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The Risk of Falling and Consequences of Falling in Patients with Atrial Fibrillation Receiving Different Types of Anticoagulant

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Abstract

Objective

Our objective was to investigate the predictors of falls requiring a visit to the emergency department in patients with nonvalvular atrial fibrillation (AF) receiving different types of anticoagulants and to investigate the clinical consequences of falling in the same population.

Methods

A total of 1217 patients with nonvalvular AF from two institutions were retrospectively evaluated. Each patient underwent a physical examination, and clinical histories and medication profiles were taken from each patient at baseline.

Results

The median age of our cohort was 71 years; 52.3% were males, and 86.1% of patients were receiving anticoagulation at study baseline. The 5-year freedom-from-falling rate was 81.6%. The use and type of anticoagulation was not significantly associated with the risk of falling (P = 0.222), whereas higher Morse Fall Scale (MFS), CHA2DS2-VASC (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65–74 years, sex category), and HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly [> 65 years], drugs/alcohol concomitantly) scores were significantly associated with a higher hazard of the first fall in univariate analyses. In the multivariate Cox regression model, MFS, older age, osteoporosis, higher levels of high-density lipoprotein cholesterol, higher diastolic blood pressure, and use of amiodarone, diuretics, or short- and medium-acting benzodiazepines were mutually independent predictors of the first fall. Of 163 patients, 93 (57%) had a bone fracture during the fall. Type of anticoagulation significantly affected survival after the first fall (P < 0.001): patients inadequately anticoagulated with warfarin had worse survival rates, and patients receiving apixaban and dabigatran had the best survival rates after the first fall.

Conclusion

Older patients who had comorbidities and were taking amiodarone, diuretics, or short- or medium-acting benzodiazepines had the highest risk of falls. The type and quality of anticoagulation did not seem to affect the risk of falling but did significantly affect survival after the first fall.

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Author information

Authors and Affiliations

  1. Cardiology Department, University Hospital Dubrava, Zagreb, Croatia

    Ivana Jurin & Irzal Hadžibegović

  2. Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia

    Marko Lucijanić

  3. School of Medicine, University of Zagreb, Zagreb, Croatia

    Marko Lucijanić & Tomislav Letilović

  4. Division of Cardiology, Department of Medicine, University Hospital Merkur, Zagreb, Croatia

    Vedran Radonić & Tomislav Letilović

  5. Health Care Center Zagreb-West, Zagreb, Croatia

    Jelena Lucijanić

  6. Urology Department, University Hospital Dubrava, Zagreb, Croatia

    Stjepan Mesarov

  7. Nephrology and Dialysis Department, University Hospital Dubrava, Zagreb, Croatia

    Nikola Zagorec

  8. Faculty of Dental Medicine and Health Care, Josip Juraj Strossmayer University, Osijek, Croatia

    Irzal Hadžibegović

Authors
  1. Ivana Jurin
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  2. Marko Lucijanić
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  4. Tomislav Letilović
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  5. Jelena Lucijanić
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  6. Stjepan Mesarov
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  8. Irzal Hadžibegović
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Corresponding author

Correspondence to Marko Lucijanić.

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Funding

No sources of funding were used to conduct this study or prepare this manuscript.

Conflict of interest

IJ and TL have received speaker honoraria from Boehringer Ingelheim. IH has received speaker honoraria from Boehringer Ingelheim, Pfizer, and Bayer. Marko Lucijanić, Vedran Radonić, Jelena Lucijanić, Stjepan Mesarov, and Nikola Zagorec have no conflicts of interest that are directly relevant to the content of this article

Ethics approval

This study was approved by the relevant institutional review boards.

Consent to participate

Not applicable as this was a retrospective study.

Consent for publication

Not applicable.

Availability of data and material

Data are available on reasonable request.

Code availability

Not applicable as commercial statistical software was used.

Author contributions

IJ, ML, and IH conceptualized the study and drafted the manuscript. ML performed statistical analysis. All authors participated in data acquisition and interpretation, critical revision of the manuscript, and final approval of the submitted version. All authors agree to be accountable for all aspects of the work.

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Jurin, I., Lucijanić, M., Radonić, V. et al. The Risk of Falling and Consequences of Falling in Patients with Atrial Fibrillation Receiving Different Types of Anticoagulant. Drugs Aging 38, 417–425 (2021). https://doi.org/10.1007/s40266-021-00843-9

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  • DOI: https://doi.org/10.1007/s40266-021-00843-9

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