Article ID: CR-25-0097
Background: This study aimed to identify fall risk indicators associated with future falls among older patients with cardiovascular disease (CVD), based on a multidimensional assessment.
Methods and Results: In this prospective cohort study, 129 patients aged ≥65 years with CVD were enrolled between 2021 and 2023. Participants were classified into fall and non-fall groups based on fall incidence during a 1-year follow up. We assessed physical frailty, systolic blood pressure, polypharmacy, and the Falls Efficacy Scale International (FES-I) to evaluate concern about falling. The overall 1-year fall incidence was 17.0% (22 falls), equating to 0.28 falls per person-year. Compared with the non-fall group, the fall group was older, had lower physical function and blood pressure, and higher FES-I scores. Multivariate logistic regression, adjusted with propensity scores, revealed that a FES-I score ≥28 was a significant predictor of falls (odds ratio [OR] 8.906, 95% confidence interval [CI] 2.556–13.031, P=0.001; adjusted OR 2.964, 95% CI 1.038–8.460, P=0.042). Receiver operating characteristic analysis identified a FES-I cut-off of 28, with an area under the curve of 0.684 (95% CI 0.527–0.840, P=0.017).
Conclusions: The 1-year fall incidence among older patients with CVD was comparable with rates in community-dwelling older adults. Higher concern about falling, as measured using FES-I, was significantly associated with future falls.
Falls are a significant public health challenge in older adults. Approximately 30% of older adults experience at least 1 fall per year.1 Falls negatively affect physical function and functional independence,2 leading to a vicious cycle that causes falls to recur. Furthermore, severe falls, such as injurious and recurrent falls in a given period, are associated with a higher risk of nursing home admissions.3,4 Therefore, fall prevention is crucial for extending the healthy life expectancy of older adults.
Psychological problems such as concerns about falling occur even if a fall does not have serious consequences.5 Concern about falling is prevalent among older adults, ranging from 3% to 85%, and is an independent risk factor for falls.5 It is recommended to check concerns about falling, measured using the Falls Efficacy Scale-International (FES-I), as part of a comprehensive fall assessment.6 This scale assesses the need for a concern-about-falling measure that considers both physical and social factors. When concerns about falling increase significantly, it may lead to decreased physical activity or difficulty participating in exercise therapy.7
Traditional therapies, pharmacological treatments, surgical interventions, comprehensive cardiac rehabilitation including exercise therapies, and lifestyle modifications have significantly improved patient outcomes over the past decades. However, despite these advancements, the prevalence of cardiovascular disease (CVD) continues to increase, driven by factors such as aging populations in numerous countries worldwide.8 CVD is reportedly associated with falls in older adults.9 Patients with CVD have multiple fall risk factors such as advanced age, frailty, low physical function, and polypharmacy, particularly the concurrent use of multiple fall-risk-increasing drugs (FRIDs).10,11 Most cardiovascular drugs, including diuretics, antihypertensive drugs, and vasodilators, are categorized as FRIDs. These findings suggest that older patients with CVD are more likely than community-dwelling older individuals to have multiple fall risk factors.11 However, to the best of our knowledge, no studies have evaluated the fall risk in older patients with CVD to identify the most significant fall risk factors based on multivariate assessment.
This study aimed to identify the characteristics of falls and the factors associated with falls derived from a multidimensional assessment in older patients with CVD.
This longitudinal prospective study was conducted between September 2021 and December 2023 in the cardiac rehabilitation unit of Juntendo University Hospital (Tokyo, Japan). The study protocol followed the ethical principles of the Declaration of Helsinki and was approved by the Institutional Review Board of the Juntendo University Hospital (H20-0203). Written informed consent was obtained from all the participants. The participants were cardiovascular patients aged ≥65 years who received early recovery phase I/II cardiac rehabilitation in the cardiac rehabilitation unit. Patients who were wheelchair users, bedridden, visually impaired, or had Parkinson disease were excluded.
Physical Frailty and Functioning StatusPhysical frailty was assessed using the revised Japanese version of the Cardiovascular Health Study (J-CHS) criteria.12 According to the revised J-CHS criteria, the participants were classified into 3 frailty status groups: frail (≥3 points); prefrail (1–2 points); and robust (0 points). To assess physical function, handgrip strength and the Short Physical Performance Battery (SPPB) were measured as indicators of physical functioning at the baseline survey. The SPPB comprises 3 components: standing balance; walking; and chair rise. Participants received between 0 and 4 points for each component, with the total SPPB score ranging from 0 to 12 points.13 Grip strength was measured on both sides of the body in a seated position and calculated as the average of the left- and right-hand grip strength measurements.
