Prior History of Falls and Risk of Outcomes in Atrial Fibrillation: The Loire Valley Atrial Fibrillation Project - 12/10/14
Abstract |
Background |
Patients with nonvalvular 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 about outcomes in individuals with nonvalvular 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 nonvalvular atrial fibrillation in a 4-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%). Compared with patients without history of falls, those patients were older and less likely to be on oral anticoagulation; they also had higher risk scores for stroke/thromboembolism but not for bleeding. Compared with no prior history of falls, rates of stroke/thromboembolism (P = .01) and all-cause mortality (P < .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% confidence interval [CI], 2.1-12.6; P < .0001), major bleeding (HR 3.32 [1.23-8.91]; P = .02), and all-cause mortality (HR 3.69; 95% CI, 1.52-8.95; P = .04), but not hemorrhagic stroke (HR 4.20; 95% CI, 0.58-30.48; P = .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 hemorrhagic 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.”
Le texte complet de cet article est disponible en PDF.Keywords : Atrial fibrillation, Bleeding, Falls, Stroke, Thromboembolism
Plan
| Funding: None. |
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| Conflicts of Interest: GYHL has served as a consultant for Bayer, Astellas, Merck, AstraZeneca, Sanofi Aventis, Biotronik, BMS/Pfizer, and Boehringer Ingelheim, and has been on the speakers bureau for Bayer, BMS/Pfizer, Boehringer Ingelheim, and Sanofi Aventis. LF has served as a consultant for Bayer, Medtronic, and Sanofi Aventis, and has received funding for conference travel and educational symposia from Boehringer Ingelheim, Bayer, Medtronic, and Sanofi Aventis. AB reports no conflicts of interest. |
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| Authorship: LF, NC, and KH made the primary contribution to data collection. AB, GYHL, and LF contributed to the study conception and design. AB performed the analyses and produced the initial manuscript. All authors contributed to interpretation of results, revising the manuscript critically for important intellectual content, and all approved the final manuscript. AB, LF, and GYHL had full access to all the data in the study and AB takes responsibility for the integrity of the data and the accuracy of the data analysis. |
Vol 127 - N° 10
P. 972-978 - octobre 2014 Retour au numéro
Article précédent
- New-onset Atrial Fibrillation Predicts Heart Failure Progression
- Ryan G. Aleong, William H. Sauer, Gordon Davis, Michael R. Bristow
- Stroke and Bleeding Risk Co-distribution in Real-world Patients with Atrial Fibrillation: The Euro Heart Survey
- Maura Marcucci, Gregory Y.H. Lip, Robby Nieuwlaat, Ron Pisters, Harry J.G.M. Crijns, Alfonso Iorio
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