In a retrospective cohort of 2,139 coronary heart disease (CHD) patients followed for a median 36 months, out-of-hospital falls — occurring in 8% of participants — independently predicted major adverse cardiovascular events (MACE: HR=1.73) and cerebrovascular events (MACCE: HR=1.67) after full covariate adjustment. Mortality risk from falls was entirely mediated by functional status decline rather than falls per se. Most strikingly, among physically robust patients, falls conferred a fourfold elevated MACE risk (HR=4.08, 95%CI: 2.37–7.01), while no significant association emerged in pre-frail or frail individuals.
This finding reframes falls not merely as injury events but as potential cardiovascular sentinel signals — particularly alarming in patients who appear physically capable. The mechanistic pathway likely involves shared vulnerabilities: autonomic dysfunction, subclinical arrhythmias, orthostatic hypotension from medications like beta-blockers, or cerebral hypoperfusion that precedes both falls and cardiac events. The robust-patient signal is counterintuitive yet clinically coherent — frail patients may already be intensively monitored, whereas robust fallers represent an underrecognized high-risk group.
Limitations are meaningful: the retrospective design, fall ascertainment by telephone interview (introducing recall bias), and a predominantly single-center Chinese cohort limit generalizability. The finding that frailty nullifies fall-associated risk warrants cautious interpretation — confounding by indication or competing mortality risks in frailer patients cannot be excluded. As a preprint not yet peer-reviewed, these results require independent validation before clinical implementation. Still, this is potentially paradigm-shifting for cardiac risk stratification: a simple fall history could flag cardiovascular vulnerability that standard metrics miss.