Psychological StatusConcerns about falling were assessed at baseline as part of the psychological status evaluation using the FES-I. The FES-I has been translated into multiple languages, including Japanese, with confirmed reliability and validity.14 The FES-I comprises 16 items, each rated on a 4-point Likert scale. The total FES-I score is obtained by summing the response values (ranging from 1 to 4) for each item, resulting in a total score ranging from 16 to 64 points. Lower scores indicate less concern about falling. In the present study, the participants were categorized into 3 levels of concern about falling: High (28–64 points); Moderate (20–27 points); and Low (16–19 points).15 Additionally, the 16 FES-I subitems were classified into 3 categories: Indoor activities with <3 METs (Class 1); Indoor activities with ≥3 METs (Class 2); and Outdoor activities with ≥3 METs (Class 3).
Hemodynamic StatusAn automatic sphygmomanometer (HCR-7608T2; OMRON, Japan) was used to measure blood pressure (BP) with the participants in a seated position after a 5-min rest. Two measurements were obtained, and the average of these values was used for the analysis. Systolic blood pressure (SBP) was categorized as follows: high SBP (<130, and ≥130 mmHg); and low SBP (<100, and ≥100 mmHg).
Polypharmacy and Fall Risk-Increasing DrugsWhen defining polypharmacy, only long-term medications were considered. Long-term medications were defined as medications used to treat chronic diseases. The number of long-term medications was recorded, and more than 5 medications were classified as polypharmacy. Additionally, the number of FRIDs, as proposed by the Swedish National Board of Health and Welfare, was recorded.16–18
Falls and Severe FallsFalls were the primary outcome of this longitudinal study. A fall was defined as unintentionally coming to rest on the ground, floor, or another lower level.19 The occurrence of falls was determined using the question, ‘Have you fallen in the past year?’ (Yes/No). The occurrence of falls, along with the number and associated injuries, was assessed using a self-reported questionnaire 1 year after the baseline survey.
Statistical AnalysisDifferences between the 2 groups were analyzed using unpaired t-tests for continuous variables, the Mann-Whitney U test for ordinal scales, and the chi-squared test for categorical variables. A logistic regression analysis was conducted to examine the effects of physical frailty, concerns regarding falls, blood pressure, and polypharmacy on falls. The incidence of falls was used as the dependent variable and the propensity score was included as a covariate in the model to adjust for or reduce potential confounding factors. The variables used to calculate the propensity score were age, sex, and body mass index, history of fall, Charlson comorbidity index, Geriatric nutritional risk index and those not included as independent variables in the logistic regression analysis for physical frailty, concerns about falling, blood pressure, and polypharmacy. Additionally, participants who fell ≥2 times within the 1-year follow up were defined as recurrent fallers. Recurrent fallers and patients who required medical treatment for fall-related injuries were classified as having experienced a ‘severe fall event’.20 We used a significance level of 0.05 for hypothesis testing. Statistical analyses were performed using IBM SPSS statistics software version 29.0 for Mac (IBM Corp., Armonk, NY, USA) and JMP software version 17.2 (SAS, Inc., Cary, NC, USA).
The final analysis included 129 older patients with CVD, including 36% octogenarians and 2% nonagenarians. The mean patient age was 77±6 years, and 38% were female. Of all the patients, 21.7% had ischemic heart disease, 21.7% had valvular disease, and 30.2% had undergone cardiovascular surgery. The total incidence of falls during the 1-year follow up was 22 (17.0%) with a 0.28 times per person-year, and 17 (13.2%) had severe falls (7 recurrent falls, and 13 received treatment for fall-related injuries).
Clinical Characteristics of This StudyClinical characteristics of the patients are shown in Table 1. Patients in the fall group were older than those in the non-fall group. However, there were no significant differences between the 2 groups in terms of sex, body mass index, etiology of CVD, or history of falls. However, the prevalence of physical frailty was higher in the fall group than that in the non-fall group, and the fall group had lower SPPB scores and handgrip strength. In addition, the fall group showed a significantly higher FES-I score and significantly lower systolic and diastolic blood pressure compared with the non-fall group.
