Some Medications for Atrial Fibrillation May Raise Risk of Falls

MedicalResearch.com Interview with:


MedicalResearch.com: What is the background for this study?

Response: We know that having atrial fibrillation puts you at a higher risk of falls, especially if you are elderly and frail. Additionally, some of the medications used to treat it can cause bradycardia (low heart rate), which could itself increase the risk of falls. Therefore, the aim of this study was to investigate if common medications used to treat atrial fibrillation in older patients were associated with fall-related injuries and syncope (fainting). The medications investigated were rate-lowering drugs (beta-blockers, digoxin, verapamil, diltiazem) and the anti-arrhythmic drugs (amiodarone, propafenone, and flecainide).

MedicalResearch.com: What are the main findings? 

Response: Our key findings are that older patients (those above 65 years of age) with atrial fibrillation, who were receiving anti-arrhythmic therapy, alone or in combination with a rate-lowering drug, were at a higher risk of experiencing a fall-related injury and syncope compared to those only using rate-lowering drugs.

Furthermore, the risk was higher within the first 90 days of treatment and strongest for the first 14 days. When we looked at the specific drug types, we found that the associations with fall-related injuries and syncope were primarily driven by the drug amiodarone.

MedicalResearch.com: What should readers take away from your report?

Response: The population of older patients with AF is growing and many receive multiple drugs for different conditions, including heart disease. Knowing the benefits and risks of a medical therapy is crucial to make shared decisions and provide quality patient care. Fall-related injuries are detrimental to old people’s health and knowledge of factors associated with falls is vital. Treatment with anti-arrhythmic drugs may have an impact on the fall risk and this should be considered when prescribing these drugs, particularly if the patient is already taking other rate-lowering medication. The initial higher risk of syncope and fall-related injuries are also important factors that should be considered before prescribing. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: These findings warrant replication in different cohorts and the investigation of a potential dose-response relationship between the amiodarone dose and the risk of falls and syncope.

Another research area is to address the frailty of these patients, it might be the frailest patients that are at highest risk of falls when prescribed anti-arrhythmic drugs. Another pertinent question to answer is ‘is the risk of syncope on anti-antiarrhythmic drugs large enough that driving could be affected’? 


Frederik Dalgaard, Jannik L. Pallisgaard, Anna‐Karin Numé, Tommi Bo Lindhardt, Gunnar H. Gislason, Christian Torp‐Pedersen, Martin H. Ruwald. Rate or Rhythm Control in Older Atrial Fibrillation Patients: Risk of Fall‐Related Injuries and Syncope. Journal of the American Geriatrics Society, 2019; DOI: 10.1111/jgs.16062

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Last Updated on July 30, 2019 by Marie Benz MD FAAD