PO140 | HISTORY OF FALLS IN PATIENTS WITH ATRIAL FIBRILLATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

A.P. Speziale¹, G. Buoninfante¹, A. Ronca^2|4, B. Corica³, V. Trapani¹, M. Moretti¹, G. Annecchini¹, R. Cangemi¹, V. Raparelli¹, M. Proietti^2|4, S. Basili¹, G.F. Romiti⁵ | ¹Department of Translational and Precision Medicine, Sapienza University of Roma, Roma, Italy; ²Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy; ³University of Modena and Reggio Emilia, Modena, Italy; ⁴Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milano, Italy; ⁵Department of Wellbeing, Health and Environmental Sustainability, Sapienza University of Roma, Rieti, Italy

Background and Aims. In patients with Atrial Fibrillation (AF), falls pose substantial challenges in the management, particularly due to the increased risk of bleeding, and uncertainties on the use of oral anticoagulants (OAC). Nonetheless, epidemiological data on falls in patients with AF and their consequences are still scarce. We aimed to perform a systematic review and meta-analysis to evaluate the prevalence of history of falls in patients with AF, and their association with use of OAC, and with long-term clinical outcomes.
Methods. We performed a systematic review and meta-analysis, according to PRISMA Guidelines. MEDLINE and EMBASE were searched up to May 2025; we included all studies reporting either the prevalence of history of falls or the association of history of falls with long-term outcomes (all-cause death, stroke/thromboembolism [TE], major bleeding, intracranial hemorrhage [ICH], and recurrent falls) in patients with AF. Among the studies included, we also evaluated the use of OAC according to history of falls. Data on the prevalence of history of falls were pooled using a generalized linear mixed model, and results were reported as pooled prevalence and 95% Confidence Intervals (95%CI). Number of patients prescribed with OAC and total number of patients were pooled using random-effect models, and results were reported as pooled Odds Ratios (OR) and 95%CI. For long-term outcomes, we extracted Hazard Ratios (HR) and 95%CI and converted them to log-scale for pooling; where HR and 95%CI were unavailable, number of events and total number of patients were extracted. Results were reported as pooled Hazard Ratios (HR) and 95%CI. Heterogeneity was estimated using the restricted maximum-likelihood estimator, and the inconsistency index (I²) was also reported. Subgroup analyses and meta-regressions were also performed to explore potential sources of heterogeneity.
Results. 4,357 studies were found through literature search; after duplicates removal, screening of records, and cross-reference search, 37 studies were included, with over 2 million patients with AF. The pooled prevalence of history of falls was 11.4% (95%CI: 8.3-15.4%), with substantial heterogeneity observed across studies (I²=99.9%; Figure 1, left panel). History of falls was associated with lower odds of receiving OAC (OR: 0.57; 95%CI: 0.39-0.83 across 14 studies; I²=98.6%); prevalence of male sex, and higher uptake of direct oral anticoagulants were associated with higher odds of receiving OAC at meta-regression analysis. History of falls was associated with a higher risk of long-term outcomes (Figure 1, right panel), including all-cause mortality (HR 1.63, 95%CI: 1.23-2.18, I²=91.4%), stroke/TE (HR: 1.30, 95%CI: 1.01-1.66, I²=70.6%), major bleeding (HR: 1.54, 95%CI: 1.14-2.06, I²=91.8%) and ICH (HR: 1.71, 95%CI: 1.14-2.58, I²=82.8%). only 2 studies reported data on recurrent falls, both showing an increased risk in patients with previous falls, although without statistical significance at pooled analysis. Results were consistent at subgroup analyses and meta-regressions.
Conclusions. A history of previous falls is frequently found in patients with AF. Previous falls lead to lower use of OAC and are associated with a higher risk of all AF-related long-term outcomes. These patients require further efforts and dedicated approach to improve thromboembolic risk prevention, and to improve their prognosis.