Atrial fibrillation (AF) is the most common chronic cardiac rhythm disturbance and increases an individual’s risk of stroke 5-fold.1 Anticoagulation therapy reduces the risk of stroke by > 60% in patients with AF.2 The risk of AF increases with age, yet the perceived risk of fall in elderly patients taking warfarin reduces the use of this therapy.3
A single-institution study in 2000 revealed that 49% of veterans with AF were not receiving anticoagulation therapy. In 13% of cases, warfarin was withheld due to the perceived fall risk.4 Some studies of anticoagulation therapy for AF, in keeping with recommendations of the Medicare Health Care Quality Improvement Program National Stroke Project, have excluded patients who are deemed at high risk for falls.5 Although fall risk is being used in both research and clinical settings to determine the safety of prescribing warfarin for AF, how to determine such a patient’s fall risk has not been defined.
Although several rules for predicting falls in community dwellers have been published, none are routinely assessed during a patient’s hospital stay.6 Research shows the Morse Fall Scale (MFS) is a widely used, validated tool for assessing fall risk among hospitalized patients and indicates VA patients to be at high risk for falls.7,8 All patients hospitalized at the John L. McClellan Memorial Veterans Hospital (JLMMVH) in Little Rock, Arkansas, receive a MFS score at admission. If the MFS score is predictive of the postdischarge risk of a veteran with AF falling, the score would assist in determining which patients can be safely discharged while taking anticoagulation therapy.