The present study is a retrospective chart review of all patients with AF discharged from the JLMMVH during 2006 and their subsequent risk of falls requiring acute medical care. Based on CDC data indicating the risk for nonfatal falls by persons aged > 65 years to be more than twice that of younger persons and the established fall risk ranges of the MFS, it was hypothesized that AF patients aged ≥ 65 years with a modified MFS score (MMS) ≥ 55 would be at a significantly greater risk of fall requiring acute medical care following hospital discharge than would those of the same age with lower scores.
Methods
This study was approved by the JLMMVH Institutional Review Board. The electronic medical records (EMRs) of all veterans with a diagnosis of AF discharged from the JLMMVH during 2006 were manually reviewed for study inclusion. The year 2006 was chosen in order to ensure adequate subject follow-up time.
Inclusion criteria consisted of discharge from an acute care unit and the patient’s most recent electrocardiogram (ECG) prior to the index discharge, showing AF or atrial flutter; or the most recent ECG prior to the index discharge, showing a fully paced rhythm consistent with an underlying rhythm of AF and documentation of previously diagnosed chronic AF for which a permanent pacemaker was placed.
Exclusion criteria consisted of discharge due to patient death; transient (persisting < 24 hours) AF associated with an acute medical illness or surgical procedure; index hospitalization representing transfer temporarily from another VAMC for the sole purpose of performing a procedure; hospitalization lasting < 24 hours (not coded as a hospital admission); mechanical heart valve; index admission for a neurosurgical procedure, hemorrhagic stroke, or bleeding esophageal/gastric varices; anticoagulation therapy recommended by the physician at the time of discharge but declined by the patient; incomplete or missing MFS score in the EMR; and lack of follow-up after the index discharge. Temporary transfers from outside facilities were excluded, due to anticipated difficulty in performing follow-up. Individuals for whom anticoagulation therapy was either inappropriate (eg, bleeding varices) or absolutely required (eg, mechanical heart valve) also were excluded.