Characteristics of Participants
| Fall group (n=22) |
Non-fall group (n=107) |
P value | |
|---|---|---|---|
| Age (years) | 80.1±4.9 | 76.8±6.6 | 0.024 |
| Sex, female | 9 (40.9) | 40 (37.4) | 0.812 |
| BMI (kg/m2) | 22.0±3.3 | 22.8±3.3 | 0.916 |
| Etiology | |||
| Ischemic heart disease | 6 (27.3) | 22 (20.6) | 0.570 |
| Valvular disease | 3 (13.6) | 25 (23.4) | 0.404 |
| Cardiomyopathy | 2 (9.1) | 3 (2.8) | 0.201 |
| Aortic disease | 4 (18.2) | 35 (32.7) | 0.211 |
| Other | 7 (31.8) | 21 (19.6) | 0.256 |
| Physical frailty | 12 (54.5) | 29 (27.1) | 0.022 |
| SPPB (points) | 9.91±2.56 | 11.3±1.4 | 0.020 |
| Handgrip strength (kg) | 20.9±7.8 | 25.2±8.4 | 0.031 |
| Fall efficacy scale (points) | 29.2±13.1 | 19.5±7.7 | 0.004 |
| SBP (mmHg) | 115.2±11.7 | 122.8±15.0 | 0.028 |
| DBP (mmHg) | 72.2±8.3 | 77.5±9.9 | 0.021 |
| History of falls | 6 (27.3) | 13 (12.1) | 0.095 |
| No. falls | 1.64±1.18 | – | – |
| Recurrent falls | 7 (31.8) | ||
| Treatment for fall-related injuries | 13 (59.1) | ||
| Severe fall | 17 (77.3) | – | – |
Data are presented as n (%), or mean±SD. BMI, body mass index; DBP, diastolic blood pressure; SBP, systolic blood pressure; SPPB, Short Physical Performance Battery.
FRID Class Medications and Polypharmacy
Table 2 shows FRID class medications and polypharmacy. The use of α-blockers showed a significant difference between the 2 groups. However, there was no significant difference in the use of other FRID class medications or in the prevalence of polypharmacy, or the use of at least 2 FRID class medications.
FRID Classes Medication and Polypharmacy
| Fall group (n=22) |
Non-fall group (n=107) |
P value | |
|---|---|---|---|
| Drugs that lead to a high risk of falling | |||
| Opioids | 0 (0) | 0 (0) | – |
| Antipsychotics | 1 (4.5) | 1 (0.9) | 0.313 |
| Anxiolytics | 1 (4.5) | 5 (4.7) | 1.000 |
| Hypnotics and sedatives | 1 (4.5) | 3 (2.8) | 0.531 |
| Antidepressants | 0 (0) | 1 (0.9) | 1.000 |
| Drugs that cause orthostatism/hypotension | |||
| Vasodilators used in cardiac diseases (%) | 1 (4.5) | 17 (15.9) | 0.307 |
| Diuretics | 13 (59.1) | 67 (62.6) | 0.812 |
| β-blockers | 15 (68.2) | 56 (52.3) | 0.240 |
| Calcium channel blockers | 6 (27.3) | 20 (18.7) | 0.386 |
| Agents acting on the renin-angiotensin system | 10 (45.5) | 37 (34.6) | 0.342 |
| α-adrenoreceptor antagonists | 7 (33.3) | 9 (8.4) | 0.005 |
| Anti-Parkinson drugs | 0 (0) | 0 (0) | – |
| Polypharmacy | 17 (77.3) | 77 (72.0) | 0.794 |
| FRID ≥2 | 17 (77.3) | 76 (71.0) | 0.614 |
Data are presented as n (%). FRID, fall risk-increasing drugs.
Predictors of Future Falls Events
Table 3 presents the results of univariate and multivariate logistic regression analyses. On univariate logistic regression analysis, physical frailty and FES-I scores showed significant associations with fall incidence within 1 year. In the multivariate logistic regression analysis with the propensity score included as a covariate, both FES-I ≥28 points vs. <28 points and FES-I ≥20 points vs. <20 points were identified as significant risk factors for fall incidence within 1 year. In addition, both models demonstrated good calibration, as indicated by P values >0.05 in the Hosmer–Lemeshow test. Using receiver operating characteristic (ROC) curve analysis to determine the risk of 1-year falls, a FES-I cut-off of 28 points showed an AUC of 0.684 (95% confidence interval [CI] 0.527, 0.840; P=0.017), with a sensitivity of 0.471, specificity of 0.897, positive predictive value (PPV) of 52.6%, and negative predictive value (NPV) of 89.1%. In contrast, a cut-off of 20 points showed an AUC of 0.633 (95% CI 0.500, 0.765; P=0.055).
