TY - JOUR
T1 - Atrial Fibrillation Is Associated With Syncope and Falls in Older Adults
T2 - A Systematic Review and Meta-analysis
AU - Malik, Varun
AU - Gallagher, Celine
AU - Linz, Dominik
AU - Elliott, Adrian D.
AU - Emami, Mehrdad
AU - Kadhim, Kadhim
AU - Mishima, Ricardo
AU - Hendriks, Jeroen M.L.
AU - Mahajan, Rajiv
AU - Arnolda, Leonard
AU - Sanders, Prashanthan
AU - Lau, Dennis H.
PY - 2020/4
Y1 - 2020/4
N2 - Objective: To examine the potential association of atrial fibrillation (AF) to syncope and falls, we undertook a systematic review and meta-analysis given the increasing prevalence of AF in older adults as well as emerging data that it is a risk factor for dementia. Patients and Methods: CENTRAL, PubMed, and EMBASE databases were searched from inception to January 31, 2019, to retrieve relevant studies. Search terms consisted of MeSH, tree headings, and keywords relating patients with “AF,” “falls,” “syncope,” and “postural hypotension.” When possible; results were pooled using a random-effects model. Results: A total of 10 studies were included, with 7 studies (36,444 patients; mean ± SD age, 72±10 years) reporting an association between AF and falls and 3 studies (6769 patients; mean ± SD age, 65±3 years) reporting an association between AF and syncope. Pooled analyses demonstrate that AF is independently associated with falls (odds ratio, 1.19; 95% CI, 1.07-1.33; P=.001) and syncope (odds ratio, 1.88; 95% CI, 1.20-2.94; P=.006). There was overall moderate bias and low-moderate heterogeneity (I2=37%; P=.11) for falls and moderate bias with low statistical heterogeneity (I2=0%; P=.44) for syncope. Persistent AF, but not paroxysmal AF, was associated with orthostatic intolerance in 1 study (4408 patients; mean ± SD age, 66±6 years). Conclusion: AF is independently associated with syncope and falls in older adults. Further studies are needed to delineate mechanistic links and to guide management to improve outcomes in these patients. Trial Registration: PROSPERO: trial identifier: CRD4201810721.
AB - Objective: To examine the potential association of atrial fibrillation (AF) to syncope and falls, we undertook a systematic review and meta-analysis given the increasing prevalence of AF in older adults as well as emerging data that it is a risk factor for dementia. Patients and Methods: CENTRAL, PubMed, and EMBASE databases were searched from inception to January 31, 2019, to retrieve relevant studies. Search terms consisted of MeSH, tree headings, and keywords relating patients with “AF,” “falls,” “syncope,” and “postural hypotension.” When possible; results were pooled using a random-effects model. Results: A total of 10 studies were included, with 7 studies (36,444 patients; mean ± SD age, 72±10 years) reporting an association between AF and falls and 3 studies (6769 patients; mean ± SD age, 65±3 years) reporting an association between AF and syncope. Pooled analyses demonstrate that AF is independently associated with falls (odds ratio, 1.19; 95% CI, 1.07-1.33; P=.001) and syncope (odds ratio, 1.88; 95% CI, 1.20-2.94; P=.006). There was overall moderate bias and low-moderate heterogeneity (I2=37%; P=.11) for falls and moderate bias with low statistical heterogeneity (I2=0%; P=.44) for syncope. Persistent AF, but not paroxysmal AF, was associated with orthostatic intolerance in 1 study (4408 patients; mean ± SD age, 66±6 years). Conclusion: AF is independently associated with syncope and falls in older adults. Further studies are needed to delineate mechanistic links and to guide management to improve outcomes in these patients. Trial Registration: PROSPERO: trial identifier: CRD4201810721.
KW - atrial fibrillation
KW - falls - elderly
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=85081953539&partnerID=8YFLogxK
U2 - 10.1016/j.mayocp.2019.09.029
DO - 10.1016/j.mayocp.2019.09.029
M3 - Review article
C2 - 32247342
AN - SCOPUS:85081953539
VL - 95
SP - 676
EP - 687
JO - Mayo Clinic Proceedings
JF - Mayo Clinic Proceedings
SN - 0025-6196
IS - 4
ER -