Article Text

Download PDFPDF
Drug-related bradycardia precipitating hospital admission in older adults: an ongoing problem
  1. Charlotte Griffiths1,
  2. Adam Ioannou2,
  3. Benjamin Dickinson1,
  4. Sofia Metaxa1,
  5. Fouad R Amin1,3,
  6. Amit K J Mandal1,
  7. Constantinos G Missouris1,4
  1. 1Cardiology/Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
  2. 2Cardiology/Medicine, Royal Free Hampstead NHS Trust, London, UK
  3. 3Al Azhar University Hospital, Cairo, Egypt
  4. 4Clinical Cardiology, University of Cyprus Medical School, Nicosia, Cyprus
  1. Correspondence to Dr Amit K J Mandal, Cardiology/Medicine, Wexham Park Hospital, Slough SL2 4HL, UK; amit.mandal{at}


Background Drug-related bradycardia (DRB) is a common clinical conundrum and can result in multiple hospital admissions as a result of the increased prescription of rate-limiting medications that can predispose to presyncopal or syncopal episodes.

Aim To evaluate the incidence of DRB in elderly hospital inpatients.

Methods We conducted a retrospective analysis of all patients admitted to our acute medical unit between November 2018 and February 2019 and identified patients over the age of 70 with more than one diurnal bradycardic episode during their admission. We extracted patient demographics, presenting complaint, admission 12-lead ECG and medications from the hospital electronic database.

Results We screened 2312 adults and identified 100 patients over the age of 70 years with two or more episodes of diurnal bradycardia during their hospital admission. This constituted 4.32% of total admissions. Beta blockers were the most commonly prescribed rate-limiting medication (n=54, 87.1%), of which bisoprolol was the most frequently prescribed (n=41) and sinus bradycardia was the most commonly identified rhythm disturbance in our cohort of patients (n=41, 41%). Syncope was the most common presenting symptom and occurred in 23 patients, 14 (60.9%) of which were diagnosed with a DRB. Atrial fibrillation was more common in those with DRB compared with those with bradycardia not caused by medications (35.5% vs 10.5%, p=0.006), and atrial fibrillation was a significant predictor of DRB (OR=10.2, 95% CI 3.3 to 31.6, p<0.001).

Conclusion Bradycardia is a significant cause of hospital admissions in older adults and can be avoided with pharmacovigilance. Caution should be exercised when initiating or changing the dose of rate-limiting agents in these patients; while those with atrial fibrillation should undergo regular review of their heart rate followed by appropriate medication dose adjustments.

  • clinical medicine
  • drug-related side effects and adverse reactions
  • geriatrics
  • safety
  • drug compounding

Data availability statement

Data are available upon reasonable request.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.