a fun time. I am inclined to not be aggressive.
  7. by   cardiacfreak
    My heart goes out to you, these are never easy decisions to make.
  8. by   marienm, RN, CCRN
    An elderly relative in my family was encouraged to get a pacemaker at age 92. She was in fair to poor health. I was strongly against it, doubting she would even leave the hospital. She did leave, went through cardiac rehab, and returned home (cared for by another family member) where she lived another 3 years plagued by CHF exacerbations and UTIs. Did she regret the decision? I suspect so, but it was her decision and not mine.

    I do question the value of an implantable monitor. That seems very invasive, especially in light of your hesitations regarding treatment. What does the cardiologist think? Do you think the stroke clinic isn't seeing the whole picture? What about a palliative care consult to help clarify things?

    Best of luck...these decisions are hard.
  9. by   NutmeggeRN
    She will see her PCP today and hopefully she will define a plan that does not include adding a cardiologist. We are looking into the palliative care process, it is much more extensive than I realized. That may well be option. SHe is tires, her friends are dying, she doesn't feel well...it sucks
  10. by   cardiacfreak
    Quote from NutmeggeRN
    She will see her PCP today and hopefully she will define a plan that does not include adding a cardiologist. We are looking into the palliative care process, it is much more extensive than I realized. That may well be option. SHe is tires, her friends are dying, she doesn't feel well...it sucks
    Please keep us posted, my prayers are with you.
  11. by   NutmeggeRN
    She will stay with her PCP no cardiologist and on Eliquis. Hopefully that will ease some of her Afib. Thank you for your thoughts

close