Predictors of the risk of falls among elderly with chronic atrial fibrillation

Abstract

OBJECTIVES:Though elderly persons with chronic atrial fibrillation have more comorbidities that could limit indications for the chronic use of anticoagulants, few studies have focused on the risk of falls within this particular group. To evaluate the predictors of the risk of falls among elderly with chronic atrial fibrillation, a cross-sectional, observational study was performed.METHODS:From 295 consecutive patients aged 60 years or older with a history of atrial fibrillation who were enrolled within the last 2 years in the cardiogeriatrics outpatient clinic of the Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 107 took part in this study. Their age was 77.9±6.4 years, and 62 were female. They were divided into two groups: a) no history of falls in the previous year and b) a history of one or more falls in the previous year. Data regarding the history of falls and social, demographic, anthropometric, and clinical information were collected. Multidimensional assessment instruments and questionnaires were applied.RESULTS:At least one fall was reported in 55 patients (51.4%). Among them, 27 (49.1%) presented recurrent falls, with body lesions in 90.4% and fractures in 9.1% of the cases. Multivariate logistic regression showed that self-reported difficulty maintaining balance, use of amiodarone, and diabetes were independent variables associated with the risk of falls, with a sensitivity of 92.9% and a specificity of 44.9%.CONCLUSION:In a group of elderly patients with chronic atrial fibrillation who were relatively independent and able to attend an outpatient clinic, the occurrence of falls with recurrence and clinical consequences was high. Difficulty maintaining balance, the use of amiodarone and a diagnosis of diabetes mellitus were independent predictors of the risk for falls. Thus, simple clinical data predicted falls better than objective functional tests.

Predicting falls in elderly patients with chronic pain and other chronic conditions

“…Hung et al [10] found that benzodiazepine use, hypertension and a history of paroxysmal atrial fibrillation were fall predictors in elderly. Santos et al [36] found that difficulty in maintaining balance, amiodarone use and diabetes were strongly associated with falls in a similar study. Different factors were identified in these studies and only one was related to AF.…”

Prior History of Falls and Risk of Outcomes in Atrial Fibrillation: The Loire Valley Atrial Fibrillation Project

“…24 Some studies have considered patients with AF at increased risk of falls but with varying definitions and in different subpopulations. [21][22][23][24][25][26][27] A previous history of (actual) falls is probably the strongest risk factor for future falls, but the risk of cardiovascular events associated with previous history of falls has not been compared with risk of major bleeding in AF patients.…”

“…19,20 Atrial fibrillation (AF) itself is an independent predictor of falls. 21,22 In the setting of AF, the main focus of the physician's concern about falls is the increased predisposition to major bleeding if oral anticoagulation is initiated. 14,15 However, patients on oral anticoagulation at high risk of falls do not necessarily have a significantly increased risk of major bleeds, 23 suggesting that being at risk of falls is not a contraindication to oral anticoagulation.…”

The predictors of falls in adult and senior women from cities of Lower Silesia, Poland

“…In this case, the estimated risk of a fracture (Or) increases in proportion to a lower value of body mass, with many of the reports indicating that bMI is a better predictor of fractures than body mass. However, some studies have indicated no relationship between bMI and falls [28]. Furthermore, Himes and reynolds observed a high correlation between falls and bMI and the significant predictive power of this factor [29].…”