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

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@article{a7c5a79aa3fb4b94864975481a04adb1,
title = "Rate or Rhythm Control in Older Atrial Fibrillation Patients: Risk of Fall-Related Injuries and Syncope",
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. J Am Geriatr Soc 67:2023-2030, 2019.",
author = "Frederik Dalgaard and Pallisgaard, {Jannik L} and Anna-Karin Num{\'e} and Lindhardt, {Tommi Bo} and Gislason, {Gunnar H} and Christian Torp-Pedersen and Ruwald, {Martin H}",
note = "{\circledC} 2019 The American Geriatrics Society.",
year = "2019",
month = "10",
doi = "10.1111/jgs.16062",
language = "English",
volume = "67",
pages = "2023--2030",
journal = "American Geriatrics Society. Journal",
issn = "0002-8614",
publisher = "Wiley-Blackwell Publishing, Inc",
number = "10",

}

RIS

TY - JOUR

T1 - Rate or Rhythm Control in Older Atrial Fibrillation Patients

T2 - Risk of Fall-Related Injuries and Syncope

AU - Dalgaard, Frederik

AU - Pallisgaard, Jannik L

AU - Numé, Anna-Karin

AU - Lindhardt, Tommi Bo

AU - Gislason, Gunnar H

AU - Torp-Pedersen, Christian

AU - Ruwald, Martin H

N1 - © 2019 The American Geriatrics Society.

PY - 2019/10

Y1 - 2019/10

N2 - 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.

AB - 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.

U2 - 10.1111/jgs.16062

DO - 10.1111/jgs.16062

M3 - Journal article

VL - 67

SP - 2023

EP - 2030

JO - American Geriatrics Society. Journal

JF - American Geriatrics Society. Journal

SN - 0002-8614

IS - 10

ER -

ID: 59123096