Multivariate Logistic Regression Analysis
| Univariate analysis | Multivariate analysis | |||||
|---|---|---|---|---|---|---|
| Odds ratio | 95% CI | P value | Odds ratio | 95% CI | P value | |
| Physical frailty | ||||||
| Physical frailty vs. non-physical frailty | 3.228 | 1.259, 8.273 | 0.015 | 1.308 | 0.411, 4.164 | 0.649 |
| Physical frailty+pre-frailty vs. robust | 0.3259 | 0.1160, 0.8395 | 0.019 | 0.757 | 0.255, 2.242 | 0.615 |
| Blood pressure | ||||||
| SBP <130 vs. SBP ≥130 mmHg | 0.3390 | 0.0760, 1.0809 | 0.0699 | 2.8606 | 0.684, 0.719 | 0.152 |
| SBP <100 vs. SBP ≥100 mmHg | 0.5185 | 0.0273, 2.9855 | 0.5116 | 0.748 | 0.077, 7.258 | 0.802 |
| Polypharmacy | ||||||
| Polypharmacy vs. non-polypharmacy | 1.325 | 0.474, 4.313 | 0.611 | 0.656 | 0.196, 2.189 | 0.493 |
| FRID ≥2 vs. FRID <2 | 1.3868 | 0.4981, 4.510829 | 0.5453 | 1.128 | 0.328, 3.874 | 0.848 |
| FES-I | ||||||
| FES-I ≥28 vs. FES-I <28 points | 4.84 | 1.49, 15.48 | <0.001 | 8.906 | 2.556, 13.031 | 0.001 |
| FES-I ≥20 vs. FES-I <20 points | 3.75 | 1.295, 11.429 | 0.0149 | 2.964 | 1.038, 8.460 | 0.042 |
Multivariate logistic regression analysis was performed using the dependent variable and the propensity score. The propensity score was calculated by including age, sex, BMI, history of falls, Charlson comorbidity score, and the Geriatric Nutritional Risk Index as covariates, along with 3 of the following variables: FES-I score, SBP, number of medications, and J-CHS score, depending on the model. CI, confidence interval; FES-I, Falls Efficacy Scale International; J-CHS, Cardiovascular Health Study Japanese version. Other abbreviations as in Tables 1,2.
Factors Associated With Concern About Falling
A multiple regression analysis was conducted with the FES-I score as the dependent variable and modifiable factors such as physical function, physical frailty, and FRIDs-related factors as independent variables (Supplementary Table). The balance score from the SPPB subscale (B −2.414; 95% CI −4.398, −0.430; P=0.018) and grip strength (B −0.251; 95% CI −0.234, −0.027; P=0.028), a subcomponent of J-CHS-defined physical frailty, were identified as significant factors.
Association Between Fall Events and Subitems of the FES-I ScoreTable 4 shows the relationship between the subitems of the FES-I and fall incidence within 1 year. An analysis of the association between the subitems of the FES-I and falls revealed significant differences between the 2 groups in 11 items, excluding ‘cleaning the house’, ‘preparing simple meals’, ‘getting in or out of a chair’, and ‘walking around in the neighborhood’. Among the 6 indoor activities, only 3 (50%) showed significant differences between the 2 groups. In Class 2, 2 (100%) items showed significant differences between the 2 groups; in Class 3, 7 (88%) items showed significant differences.
Subitmes Score of the FES-I and Fall Incidence Within 1 Year
| Fall group (n=22) |
Non-fall group (n=107) |
P value | |
|---|---|---|---|
| Class 1 | |||
| Cleaning the house | 1 (1, 2) | 1 (1, 1) | 0.051 |
| Getting dressed or undressed | 1 (1, 2) | 1 (1, 1) | 0.029 |
| Preparing simple meals | 1 (1, 1) | 1 (1, 1) | 0.129 |
| Getting in or out of a chair | 1 (1, 2) | 1 (1, 1) | 0.062 |
| Reaching for something above your head or on the ground | 1 (1, 3) | 1 (1, 1) | 0.016 |
| Going to answer the telephone before it stops ringing | 1 (1, 2) | 1 (1, 1) | 0.002 |
| Class 2 | |||
| Taking a bath or shower | 1 (1, 1.5) | 1 (1, 1) | 0.039 |
| Going up or down stairs | 2 (1, 2.5) | 1(1, 2) | 0.009 |
| Class 3 | |||
| Walking around in the neighborhood | 1 (1, 2) | 1 (1, 1) | 0.211 |
| Going to the shop | 1 (1, 2.5) | 1 (1, 1) | 0.015 |
| Walking on a slippery surface | 2 (1, 3) | 1 (1, 2) | 0.011 |
| Visiting a friend or relative | 1 (1, 2) | 1 (1, 1) | 0.026 |
| Walking in a place with crowds | 2 (1, 3) | 1 (1, 2) | 0.018 |
| Walking on an uneven surface | 2 (1, 2) | 1 (1, 2) | 0.005 |
| Walking up or down a slope | 2 (1, 2) | 1 (1, 1) | 0.027 |
| Going out to a social event | 1 (1, 2) | 1 (1, 1) | 0.021 |
FES-I, Falls Efficacy Scale International.
