Links between irregular heartbeat and unexplained falls

A new study has found strong links between irregular heartbeat and unexplained falls in the elderly, and has also shown a link between depression in older people and syncopal episodes or blackouts.

Links between irregular heartbeat and unexplained falls

The research was carried out for the Department of Gerontology in Trinity College Dublin and involved the screening of people presenting to an emergency department.

The supervisor of the research, Prof Rose Anne Kenny, said it showed that a fully-funded and properly-resourced health system that allowed specialist teams to carry out screening programmes could reduce the number of people presenting after a fall and save the exchequer money.

The study involved 970 emergency department (ED) fallers being screened over a six-month period. After a number of patients were excluded for various reasons, 84 were eligible for study inclusion as they had presented to the ED because of an unexplained fall and had at least two falls in the previous year.

According to the research, conducted by Jaspreet Bhangu: “A major finding in this study is that two thirds of older patients with unexplained falls who attend the ED have a cardiac arrhythmia that is not apparent at the time of presentation, but detected within nine months of continuous monitoring using ILR (an electrocardio monitoring device).

“In 20% of these patients, events were directly attributable to a modifiable cardiac arrhythmia. A further 11% have an arrhythmia detected during the initial detailed cardiovascular assessment.

“Furthermore, falls were five times more likely to recur in patients who had cardiac arrhythmias.”

The study also looked at the relationship between syncope or an unexplained loss of consciousness or a blackout, depression, and antidepressant use in older adults. It focussed on data from Wave 1 of The Irish Longitudinal Study on Ageing (TILDA), including 8,175 adults aged 50 and older living in the community.

Of a final sample of 7,993 participants, 225 reported one syncopal episode in the last year and 124 reported two or more episodes.

It concluded that participants classified with moderate or severe depression were more likely to have reported a syncopal event in the last year and were also more likely to have reported multiple syncopal events in the last year.

In addition to the “overlap in the epidemiology of falls, unexplained falls and syncope”, it found that cardiac arrhythmia was a significant cause of unexplained falls in older adults and that this is “potentially modifiable”.

Prof Kenny, director of the Falls and Blackout Unit at St James’s Hospital Dublin, said the findings were significant and indicated that an unexplained fall was a “red flag” for a possible underlying cardiac issue.

“If you have unexplained falls there should be a proper assessment, including a cardiac assessment,” she said. “If you think you are having irregularities of the heart you should be monitored.”

While the St James’s Unit is open five days a week, units elsewhere are not, and Prof Kenny said she had been in discussions with the Department of Health about changing this as it had been proven that preventing falls in the elderly would save money in the long-term, given the health problems associated with falls.

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