Citation

Banerjee A, Clementy N, Haguenoer K, Fauchier L, Lip GY. Am. J. Med. 2014; 127(10): 972-978.

Affiliation

University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, UK. Electronic address: g.y.h.lip@bham.ac.uk.

Copyright

(Copyright © 2014, Elsevier Publishing)

DOI

10.1016/j.amjmed.2014.05.035

PMID

24929021

Abstract

BACKGROUND AND PURPOSE: Patients with non-valvular atrial fibrillation are often denied oral anticoagulation due to falls risk. The latter is variably defined and existing studies have not compared the associated risk of bleeding with other cardiovascular events. There are no data regarding outcomes in individuals with non-valvular atrial fibrillation with a prior history of (actual) falls, rather than being 'at risk of falls'. Our objective was to evaluate the risk of cardiovascular outcomes associated with prior history of falls in patients with atrial fibrillation in a contemporary 'real world' cohort.

METHODS: Patients with non-valvular atrial fibrillation in a four-hospital-institution between 2000 and 2010 were included. Stroke/thromboembolism event rates were calculated according to prior history of falls. Risk factors were investigated by Cox regression.

RESULTS: Among 7156 atrial fibrillation patients, prior history of falls/trauma was uncommon (n=76; 1.1%) and compared with patients without history of falls, those patients were older, less likely to be on oral anticoagulation and had higher risk scores for stroke/thromboembolism, but not for bleeding. Compared with no prior history of falls, rates of stroke/thromboembolism (p=0.01) and all-cause mortality (p<0.0001) were significantly higher in patients with previous falls. In multivariable analyses, prior history of falls was independently associated with stroke/thromboembolism (hazard ratio, HR 5.19, 95% CI 2.1-12.6;p<0.0001), major bleeding (HR 4.01, 1.49-10.8;p=0.006) and all-cause mortality (HR 3.69, 1.52-8.95; p=0.04), but not haemorrhagic stroke (HR 4.20, 0.58-30.48; p=0.16) in patients on oral anticoagulation.

CONCLUSION: In this large 'real world' atrial fibrillation cohort, prior history of falls was uncommon, but independently increased risk of stroke/thromboembolism, bleeding and mortality, but not haemorrhagic stroke in the presence of anticoagulation. Prior history of (actual) falls may be a more clinically useful risk prognosticator than "being at risk of falls".

Language: en