Atrial Fibrillation Is Associated With Syncope and Falls in Older Adults: A Systematic Review and Meta-analysis.,Mayo Clinic Proceedings

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Atrial Fibrillation Is Associated With Syncope and Falls in Older Adults: A Systematic Review and Meta-analysis.
Mayo Clinic Proceedings ( IF 6.9 ) Pub Date : 2020-04-01 , DOI: 10.1016/j.mayocp.2019.09.029
Varun Malik ₁ , Celine Gallagher ₁ , Dominik Linz ₁ , Adrian D Elliott ₁ , Mehrdad Emami ₁ , Kadhim Kadhim ₁ , Ricardo Mishima ₁ , Jeroen M L Hendriks ₁ , Rajiv Mahajan ₁ , Leonard Arnolda ₂ , Prashanthan Sanders ₁ , Dennis H Lau ₁

Affiliation

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.

中文翻译：

心房颤动与老年人的晕厥和跌倒相关：系统评价和荟萃分析。

目的

为了检查房颤（AF）与晕厥和跌倒的潜在关联，鉴于老年人中AF的患病率不断上升，并且我们也将其视为痴呆的危险因素，因此我们进行了系统的回顾和荟萃分析。

患者和方法

从开始到2019年1月31日，对CENTRAL，PubMed和EMBASE数据库进行了搜索，以检索相关研究。搜索词由MeSH，树标题和将患者与“ AF”，“跌倒”，“晕厥”和“姿势性低血压”相关的关键字组成。若有可能; 使用随机效应模型汇总结果。

结果

总共纳入了10项研究，其中7项研究（36,444例患者；平均±SD年龄，72±10岁）报告了房颤与跌倒之间的相关性，还有3项研究（6769例患者；平均±SD年龄，65±3岁） AF和晕厥之间的关联。汇总分析表明，AF与跌倒（赔率，1.19; 95％CI，1.07-1.33; P = .001）和晕厥（赔率，1.88; 95％CI，1.20-2.94; P = .006 ）独立相关。跌倒总体呈中度偏倚和低中度异质性（I ² = 37％；P = .11），统计学上的异质性较低（I ² = 0％；P= .44）。一项研究（4408名患者；平均±SD年龄，66±6岁）与持续性房颤而不是阵发性房颤相关的体位性不耐受。