Underevaluation of cardiovascular risk factors in patients with nonaccidental falls

The incidence of adult patients with falls seeking medical assistance in the Salt Lake City area, Utah, is 28,000 per million adult inhabitants.

We sought to evaluate the prevalence of cardiovascular risk assessment and cardiovascular abnormalities in patients presenting with nonaccidental falls at the University of Utah hospital and its affiliated clinics.

We conducted a search of all patients in the University of Utah patient database as well as 9 affiliated primary care and family practice clinics in Utah who were evaluated for a "fall" during October 2009. We analyzed the records of 338 patients who had a fall within the previous 3 months. Nonaccidental falls were defined as falls unrelated to a contact incident or "slip or trip."

Nonaccidental falls occurred in 81 (24%) patients, 39 of these being ≥65 years old. Cardiovascular risk assessment and specifically orthostatic testing were evaluated in 40% and 3% of the patients, respectively. In patients ≥65 years old, the prevalence of cardiovascular risk assessment, orthostatic testing, and carotid sinus massage were equally low at 56%, 5%, and 0%, respectively. Cardiovascular abnormalities were present in 17 (21%) patients, with 9 of them being referred for cardiac evaluation.

Our results highlight the inconsistent assessment of potential cardiovascular risk factors in patients with nonaccidental falls, supporting the adoption of a standardized approach in these patients.