Key result
Anti-arrhythmics in older AF are linked to ~29% more fall-related injuries and syncope versus rate-lowering monotherapy.
Why the study?
AF management with rate and/or rhythm control could lead to fall-related injuries and syncope, especially in older patients, but this association required investigation in a real-world cohort.
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?
Population
100 935 AF patients aged 65 years or older claiming RLDs and/or AADs
Comparison
Rate-lowering monotherapy vs dual therapy, AAD monotherapy, or AAD plus rate-lowering therapy
Design
Retrospective cohort study
Follow-up
Median 2.1 years
Authors
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May warrant caution with AADs in older AF patients; observational data leave open causality and require prospective confirmation.
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?
Effect estimate: IRR 1.29 (95% CI 1.17-1.43)
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.
Dalgaard et al. (2019) 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).
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