Falling: should one blame the heart?

Approximately 30% of people aged 65 and older suffer a fall each year; one in five of these falls will lead to significant injury. As the world’s ageing population increases, healthcare costs associated with falls are only expected to rise. It is estimated that over a third of falls may be preventable and evidence for causative, treatable factors is therefore essential. Cardiovascular disorders are among the several risk factors which have been identified to cause falls; in particular unexplained and recurrent falls. In part, this is due to the overlap between falls and syncope secondary to underlying cardiovascular disease. The main aim of this thesis was to study the association between cardiovascular conditions and falls, in particular cardiac arrhythmia, conduction abnormalities and structural abnormalities. Because these conditions could lead to falls via several pathways, another aim was to study potential mechanisms responsible for these associations. The results of this thesis show that several cardiovascular abnormalities are associated with falls in older adults, in particular atrial fibrillation, LV dysfunction, heart failure and low blood pressure. Furthermore, atrial fibrillation is associated with impaired mobility and greater drops in blood pressure on active stand, providing additional support for the framework in which cardiovascular abnormalities could lead to falls. Extending current fall preventive care with a cardiovascular evaluation and intervention is feasible, but randomized controlled trials investigating the effect of such an intervention on falls incidence are needed.