Association Between Out-of-Hospital Falls and Cardiovascular Events in Patients with Coronary Heart Disease: A Retrospective Cohort Study
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Background
Falls are increasingly recognized as adverse events in coronary heart disease (CHD) patients, yet their prognostic implications remain incompl etely understood. This study examined the independent associations of falls wi th mortality and major adverse cardiovascular events, and the roles of functio nal status and frailty in these relationships.
Methods
This retrospective cohort study enrolled 2,139 CHD patients with m edian follow-up of 36 months. Falls were ascertained via telephone interviews every 3 months. Primary outcomes included major adverse cardiovascular eve nts (MACE) and major adverse cardiovascular and cerebrovascular events (M ACCE). Secondary outcomes comprised all-cause and cardiac mortality. Multiv ariable Cox models with stepwise adjustment for functional status indicators were constructed, with subgroup analyses stratified by frailty status.
Results
During follow-up, 171 patients (8.0%) experienced falls. Falls were a ssociated with mortality in univariate analysis but not after adjusting for funct ional status, indicating mediation by functional decline. In contrast, falls remai ned independently associated with MACE (HR=1.73, 95%CI: 1.17–2.57, P=0.0 06) and MACCE (HR=1.67, 95%CI: 1.14–2.46, P=0.009) in fully adjusted mo dels. Frailty significantly modified this association (P for interaction <0.001). Among robust patients, falls conferred substantially elevated risk (MACE: HR =4.08, 95%CI: 2.37–7.01; MACCE: HR=3.94, 95%CI: 2.30–6.76), whereas no significant association was observed in pre-frail or frail patients.
Conclusions
Falls independently predict long-term MACE and MACCE in C HD patients, with mortality effects mediated by functional status. Frailty signi ficantly modifies the fall-cardiovascular event relationship—robust patients exp eriencing falls face substantially elevated cardiovascular risk and warrant com prehensive evaluation. These findings support integrating fall history into cardi ovascular risk assessment and implementing frailty-stratified management.
