Anti-arrhythmic drugs in older atrial fibrillation patients increased the risk of fall-related injuries and syncope compared to rate-lowering monotherapy (IRR 1.29; 95% CI 1.17-1.43).
Cohort (n=100,935)
Yes
Does anti-arrhythmic drug therapy increase the risk of fall-related injuries and syncope compared to rate-lowering monotherapy in older patients with atrial fibrillation?
In older patients with atrial fibrillation, the use of anti-arrhythmic drugs (especially amiodarone) is associated with a significantly increased risk of fall-related injuries and syncope compared to rate-lowering monotherapy, particularly within the first 14 days of treatment.
Effect estimate: IRR 1.29 (95% CI 1.17-1.43)
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.
Dalgaard et al. (Wed,) conducted a cohort in Atrial fibrillation (n=100,935). Anti-arrhythmic drugs (AADs) vs. Rate-lowering monotherapy was evaluated on Composite of fall-related injuries and syncope (IRR 1.29, 95% CI 1.17-1.43). Anti-arrhythmic drugs in older atrial fibrillation patients increased the risk of fall-related injuries and syncope compared to rate-lowering monotherapy (IRR 1.29; 95% CI 1.17-1.43).