SAN FRANCISCO – A history of atrial fibrillation independently more than triples the risk of a nonaccidental fall in the elderly, an emergency department study has shown.
Of 459 consecutive elderly patients who presented to a large emergency department with a chief complaint of a fall, 225 had a fall deemed to be nonaccidental – that is, a fall not explained by mitigating circumstances such as a loose paving stone or a collision with a skateboarder.
A history of atrial fibrillation (AF) was present in 20.4% of those with a nonaccidental fall, compared with 10.6% of the 234 elderly patients who presented with an accidental fall, Dr. Joya A. Ganguly reported at the annual meeting of the Heart Rhythm Society.
The study population had a median age of 81 years. Patients not older than that who had a nonaccidental fall were 3.36-fold more likely to have a history of AF, compared with those who had an accidental fall. However, among patients older than 81 years, a history of AF was only 1.3-fold more frequent in those with a nonaccidental fall, compared with an accidental fall, and this difference was not significant, according to Dr. Ganguly of the University of Utah, Salt Lake City.
Patients with a nonaccidental fall were an average of 4 years older than those who presented with an accidental fall. In addition to being more likely to have a history of AF, patients with a nonaccidental fall were also more likely to have a neurologic disorder and to be on three or more medications.
In contrast, there were no differences between patients in the nonaccidental and accidental fall groups in terms of blood pressure, heart rate, orthostatic hypotension, prior pacemaker placement, a history of heart failure, or the prevalence of AF at presentation, which was about 8% in both groups.
Dr. Ganguly concluded that these study findings suggest elderly patients with a history of AF might be good candidates for a fall prevention education program along the lines of the national program recently proposed by investigators at the University of Southern California as a cost-effective intervention (Clin. Geriatr. Med. 2010;26:751-66).
She said she had no relevant financial disclosures.