Atrial Fibrillation: An Independent Risk Factor for Nonaccidental Falls in Older Patients

Sanders, Alison; Ganguly, Joya; Jetter, L N P Tawni; Daccarett, Marcos; Wasmund, Stephen L.; Brignole, Michele; Hamdan, M.B.A. Mohamed H.

doi:10.1111/j.1540-8159.2012.03443.x

Cited by 39 publications

(21 citation statements)

References 24 publications

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“…CVD may be associated with a higher risk of loss of consciousness and falls due to a drop in blood pressure or arrhythmias . These may be related to the disease itself or to side effects of medications.…”

Section: Discussionmentioning

confidence: 99%

High hip fracture risk in men with severe aortic calcification: MrOS study

Szulc

Blackwell

Schousboe

et al. 2013

Journal of Bone and Mineral Research

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A significant link between cardiovascular disease and osteoporosis is established in postmenopausal women, but data in men are scarce. We tested the hypothesis that greater severity of abdominal aortic calcification (AAC) was associated with an increased risk of non-spine fracture in 5994 men aged ≥65 years. AAC wasassessed on 5400 baseline lateral thoraco-lumbar radiographs using a validated visual semi-quantitative score. Total hip bone mineral density (BMD) was measured using dual energy X-ray absorptiometry. Incident non-spine fractures were centrally adjudicated. After adjustment for age, BMI, total hip BMD, fall history, prior fracture, smoking status, co-morbidities, race and clinical center, the risk of non-spine fracture (n=805) was increased among men with higher AAC (HR Q4 (AAC score ≥9) vs Q1 (0-1): 1.36, 96%CI: 1.10-1.68). This association was due to an increased risk of hip fracture (n=178) among men with higher AAC (HR Q4 vs Q1: 2.33, 95%CI: 1.41-3.87). By contrast, the association between AAC and the risk of non-spine-non-hip fracture was weaker and not significant (HR Q4 vs Q1: 1.22, 95%CI: 0.96-1.55). The findings regarding higher AAC and increased risk of fracture were not altered in additional analyses accounting for degree of trauma, estimated glomerular filtration rate, presence of lumbar vertebral fractures (which may bias AAC assessment), preexisting cardiovascular disease, ankle brachial index or competing risk of death. Thus, in this large cohort of elderly men, greater AAC was independently associated with an increased risk of hip fracture, but not with other non-spine fractures. These findings suggest that AAC assessment may be a useful method for identification of older men at high risk of hip fracture.

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Section: Discussionmentioning

confidence: 99%

High hip fracture risk in men with severe aortic calcification: MrOS study

Szulc

Blackwell

Schousboe

et al. 2013

Journal of Bone and Mineral Research

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“…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.…”

mentioning

confidence: 98%

“…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.…”

mentioning

confidence: 99%

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

Banerjee

Clémenty

Haguenoer

et al. 2014

The American Journal of Medicine

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“…Atrial fibrillation was present in 16.7 % of participants. The prevalence of atrial fibrillation has been shown to be higher in those presenting with a non-accidental fall (absence of slipping or tripping) compared to those reporting an accidental fall [ 16 ]; we did not categorize fall types. However, arrhythmias are often transient events that may not be captured on a 12-lead ECG screen.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular responses to orthostasis and their association with falls in older adults

et al. 2015

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BackgroundOrthostatic hypotension (OH) refers to a marked decline in blood pressure when upright. OH has a high incidence and prevalence in older adults and represents a potential intrinsic risk factor for falls in these individuals. Previous studies have not included more recent definitions for blood pressure responses to orthostasis, including initial, delayed, and recovery blood pressure responses. Furthermore, there is little research examining the relationships between cerebrovascular functioning and falling risk. Therefore, we aimed to: (i) test the association between different blood pressure responses to orthostatic stress and retrospective falling history and; (ii) test the association between cerebrovascular responses to orthostatic stress and falling history.MethodsWe tested 59 elderly residents in long term care facilities who underwent a passive seated orthostatic stress test. Beat-to-beat blood pressure and cerebral blood flow velocity (CBFV) responses were assessed throughout testing. Risk factors for falls and falling history were collected from facility records. Cardiovascular responses to orthostasis were compared between retrospective fallers (≥1 fall in the previous year) and non-fallers.ResultsRetrospective fallers had larger delayed declines in systolic arterial pressure (SAP) compared to non-fallers (p = 0.015). Fallers also showed poorer early (2 min) and late (15 min) recovery of SAP. Fallers had a greater decline in systolic CBFV.ConclusionsOlder adults with a positive falling history have impaired orthostatic control of blood pressure and CBFV. With better identification and understanding of orthostatic blood pressure impairments earlier intervention and management can be implemented, potentially reducing the associated risk of morbidity and mortality. Future studies should utilize the updated OH definitions using beat-to-beat technology, rather than conventional methods that may offer less accurate detection.

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Atrial Fibrillation: An Independent Risk Factor for Nonaccidental Falls in Older Patients

Abstract: AF is an independent risk factor for nonaccidental falls. Our results emphasize the need to screen for AF in patients presenting with nonaccidental fall.

Cited by 39 publications

References 24 publications

High hip fracture risk in men with severe aortic calcification: MrOS study

High hip fracture risk in men with severe aortic calcification: MrOS study

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

Cardiovascular responses to orthostasis and their association with falls in older adults

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