The present longitudinal observational study identified the characteristics of falls and factors associated with falls in older patients with CVD. The total incidence of falls during the 1-year follow up was 22 (0.28 times per person per year), and 17 were severe falls (at least 2 falls, or needed treatment for fall-related injuries). The World Falls Prevention Guidelines6 for fall prevention suggest that the fall incidence rate is approximately 15–30%. In the present study, the incidence of falls in older patients with CVD was comparable with that in older community-dwelling populations.6 However, the rate of severe falls was higher in the experimental group than in the control group. Serious falls that lead to injuries sustained may negatively impact activities of daily living (ADLs) and quality of life and are associated with increased mortality.21 Therefore, fall prevention is considered crucial in the management of older patients with CVD. A relationship between concerns about falling and fall incidence was observed, and fallers showed higher subitem scores on the FES-I, especially for activities of more than moderate intensity involving fast movement and higher balance function, in older patients with CVD.
In the World Falls Prevention Guidelines, concerns about falling are recommended as a multidimensional fall risk assessment with a Grade 1B recommendation.6 Additionally, the use of the FES-I as an assessment tool for concerns about falling was recommended with Grade 1A.6,22 In addition, various factors such as low physical functioning, physical frailty, history of falls, hemodynamic abnormalities (e.g., hypotension), and polypharmacy have been identified as risk factors of falls in community-dwelling older adults.11,23 Therefore, in the present study, these factors were adjusted to assess future fall risk factors using the propensity score,24 and it was clarified that concerns about falling are independent risk factors for future falls in older patients with CVD.
This longitudinal study found that high FES-I scores were significantly associated with future falls in older patients with CVD, even after adjusting for the effects of physical frailty, hemodynamic status, polypharmacy, and other potential risk factors. ROC curve analysis indicated that a cut-off score of 28 on the FES-I provided moderate predictive accuracy for fall events in older patients with CVD. Aburub et al. reported that the incidence of recurrent falls is higher among older adults with CVD, and concerns about falling are the only clinical factors associated with falls in older adults with CVD.25 These findings are consistent with the results of the present study. In older adults with high FES-I scores, a comprehensive program is important to prevent falls.26 A comprehensive program would include review of: pharmacotherapy, particularly medications that increase fall risk; cognitive behavioral therapy strategy, such as promoting a sense of control over falls and enhancing self-efficacy; and the assessment and mitigation of environmental hazards. Specifically, regarding the FES-I, the score is the sum of an individual’s rated concern about falling while performing specific activities. This allows practitioners to understand the patient’s emotional state about falls. Therefore, interventions aimed at building confidence in performing these activities could be effective in reducing the fear of falling among older patients with CVD. As balance function and strength were identified as a determinant of the FES-I score, it is considered important to incorporate fall-prevention-specific balance or functional exercises combined with resistance exercise in addition to the conventional cardiac rehabilitation exercise programs.27
Concerns about falling affect physical activity and may lead to a decline in physical functioning or ADLs in older patients with CVD. As shown in Table 4, among the patients who experienced a fall, higher FES-I scores were observed for certain subitems of the FES-I, including outdoor activities, indoor activities involving relatively high levels of physical activity, activities involving fast movements, and activities that were more prone to balance loss. Therefore, from the perspective of cardiac rehabilitation, it is important to implement strategies to enhance physical activity or exercise training to address concerns about falls in patients with CVD with high FES-I scores. Specifically, for outdoor activities, it is important to consider strategies such as engaging in outings with family or friends. Providing exercise programs that can be performed with a sense of security is essential for indoor activities.
