Effect of Falls on Frequency of Atrial Fibrillation and Mortality Risk (from the REasons for Geographic And Racial Differences in Stroke Study).
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.
Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. Electronic address: woneal@wakehealth.edu.
Wesley T
WT
O'Neal
Section on Cardiology, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Waqas T
WT
Qureshi
Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
Suzanne E
SE
Judd
Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta VA Medical Center, Decatur, Georgia; Department of Medicine, Emory University, Atlanta, Georgia.
C Barrett
CB
Bowling
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
Virginia J
VJ
Howard
Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
George
G
Howard
Section on Cardiology, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Elsayed Z
EZ
Soliman
D000058:Accidental Falls / Q000401:mortality*; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D012306:Risk; D057566:Self Report; D012959:Socioeconomic Factors; D015144:Southeastern United States / Q000453:epidemiology; D020521:Stroke / Q000208:ethnology* / Q000401:mortality*; D015996:Survival Rate; D044465:White People / Q000706:statistics & numerical data*