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J Am Geriatr Soc. 2019 Jul 24. doi: 10.1111/jgs.16062. [Epub ahead of print]

Rate or Rhythm Control in Older Atrial Fibrillation Patients: Risk of Fall-Related Injuries and Syncope.

Author information

1
Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark.
2
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
3
The Danish Heart Foundation, Copenhagen, Denmark.
4
The National Institute of Public Health, University of Southern Denmark, Odense, Denmark.
5
Department of Health Science and Technology, Aalborg University Hospital, Aalborg, Denmark.

Abstract

OBJECTIVES:

Management of atrial fibrillation (AF) with rate and/or rhythm control could lead to fall-related injuries and syncope, especially in the older AF population. We aimed to determine the association of rate and/or rhythm control with fall-related injuries and syncope in a real-world older AF cohort.

DESIGN:

A retrospective cohort study.

SETTING:

Danish nationwide administrative registries from 2000 to 2015.

PARTICIPANTS:

A total of 100 935 patients with AF aged 65 years or older claiming prescription of rate-lowering drugs (RLDs) and/or anti-arrhythmic drugs (AADs) were included. We compared the use of rate-lowering monotherapy with rate-lowering dual therapy, AAD monotherapy, and AAD combined with rate-lowering therapy.

MEASUREMENTS:

Outcomes were fall-related injuries and syncope as a composite end point (primary) or separate end point (secondary).

RESULTS:

In this population, the median age was 78 years (interquartile range [IQR] = 72-84 y), and 53 481 (53.0%) were women. During a median follow-up of 2.1 years (IQR = 1.0-5.1), 17 132 (17.0%) experienced a fall-related injury, 5745 (5.7%) had a syncope, and 21 093 (20.9%) experienced either. Compared with rate-lowering monotherapy, AADs were associated with a higher risk of fall-related injuries and syncope. The incidence rate ratio (IRR) for the composite end point was 1.29 (95% confidence interval [CI]: 1.17-1.43) for AAD monotherapy and 1.46 [95% CI = 1.34-1.58] for AAD combined with rate-lowering therapy. When stratifying by individual drugs, amiodarone significantly increased the risk of fall-related injuries and syncope (IRR = 1.40 [1.26-1.55]). Compared with more than 180 days of rate-lowering monotherapy, a higher risk of all outcomes was seen in the first 90 days of any treatment; however, the greatest risk was in the first 14 days for those treated with AADs.

CONCLUSION:

In AF patients aged 65 years and older, AAD use was associated with a higher risk of fall-related injuries and syncope, and the risk was highest within the first 14 days for those treated with AADs. Only amiodarone use was associated with a higher risk.

KEYWORDS:

anti-arrhythmic drugs; atrial fibrillation; fall-related injury; rate-lowering drugs; syncope

PMID:
31339174
DOI:
10.1111/jgs.16062

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