Effect of Falls on Frequency of Atrial Fibrillation and Mortality Risk (from the REasons for Geographic And Racial Differences in Stroke Study)

• Type of Material: Article
• Authors: Wesley T. O'Neal, Wake Forest Sch Med; Waqas T. Qureshi, Wake Forest Sch Med; Suzanne E. Judd, University of Alabama Birmingham; Christopher Bowling, Emory University; Virginia J. Howard, University of Alabama Birmingham; George Howard, University of Alabama Birmingham; Elsayed Z. Soliman, Wake Forest Sch Med
• Language: English
• Date: 2015-10-15
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 Elsevier Inc.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amjcard.2015.07.036
• Title of Journal or Parent Work: American Journal of Cardiology
• ISSN: 0002-9149
• Volume: 116
• Issue: 8
• Start Page: 1213
• End Page: 1218
• Grant/Funding Information: This research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Service.
• Keywords: POPULATION; Cardiovascular System & Cardiology; TRIAL; QUALITY-OF-LIFE; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; PROGRAM; Science & Technology; PREVENTION; COMMUNITY; RHYTHM; EXERCISE; OLDER PERSONS

Abstract

It is unclear if patients who have atrial fibrillation (AF) have a greater fall risk compared with those in the general population and if falls increase mortality beyond that observed in AF. A total of 24,117 (mean age 65 ± 9.3 years; 55% women; 38% black) participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were included. AF was identified from baseline electrocardiogram data and by self-reported history. Falls were considered present if participants reported ≥2 falls within the year before the baseline examination. Logistic regression was used to examine the relationship between prevalent AF and falls. Cox regression was used to examine the risk of death in those with AF and falls, separately and in combination, compared with those without either condition. A total of 2,007 participants (8.3%) had baseline AF and 1,655 (6.7%) reported falls. A higher prevalence of falls was reported in those with AF (n = 209; 10%) than those without AF (n = 1,446; 6.5%; p <0.0001). After adjustment for fall risk factors, AF was significantly associated with falls (odds ratio 1.22, 95% confidence interval [CI] 1.04 to 1.44). Compared with no history of AF or falls, the concomitant presence of AF and falls (hazard ratio [HR] 2.12, 95% CI 1.64 to 2.74) was associated with a greater risk of death than AF (HR 1.44, 95% CI 1.28 to 1.62) or falls (HR 1.61, 95% CI 1.42 to 1.82). In conclusion, patients with AF are more likely to report a history of falls in REGARDS. Additionally, participants with AF who report falls have an increased risk of death than those with either condition in isolation.