Fall Risk and Fear of Falling Among Older Adults in Cardiac Rehabilitation: ARTICULATING RISK FACTORS, PREVALENCE, PATIENT CHARACTERISTICS, AND OUTCOMES

Purpose: Fall risk is associated with restricted exercise and increased morbidity and mortality. Outcomes of patients with high fall risk in cardiac rehabilitation (CR) are not well documented. This study describes the prevalence of high fall risk in CR, associated patient characteristics, CR engagement, and outcomes. Methods: Electronic records were examined from CR patients aged ≥65 years. An 11-variable checklist identified high (≥2 risk factors) versus low fall risk. Groups were compared on demographic, medical, and psychosocial variables, CR sessions completed, and pre–post-CR functional capacity change per maximum effort exercise tolerance test (metabolic equivalent of task) or 6-Minute Walk Test distance. Results: The CR falls incident rate among 384 patients (70% male, mean age 74.2 ± 6.5) was 0.137/1000 visits. One quarter was identified as “high fall risk.” Ten percent reported fear of falling. The most common risk factors included visual difficulty (41%), balance disturbance (24%), and gait disturbance (23%). Patients with high fall risk were older (78.03 ± 6.78, P < .001), reported lower physical and mental health-related quality of life ( P ≤ .001), and attended slightly fewer CR sessions (23.80 ± 11.04 vs 26.47 ± 9.91; P = .18). There were no significant differences between groups in functional capacity (metabolic equivalent of task: P = .193; 6-Minute Walk Test: P = .141). Conclusions: Though patients with high fall risk share characteristics with known associations to lower CR referral (eg, older age and comorbidities), they are as likely to benefit from CR participation as patients with lower risk when supported by tailored exercise prescriptions and safety modifications.