In community-dwelling older adults, physical frailty, hypotension, and polypharmacy have been identified as risk factors for falls; however, no associations were found in this study. Cheng et al. conducted a meta-analysis on the relationship between physical frailty and falls and reported that physical frailty was a risk factor for falls.28 In a systematic review by Yang et al., many studies that identified frailty as a risk factor for falls were characterized by a low prevalence of frailty and a long follow-up period.29 Li et al.30 with a 1-year follow up (frailty rate 34.7%), Leblanc et al.31 with a 6-month follow up (frailty rate 81.5%), and Grosshauser et al.32 with a 3-month follow up (frailty rate 97.5%) reported that in studies with shorter observation periods (3–12 months) and higher physical frailty rates, physical frailty was not a significant risk factor for falls. In the present study, the frailty rate among all participants was 32%, which is higher than that in studies targeting community-dwelling elderly individuals, and the study design involved a 1-year follow-up period for fall events. Although physical frailty was identified as a significant factor in the univariate analysis, the impact of physical frailty in the multivariate logistic analysis of falls may have been attenuated in older patients with CVD. Song et al. examined the relationship between hemodynamics and falls in community-dwelling elderly individuals and reported a median systolic blood pressure was reported to be 140.5 mmHg.33 Similarly, Klein et al. reported that approximately 70% of community-dwelling elderly individuals had a systolic blood pressure >140 mmHg.34 In this study, which focused on patients with CVD, many participants were taking antihypertensive or diuretic medications, resulting in a low systolic blood pressure of <100 mmHg. Therefore, systolic blood pressure may not have been identified as a fall risk factor in elderly patients with CVD.
However, the association between polypharmacy and falls remains unclear. A recent systematic review by Fried et al.35 found that polypharmacy was not a significant risk factor for falls. Rather, as reported by Ie et al., polypharmacy involving FRIDs is suggested as a fall risk factor.36 In the present study, diuretics and β-blockers, which have been reported as risk factors for falls,37 did not show a significant difference between the 2 groups. This is likely because the study focused on patients with CVD and the medications typically prescribed for standard treatment did not show significant differences between the 2 groups. In contrast, alpha-adrenoreceptor antagonists, which are not standard treatments for cardiovascular diseases but are frequently prescribed to fallers, may have contributed to falls. The adverse effects of α-1 blockers, notably the risk of falls and hypotension, are well known and thought to be a result of orthostatic hypotension.38 Therefore, the American Geriatric Society recommends avoiding their use for routine treatment of hypotension in patients aged ≥65 years and instead selecting alternative agents with a lower fall risk.39
Study LimitationsThis study had several limitations. First, the small sample size and low number of fall events may have reduced the statistical power of this study. In the multivariate logistic regression analysis, the 95% CI for the FES-I was wide, suggesting that the model adequacy may have been compromised due to these limitations. Therefore, larger-scale studies are warranted to validate the findings of the present study. Second, we did not assess visual or auditory impairment, cognitive function, or household environmental hazards, all of which have been reported as risk factors for falls in community-dwelling older adults.40 However, it remains unclear whether these factors are similarly associated with fall risk in patients for older patients with CVD. Therefore, future studies should investigate these potential risk factors in this population. Moreover, not only falls but also fall-related fractures are considered important clinical outcomes. Fall-related fractures have been identified as independent factors contributing to a decline in activities of daily living. Therefore, from the perspective of preventing such fractures, it is important for future studies to include assessments of bone mineral density. Third, recall bias may have been present given that fallers were asked to remember falls that occurred in the past year. Consequently, the fall group may have been underestimated in this study. Last, among cases with missing follow-up data, there were instances of death due to severe fall-related injuries or cases requiring admission to a nursing home. This suggests that the fall rates may have been underestimated.
The incidence of falls among patients with CVD was 17%, which is comparable with that reported in previous studies on community-dwelling older adults. Concerns about falling, as measured by the FES-I, are probably an independent risk factor for future falls, and that concerns about falling also probably play an important element in the multicomponent disease management in older patients with CVD.
We acknowledge Mayumi Doi, Yoshiki Anzawa, and Yusei Sato for their contribution to data collection.
None.
T.T. is a member of Circulation Reports’ Editorial Team.
The Ethics Committee of the Juntendo University Hospital, Tokyo, Japan (reference no. H20-0203).
The deidentified participant data will not be shared.
Please find supplementary file(s);
https://doi.org/10.1253/circrep.CR-25-0097
