Abstract
Atrial fibrillation (AF) is a relatively common clinical entity with significant morbidity and mortality, particularly in the elderly. Stroke is one of the most significant complications of AF, which can be prevented with the use of anticoagulation. Elder population are at an increased risk of falls and the use of anticoagulation in this group can lead to intracranial hemorrhage. Therefore, it is unclear whether patients at high risk of falls should be anticoagulated. This review article discusses the epidemiology of AF and falls in the elder population, and whether the benefit of anticoagulation outweighs the risks in this group.
Highlights
Atrial fibrillation (AF) is a cardiac arrhythmia defined by the presence of disorganized atrial activity with an irregularly irregular ventricular response on electrocardiogram
They reported that the incidence rates from multiple prospective studies were between 0.2 and 1.6 falls per individual per year with the incidence increasing with advancing age, individuals 80 years of age and older having the highest incidence
Even with the low utilization of warfarin, patients at high risk for falls had 2.8 intracranial hemorrhage (ICH) per 100 patient-years, more than double the 1.1 rate of ICHs found in other patients
Summary
Atrial fibrillation (AF) is a cardiac arrhythmia defined by the presence of disorganized atrial activity with an irregularly irregular ventricular response on electrocardiogram. Rubenstein and Josephson provided an overview of the epidemiology of falls in the elderly both in the community and institutions [12] They reported that the incidence rates from multiple prospective studies were between 0.2 and 1.6 falls per individual per year with the incidence increasing with advancing age, individuals 80 years of age and older having the highest incidence. Even with the low utilization of warfarin, patients at high risk for falls had 2.8 ICHs per 100 patient-years, more than double the 1.1 rate of ICHs found in other patients This increase in ICH was secondary to a higher incidence in ICH resulting from trauma, which was nearly fourfold that of other patients. In patients in this age group, eligible and willing to receive anticoagulation, the data lend support in favor of the use of anticoagulation [19]
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