Aguirre, Kevin Sam D.

BSN- 406

Atrial Fibrillation: An Independent Nonaccidental Falls in Older Patients

Risk

Factor

for

Natalie A. Sanders, D.O; Joya A. Ganguly, M.D; Tawni L. Jetter, N.P; Marcos Daccarett, M.D; Stephen L. Wasmund, Ph.D; Michelino Brignole, M.D; Mohamed H. Hamdan, M.D., M.B.A.

September 04, 2012 Background:

Nonaccidental falls are often the result of a combination of factors including cardiovascular disorders such as orthostatic hypotension and unspecified cardiac arrhythmias. The objective of this study was to determine if there is an association between atrial fibrillation (AF) and nonaccidental falls.

Methods:
We reviewed the records of 442 consecutive patients >65 years old who presented to the Emergency Department at the University of Utah Medical Center with a complaint of fall.

Results:
Two-hundred eleven patients presented with nonaccidental fall, 231 patients with accidental fall. Patients with nonaccidental fall were more likely to be older, have a history of hypertension and neurological disorders, and taking five or more medications when compared to patients with accidental fall. Despite a similar prevalence of sinus rhythm at presentation, the prevalence of a history of AF was significantly higher in patients with nonaccidental fall compared to patients with accidental fall (26% vs 15%; P = 0.003). After adjusting for clinically and statistically significant predictors with a multivariate logistic regression analysis, AF, neurological disorders, and age 81 years were independent predictors of nonaccidental fall. In patients 81 years old (median age), the risk of nonaccidental falls was 2.5 times greater in patients with a history of AF when compared to those without a history of AF (odds ratio = 2.53 [confidence interval 95% 1.35], P = 0.007).

Reaction:
In this study, I found that the prevalence of a history of AF was significantly higher in patients with nonaccidental falls when compared to those with accidental falls despite a similar prevalence of sinus rhythm at presentation. In addition, we found that a history of AF conferred a 2.5-fold greater risk for a nonaccidental fall in patients 81 years old (median age). To our knowledge, this is the first study to report that a history of AF independently increases the risk for nonaccidental falls in older patients. The underlying mechanisms and clinical implications shoul be evaluated because it is not yet precise and complete. Further studies should be made evaluating this relationship including the proposed ideas and informations are needed.