Impact of accidental falls on 1-year prognosis or rehospitalization in elderly hospitalized patients with heart failure undergoing cardiac rehabilitation

Accidental falls (AFs) occasionally occur during hospitalization in older patients with heart failure (HF); however, limited evidence exists regarding their clinical significance. We aimed to evaluate the impact of AFs on prognosis, one-year HF readmission, and associated risk factors in hospitalized patients with HF.

This single-centre, retrospective, observational study included 462 patients (mean age: 83.0 years; 47% female) hospitalized with acute decompensated HF and followed for one year post-discharge. Among patients who experienced AFs (n = 32; median days to onset: 10.0 days), the incidence of the primary outcome, composite of all-cause mortality or HF readmission, was significantly higher (hazard ratio = 2.583; P = 0.002, multivariate Cox proportional hazards analysis) than in those without AFs. Patients who experienced AFs were generally older and demonstrated poorer physical function, greater frailty, and signs of malnutrition using Geriatric Nutritional Risk Index (GNRI). Significant risk factors for AFs identified via multiple logistic regression included the Kihon Checklist score [odds ratio (OR) = 1.110; P = 0.036] and a diagnosis of schizophrenia (OR = 6.560; P = 0.049). Notably, GNRI-defined malnutrition was associated with adverse outcomes only in the non-falls group. Accidental falls did not significantly affect secondary outcomes, including major adverse cardiovascular and cerebrovascular events.

Accidental falls were associated with poorer prognosis and higher HF readmission risk within one year among older patients. Malnutrition may increase the risk. Pre-admission frailty and psychiatric comorbidities are key fall risk factors, suggesting that frailty interventions may reduce fall incidence and improve outcomes.