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Anticoagulation therapy in an elderly woman with atrial fibrillation.

78-YEAR-OLD WOMAN with hypertension, diabetes, and a 2-year history of paroxysmal atrial fibrillation comes in for an office visit after hospitalization for an episode of symptomatic atrial fibrillation. She was discharged on a regimen of aspirin, metoprolol, an angiotensin-converting enzyme inhibitor, and an oral hypoglycemic. She has never taken anticoagulants and before this hospitalization had never been on prophylactic aspirin therapy. Her medical history also includes an ejection fraction of 35% to 40% (normal 50% to 75% of end-diastolic volume at rest), osteoarthritis of the knees, and early Alzheimer disease. She lives in an assisted living facility where she prepares her own breakfast and lunch and eats a communal supper. A nurse’s aide administers her daily medications and checks her blood sugar regularly. The patient performs all activities of daily living (washing, bathing, dressing, toileting, feeding) and most of the instrumental activities of daily living (shopping, light cleaning, laundry, food preparation, telephoning), but she has delegated her personal bookkeeping to her son. She has stopped driving a car but is able to shop and socialize using transportation provided either by her assisted living facility or by the community. She reports falling last year on an icy sidewalk. She has mild dyspnea on exertion since leaving the hospital, but overall she feels much better. She neither smokes nor drinks. She is pleasant and conversant. On physical examination, she has a steady gait and an irregularly irregular heart rhythm. Jugular venous distention is at the upper limits of normal. No bruits are noted over the carotid arteries. Her lungs are clear except for a few bibasilar crackles. Trace lower-extremity pitting edema is noted, as is a decrease in sensation to vibration and light touch in a bilateral stocking distribution. Would this elderly woman with atrial fibrillation benefit from long-term anticoagulation?