September 27, 2018 / 7:21 PM / 19 days ago

Fall risk may increase after heart attack patients leave hospital

(Reuters Health) - Three in five patients hospitalized for heart attacks or other serious cardiovascular problems have at least a moderate risk of falling after they go home, and this risk is tied to higher odds of premature death, a U.S. study suggests.

Researchers examined data on 2,456 people hospitalized for heart attacks, heart failure, or a heart rhythm disorder known as atrial fibrillation. Within one year of the hospitalizations, 362 patients died, for a one-year mortality rate of 15 percent.

Based on assessments of overall health and functioning, 22 percent of the patients had a high risk of falls and another 38 percent had a moderate risk. Compared with people at low risk for falls, individuals with moderate risk were 51 percent more likely to die within one year, and patients at high risk for falls were more than three times as likely to die.

“Increased risk of falling can be conceptualized as a proxy for frailty, or increased vulnerability to stressors,” said senior study author Dr. Veronique Roger of the Mayo Clinic College of Medicine in Rochester, Minnesota.

“The most important factor in reducing the risk of falls is to preserve muscle mass and equilibrium,” Roger said by email. “This can be achieved by regular physical activity in a safe environment.”

Patients in the study were 71 years old on average and many of them had high blood pressure, elevated cholesterol, a history of smoking and were overweight or obese.

Overall, 18 percent had at least one repeat hospitalization within 30 days of discharge. Within one year, 1,177 patients had a total of 2,325 readmissions.

Most of the repeat hospitalizations and deaths in the study were not related to cardiovascular conditions, researchers report in Circulation: Cardiovascular Quality Outcomes. Overall, 59 percent of deaths, 57 percent of readmissions within 30 days and 65 percent of repeat hospitalizations within one year were not for heart problems.

People with a higher risk of falling were much older - 81 years old, on average, compared with 71 years old for individuals with a moderate risk of falling and 65 for people with a low risk.

The study wasn’t a controlled experiment designed to prove whether or how cardiovascular problems might contribute to falls or how an elevated risk of falling might make people more likely to have serious complications or deaths from cardiovascular disease.

Even so, the results underscore the importance of maintaining mobility after a heart attack or hospitalization for other serious heart problems, said Dr. Sharon Straus, director of the division of geriatric medicine at the University of Toronto.

“When patients are admitted to the hospital with cardiac events, they are usually put to bed and older adults can become deconditioned in a hospital as a result - which means they get weak and lose muscle strength,” Straus, who wasn’t involved in the study, said by email.

“And, if they had cardiac problems prior to admission, this may have impacted their mobility and functional status prior to admission,” Straus added. “We need to assess functional status of older adults and optimize their mobility, which will impact fall risk.”

Poor mobility and functioning not only increases the risk of falls, it can also lead to more severe injuries, said Saija Karinkanta of the UKK Institute for Health Promotion Research in Tampere, Finland. Falls that result in hip fractures or head injuries may lead to more fatalities, Karinkanta, who wasn’t involved in the study, said by email.

“A good way for everybody to avoid falls is to improve mobility by training gait, lower limb muscle strength, and balance,” Karinkanta said. “Starting exercise with an expert like a physical therapist, is the safest way for cardiovascular disease patients.”

SOURCE: bit.ly/2NruuZp Circulation: Cardiovascular Quality Outcomes, online August 3, 2018.

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