Association of Atrial Fibrillation With an Increased Risk of Stroke and Functional Disability Following Hip and Pelvic Fractures

TL;DR

Atrial fibrillation increases stroke risk and disability in elderly patients with hip or pelvic fractures, requiring better care strategies.

Contribution

This study identifies atrial fibrillation as a critical risk factor for stroke, disability, and mortality in fracture patients.

Findings

Atrial fibrillation was independently associated with a 5.2-fold higher risk of ischemic stroke within 90 days.

Patients with atrial fibrillation had worse functional outcomes and higher mortality rates compared to those without.

Integrated care strategies are needed to address the increased risks in atrial fibrillation patients with fractures.

Abstract

Background: Atrial fibrillation (AF) is a common arrhythmia in elderly patients and is strongly associated with increased risk of ischemic stroke, disability, and mortality.

Objective: The objective of the study is to evaluate the association of AF with ischemic stroke, functional disability, and mortality in patients presenting with hip and pelvic fractures.

Methods: This case-control study was conducted at Niazi Medical and Dental College, Sargodha, Pakistan, from January 2024 to January 2025. This study included 273 patients aged ≥50 years admitted with hip or pelvic fractures, of whom 137 had AF and 136 did not. Baseline demographics, comorbidities, and fracture characteristics were recorded. AF was confirmed via electrocardiography (ECG) or prior medical history. The primary outcome was the incidence of ischemic stroke within 90 days.

Results: The mean age of the overall cohort was 71.8 ± 8.9 years, with 59.3% being female. Compared to patients who did not have AF, those with AF were older and had higher rates of hypertension, coronary artery disease, and previous strokes. Ischemic stroke occurred in 12.4% of AF patients compared to 1.5% of non-AF patients within 90 days (p = 0.001). AF was independently associated with stroke (adjusted odds ratio (OR) = 5.2, 95% confidence interval (CI): 2.0-13.6, p < 0.001) and poor functional outcome (modified Rankin Scale (mRS) ≥ 4 at 90 days: adjusted OR = 2.1, 95% CI: 1.3-3.5, p = 0.002). At 90 days, 38.0% of AF patients were functionally independent (Barthel Index 80), compared to 56.6% of non-AF patients (p = 0.003). Mortality at 90 days was also higher in AF patients (12.4% vs. 4.4%, p = 0.021).

Conclusion: AF significantly increases the risk of ischemic stroke, functional disability, and short-term mortality in patients with hip and pelvic fractures. AF should be considered a critical prognostic factor in fracture management, and integrated multidisciplinary strategies, including optimized anticoagulation and early rehabilitation, are needed to improve outcomes.