{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T08:07:23Z","timestamp":1784189243336,"version":"3.55.0"},"reference-count":101,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>The association of atrial fibrillation (AF) and neck of femur fractures (NOF) are common in old people, creating a complex clinical scenario with significant implications for morbidity, mortality, and healthcare systems. This narrative review explores the bidirectional relationship between AF and NOF, focusing on shared risk factors, pathophysiological links, and challenges in clinical management, and also reviews the benefit of an orthogeriatric model. Advanced age, frailty, osteoporosis, polypharmacy, and cardiovascular comorbidities predispose patients to both conditions, while AF itself increases fall risk through haemodynamic instability, syncope, and adverse effects of rate- or rhythm-controlling medications. Importantly, the physiological stress of hip fracture and subsequent surgery can precipitate new-onset or worsening AF via inflammatory, neurohormonal, and metabolic mechanisms. The main challenge for ortho-geriatricians lies in anticoagulation management and preoperative and postoperative management. While anticoagulation reduces thromboembolic risk in AF, it increases perioperative bleeding risk in patients with NOF, often leading to delays in surgery that are independently associated with poorer outcomes. This review examines the current evidence regarding perioperative anticoagulation strategies, timing of surgery, and postoperative resumption of therapy. In addition, the review examines important outcome parameters such as mortality, stroke, bleeding, length of hospital stay, and functional recovery. This highlights the importance of not only improving multidisciplinary care involving orthopaedics, cardiology, geriatrics, and anaesthesia to optimise outcomes, but also enhancing risk stratification. Standardised perioperative pathways and integrated geriatric\u2013cardiac assessment may help mitigate complications. Therefore, understanding how AF and NOF interact is key to delivering holistic, patient-centred care for an increasingly elderly population in orthogeriatric wards.<\/jats:p>","DOI":"10.3390\/jcdd13070334","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T06:49:36Z","timestamp":1784184576000},"page":"334","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["When the Heart and Hip Collide: The Interplay Between Atrial Fibrillation and Neck of Femur Fractures"],"prefix":"10.3390","volume":"13","author":[{"given":"Hannah","family":"Faherty","sequence":"first","affiliation":[{"name":"Department of General Surgery, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes MK6 5LD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0921-8739","authenticated-orcid":false,"given":"Thin Ei","family":"Hlaing","sequence":"additional","affiliation":[{"name":"Division of Acute Medicine, The James Cook University Hospital NHS Trust, Middlesbrough TS4 3BW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khushi","family":"Thakkar","sequence":"additional","affiliation":[{"name":"Department of Medicine, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes MK6 5LD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahir","family":"Hamad","sequence":"additional","affiliation":[{"name":"Division of Acute Medicine, The James Cook University Hospital NHS Trust, Middlesbrough TS4 3BW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Hassan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Alexandria University, Alexandria 21500, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah K.","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Tele-Geriatric Research Fellowship, Geriatric Division, Family Medicine Department, Michigan State University, East Lansing, MI 48824, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Musaab","family":"Ahmed","sequence":"additional","affiliation":[{"name":"College of Medicine, Ajman University, Ajman P.O. Box 346, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed T.","family":"Hassan","sequence":"additional","affiliation":[{"name":"Kasr Alainy Faculty of Medicine, Cairo University, Cairo 12613, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8045-6996","authenticated-orcid":false,"given":"Mohamed H.","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Medicine for Older People, North Cheshire and Mersey NHS Foundation Trust, Warrington WA5 1QG, UK"},{"name":"Department of Diabetes, North Cheshire and Mersey NHS Foundation Trust, Warrington WA5 1QG, UK"},{"name":"Faculty of Medicine and Health Sciences, University of Buckingham, Buckingham MK18 1EG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1161\/CIRCULATIONAHA.113.005119","article-title":"Worldwide epidemiology of atrial fibrillation: A Global Burden of Disease 2010 Study","volume":"129","author":"Chugh","year":"2014","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e28","DOI":"10.15420\/aer.2025.33","article-title":"The Global Impact of Atrial Fibrillation","volume":"14","author":"Karatela","year":"2025","journal-title":"Arrhythm. 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