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Rate or Rhythm Control in Older Atrial Fibrillation Patients: Risk of Fall‐Related Injuries and Syncope
Author(s) -
Dalgaard Frederik,
Pallisgaard Jannik L.,
Numé AnnaKarin,
Lindhardt Tommi Bo,
Gislason Gunnar H.,
TorpPedersen Christian,
Ruwald Martin H.
Publication year - 2019
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.16062
Subject(s) - medicine , interquartile range , atrial fibrillation , rate ratio , confidence interval , population , cardiology , retrospective cohort study , odds ratio , pediatrics , emergency medicine , environmental health
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. J Am Geriatr Soc 67:2023–2030, 2019