History of falls in patients with atrial fibrillation and risk of major outcomes: analysis from the Prospective GLORIA-AF Registry.

Abstract

Falls pose concerns for the management and prognosis of patients with atrial fibrillation (AF). Epidemiological data on patients with AF who fall are limited. From the prospective global GLORIA-AF Registry Phase III study, we evaluated patients with a recent diagnosis of AF and CHA₂DS₂-VASc score ≥ 1 according to previous history of falling at baseline. We analyzed the associations with use of oral anticoagulant (OAC) and other drugs, risk of OAC discontinuation, and risk of major outcomes using multivariable regression models. Primary outcome was a composite of all-cause death and major adverse cardiovascular events (MACE); exploratory secondary outcomes were also analyzed. 20,875 patients (age 70.1 ± 10.3 years, 45.0% females) were included: 874 (4.2%) had prior falls. Patients with falls had more complex clinical profiles, were older, and were more likely female. No difference in OAC use was observed at baseline based on prior falls (OR [95%CI] 0.90 [0.75-1.08]), but patients with previous falls who received OAC were more likely treated with a NOAC compared to VKA (OR [95%CI] 1.29: 1.07-1.55) and were more likely to discontinue OAC during follow-up (HR 1.18, 95%CI 1.02-1.36). Patients with prior falls had a higher risk of the primary composite outcome (HR 1.63, 95%CI 1.40-1.90) and all secondary outcomes explored, including thromboembolism and major bleeding. Patients in the GLORIA-AF Registry with prior falls were more likely to receive a NOAC (vs. VKA) and had a higher risk of major adverse events, including all-cause mortality, thromboembolism, and major bleeding.