Fall Risk and Outcomes Among Patients Hospitalized With Cardiovascular Disease in the Community

Abstract

Background: As the population with cardiovascular disease (CVD) ages, geriatric conditions are of increasing relevance. A possible geriatric prognostic indicator may be a fall risk score, which is mandated by the Joint Commission to be measured on all hospitalized patients. The prognostic value of a fall risk score on outcomes after dismissal is not well known. Thus, we aimed to determine whether a fall risk score is associated with death and hospital readmissions in patients with a recent incident CVD event. Methods and Results: In this retrospective cohort study, Olmsted County, MN, patients with incident heart failure (HF), myocardial infarction (MI) or atrial fibrillation (AF) between 8/1/2005 and 12/31/2011 who were hospitalized within 180 days after the event were studied. Fall risk was measured by the Hendrich II Fall Risk Model. Patients were followed for death or readmission within 30 days or 1 year. Among 2456 hospitalized patients with recent incident cardiovascular disease (549 HF, 784 MI, 1123 AF; mean (SD) age 71 (15); 55% male), the fall risk score was high in 22% of patients and moderate in 38%. The risk of death was increased if the fall risk score was increased, independently of age and comorbidities (moderate: HR: 1.51; 95% CI: 1.09–2.08; high HR: 3.49; 95% CI: 2.52–4.85). Similarly, the risk of 30-day readmissions was substantially increased with a greater fall risk score (moderate: HR: 1.29; 95% CI: 1.03–1.62; high HR: 1.63; 95% CI: 1.23–2.15). Results were similar for readmissions within 1 year. Conclusions: More than half of hospitalized patients with recent incident CVD have an elevated fall risk score, which is associated with an increased risk in readmissions and death. These results delineate an approach for risk stratification and management that may prevent readmissions and improve survival.

Comparison of Factors Associated with Fear of Falling between Older Adults with and without a Fall History

“…Falls are a common problem in community-dwelling older adults [ 1 ] and are a leading cause of adverse health outcomes such as fall-related injuries [ 1 , 2 ], hospitalization [ 3 ], and death [ 3 , 4 ]. The increasing medical expenses and burden of falls constitute a global problem, and fall incidence and total cost of fall increase with age [ 5 , 6 ].…”

Link between cardiovascular disease and the risk of falling: A comprehensive review of the evidence

“…It is essential to remember the often multifactorial nature of risk factors contributing towards falls, and it is crucial to understand each factor's potential contributions towards the patient's propensity to fall [8]. The prevalence of cardiovascular conditions generally increases with age, and the most frequently cited associations of fall risk in the elderly include carotid sinus syndrome (CSS), arrhythmias such as atrial fibrillation (AF), heart failure (HF), and vasovagal syndromes [11][12][13].…”

“…As patients in later stages of HF face disturbances across multiple organ systems, a balance between symptomatic relief and treatment of the underlying issues must be reached. Among hospitalized patients with recent incidence of cardiovascular disease, including HF, myocardial infarction, and AF, the fall risk score was high in 22% of patients and was associated with an increased risk of death and 30-day readmission [12].…”

“…New fall history in a patient suffering from a chronic illness, such as that of cardiovascular disease, can suggest the disease's progression into a state where the balance between the pathologic process and cardiovascular compensation (even under pharmacotherapy) may begin to become disharmonious. One study quoted that more than half of hospitalized patients with recent cardiovascular disease diagnosis (including HF, myocardial infarction, and AF) had a moderate or high risk of falls, and greater fall risk score was tied to a significant increase in the risk of readmissions as well as death [12]. This leads to further implications in the necessary care for patients following falls; one such alternative is institutionalization.…”

An eight-camera fall detection system using human fall pattern recognition via machine learning by a low-cost android box

“…Many common neurological problems result in falls 2 : Peripheral neuropathy 3 manifesting with numbness and imbalance, spinal stenosis 4 resulting in pain and incoordination, acute strokes 5 leading to sudden weakness, and Parkinson disease 6 , 7 characterized by postural instability, etc. In addition, cardiovascular 8 , musculoskeletal 9 , 10 , and medication-induced 11 problems often coexist 12 . Orthostatic hypotension 13 , 14 , knee arthritis 15 , and iatrogenic dizziness 12 , 16 are only a few examples.…”