Impact of a history of falls on clinical outcomes in older adult non-valvular atrial fibrillation patients: an ANAFIE registry study.

BACKGROUND

A history of falls represents frailty in older adult patients. However, the influence of a history of falls on clinical outcomes in older adult non-valvular atrial fibrillation (NVAF) patients has not been fully elucidated. This All Nippon AF In the Elderly (ANAFIE) Registry sub-analysis evaluated the relationship between a history of falls within the year prior to the study's commencement and 2-year clinical outcomes in a large, older adult (aged ≥ 75 years) Japanese population with NVAF.

METHODS

The ANAFIE Registry (UMIN000024006) was a multicenter, prospective, observational study with a 24-month follow-up period. Of the 32,275 enrolled patients, 28,664 with available fall history data were divided into two groups: those with and without a history of falls within the previous year (n = 2,347 and 26,317, respectively).

RESULTS

Anticoagulant therapy was administered in 95% and 94% of these patients, respectively. Compared with patients without a history of falls, those with a fall history had higher incidences of stroke/systemic embolic events (2.59 vs. 1.52 per 100 person-years), major bleeding (2.20 vs. 0.96), intracranial hemorrhage (ICH) (1.71 vs. 0.66), cardiovascular death (2.12 vs. 0.97), all-cause death (6.78 vs. 3.34), and falls/fractures (13.52 vs. 5.44) (all, P < 0.001) during the follow-up period. In multivariable models, these associations remained significant for all outcomes. Notably, these clinical events, particularly major bleeding and ICH, were frequently observed after falls/fractures that occurred during the follow-up period. Compared with warfarin, direct oral anticoagulants were associated with significantly lower risks of new falls/fractures during the follow-up period, irrespective of baseline fall history.

CONCLUSIONS

A history of falls within the previous year was associated with worse prognosis in older adult Japanese NVAF patients. Major bleeding (particularly ICH) occurred frequently following new occurrences of falls/fractures. Warfarin was associated with higher risks of subsequent falls/fractures.

TRIAL REGISTRATION: ANAFIE Registry was registered in the UMIN Clinical Trials Registry (identifier: UMIN000024006) on September 12, 2016.