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Comorbidity patterns and the risk of injurious falls in older people with atrial fibrillation : findings from a Swedish nation-wide population-based study

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Abstract
Background: Atrial fibrillation (AF) is associated with an increased fall risk, partly due to AF-related comorbidities. We investigated the impact of different comorbidity patterns on fall risk in older adults with AF. Methods: Using the Swedish National Patient Register, we identified 203,042 adults (45% females) with AF and at least one comorbidity, aged 65 years or older, on 01/01/2017. The primary study outcome was any fall requiring medical attention. Secondary outcomes were falls with fractures, falls with hip fractures, and falls with head trauma. Comorbidity patterns were identified through latent class analysis, and their association with 3-year fall risk was tested through Cox regressions. Results: The sample mean age was 79.6 (SD: 7.9) years, and the mean number of chronic diseases was 6.6 (SD 3.2). We identified one unspecific (34.2%) and six specific comorbidity patterns characterized by neuropsychiatric (6.6%), eye (17.4%), musculoskeletal (7.2%), metabolic (15.8%), cardiovascular (7.4%), and complex (11.3%) chronic conditions coexisting with AF. Older adults with AF and complex (HR=1.63, 95%CI: 1.56-1.70), neuropsychiatric (HR=1.48, 95%CI: 1.41-1.56), cardiovascular (HR=1.21, 95%CI: 1.15-1.27), eye (HR=1.16, 95%CI: 1.12-1.20), and musculoskeletal (HR=1.07, 95%CI: 1.01-1.13) comorbidity had an increased fall risk compared to those with unspecific comorbidity. The highest risk of falls with fractures or head trauma was found in older adults displaying a complex or neuropsychiatric disease pattern, respectively. Higher estimates emerged in males and those aged <80 years. Conclusions: Evaluating comorbidity patterns in older AF patients could help stratify the risk of falls in this population and support targeted preventive interventions.
Keywords
atrial fibrillation, falls, fractures, multimorbidity

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MLA
Trevisan, Caterina, et al. “Comorbidity Patterns and the Risk of Injurious Falls in Older People with Atrial Fibrillation : Findings from a Swedish Nation-Wide Population-Based Study.” EUROPEAN JOURNAL OF INTERNAL MEDICINE, 2024, doi:10.1016/j.ejim.2024.11.011.
APA
Trevisan, C., Damiano, C., Dai, L., Calderón‑Larrañaga, A., Wastesson, J., Johnell, K., … AFFIRMO Consortium, [missing]. (2024). Comorbidity patterns and the risk of injurious falls in older people with atrial fibrillation : findings from a Swedish nation-wide population-based study. EUROPEAN JOURNAL OF INTERNAL MEDICINE. https://doi.org/10.1016/j.ejim.2024.11.011
Chicago author-date
Trevisan, Caterina, Cecilia Damiano, Lu Dai, Amaia Calderón‑Larrañaga, Jonas Wastesson, Kristina Johnell, Cheïma Amrouch, et al. 2024. “Comorbidity Patterns and the Risk of Injurious Falls in Older People with Atrial Fibrillation : Findings from a Swedish Nation-Wide Population-Based Study.” EUROPEAN JOURNAL OF INTERNAL MEDICINE. https://doi.org/10.1016/j.ejim.2024.11.011.
Chicago author-date (all authors)
Trevisan, Caterina, Cecilia Damiano, Lu Dai, Amaia Calderón‑Larrañaga, Jonas Wastesson, Kristina Johnell, Cheïma Amrouch, Graziano Onder, Alessandra Marengoni, Riccardo Proietti, Gregory Lip, Søren Johnsen, Mirko Petrovic, Davide Liborio Vetrano, Delphine De Smedt, Stefanie De Buyser, and [missing] AFFIRMO Consortium. 2024. “Comorbidity Patterns and the Risk of Injurious Falls in Older People with Atrial Fibrillation : Findings from a Swedish Nation-Wide Population-Based Study.” EUROPEAN JOURNAL OF INTERNAL MEDICINE. doi:10.1016/j.ejim.2024.11.011.
Vancouver
1.
Trevisan C, Damiano C, Dai L, Calderón‑Larrañaga A, Wastesson J, Johnell K, et al. Comorbidity patterns and the risk of injurious falls in older people with atrial fibrillation : findings from a Swedish nation-wide population-based study. EUROPEAN JOURNAL OF INTERNAL MEDICINE. 2024;
IEEE
[1]
C. Trevisan et al., “Comorbidity patterns and the risk of injurious falls in older people with atrial fibrillation : findings from a Swedish nation-wide population-based study,” EUROPEAN JOURNAL OF INTERNAL MEDICINE, 2024.
@article{01JDYKN1KNNVNFGK9CTJ2H0W8Z,
  abstract     = {{Background: Atrial fibrillation (AF) is associated with an increased fall risk, partly due to AF-related comorbidities. We investigated the impact of different comorbidity patterns on fall risk in older adults with AF.
Methods: Using the Swedish National Patient Register, we identified 203,042 adults (45% females) with AF and at least one comorbidity, aged 65 years or older, on 01/01/2017. The primary study outcome was any fall requiring medical attention. Secondary outcomes were falls with fractures, falls with hip fractures, and falls with head trauma. Comorbidity patterns were identified through latent class analysis, and their association with 3-year fall risk was tested through Cox regressions. 
Results: The sample mean age was 79.6 (SD: 7.9) years, and the mean number of chronic diseases was 6.6 (SD 3.2). We identified one unspecific (34.2%) and six specific comorbidity patterns characterized by neuropsychiatric (6.6%), eye (17.4%), musculoskeletal (7.2%), metabolic (15.8%), cardiovascular (7.4%), and complex (11.3%) chronic conditions coexisting with AF. Older adults with AF and complex (HR=1.63, 95%CI: 1.56-1.70), neuropsychiatric (HR=1.48, 95%CI: 1.41-1.56), cardiovascular (HR=1.21, 95%CI: 1.15-1.27), eye (HR=1.16, 95%CI: 1.12-1.20), and musculoskeletal (HR=1.07, 95%CI: 1.01-1.13) comorbidity had an increased fall risk compared to those with unspecific comorbidity. The highest risk of falls with fractures or head trauma was found in older adults displaying a complex or neuropsychiatric disease pattern, respectively. Higher estimates emerged in males and those aged <80 years.
Conclusions: Evaluating comorbidity patterns in older AF patients could help stratify the risk of falls in this population and support targeted preventive interventions.}},
  author       = {{Trevisan, Caterina and Damiano, Cecilia and Dai, Lu and Calderón‑Larrañaga, Amaia and Wastesson, Jonas and Johnell, Kristina and Amrouch, Cheïma and Onder, Graziano and Marengoni, Alessandra and Proietti, Riccardo and Lip, Gregory and Johnsen, Søren and Petrovic, Mirko and Vetrano, Davide Liborio and De Smedt, Delphine and De Buyser, Stefanie and AFFIRMO Consortium, [missing]}},
  issn         = {{0953-6205}},
  journal      = {{EUROPEAN JOURNAL OF INTERNAL MEDICINE}},
  keywords     = {{atrial fibrillation,falls,fractures,multimorbidity}},
  language     = {{eng}},
  pages        = {{9}},
  title        = {{Comorbidity patterns and the risk of injurious falls in older people with atrial fibrillation : findings from a Swedish nation-wide population-based study}},
  url          = {{http://doi.org/10.1016/j.ejim.2024.11.011}},
  year         = {{2024}},
}

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