Top Things to Know: Preventing and Managing Falls in Adults With Cardiovascular Disease
Published: May 19, 2022
Prepared by Paul St. Laurent, DNP, RN, Senior Science and Medicine Advisor, Lead
- Falls and fear of falling are a major health issue and associated with high injury rates, high medical care costs, and significant negative impact on the quality of life.
- This statement provides consensus on the interdisciplinary evaluation, prevention, and management of falls among adults with CVD, the management of CV care when patients are at risk of falling, outlines research needed to clarify prevalence and factors associated with falls and identifies interventions that will prevent falls among adults with CVD.
- Increased fall risk is associated with medications, structural heart disease, heart failure, orthostatic hypotension, arrhythmias, abnormal gait and balance, physical frailty, sensory impairment and environmental hazards.
- Fall risk-increasing drugs include antidiabetic agents, digoxin, diuretics, antianxiety drugs, antidepressants, antipsychotics, antiepileptics, opioids, antiarrhythmics, antihypertensives and sleep medications.
- Orthostatic hypotension, prevalent in 30% of older adults, is a risk factor for dizziness and falling and increases with age, hypertension, antihypertensive treatment, diuretic use, hypovolemia, and other comorbidities.
- Syncope (neurally-mediated, orthostatic, or cardiac) increases with age and can manifest as falls.
- Frailty, defined as decreased physiological reserves and increased vulnerability to stressors, is highly prevalent among older adults with CVD and is a significant risk factor for future falls.
- Sensory deficits, musculoskeletal problems, neurological disorders and cognitive impairment can significantly affect postural control and impair gait and balance, which in turn increases the likelihood of falling.
- For patients with atrial fibrillation at risk for falling and in need of anticoagulation therapy, a thorough evaluation of stroke risk, bleeding, and falls should be incorporated into shared-decision making about anticoagulation.
- Strategies to address falls must include close collaboration with the patient and their support network of family and friends.
Citation
Denfeld QE, Turrise S, MacLaughlin EJ, Chang P-S, Clair WK, Lewis EF, Forman DE, Goodlin SJ; on behalf of the American Heart Association Cardiovascular Disease in Older Populations Committee of the Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing; Council on Lifestyle and Cardiometabolic Health; and Stroke Council. Preventing and managing falls in adults with cardiovascular disease: a scientific statement from the American Heart Association. Circ Cardiovasc Qual Outcomes. 2022;15:e000108. doi: 10.1161/HCQ.0000000000000108