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Background <p>Cardiovascular disorders are important fall risk factors, especially in unexplained recurrent falls. According to (international) guidelines, a standard workup of cardiovascular fall risk factors is indicated; however, its implementations is lagging. This study aimed to map the daily practice of cardiovascular fall risk assessment and management in Dutch fall clinics, comparing guideline recommendations (work-as-imagined) with actual practice (work-as-done), and to identify barriers to implementation.</p> Methods <p>The functional resonance analysis method (FRAM) was used to visualize work-as-imagined and work-as-done. Input for work-as-imagined was the Dutch guideline on fall prevention, which follows the ESC syncope guideline recommendations where applicable. Work-as done and barriers for guideline implementation were derived from semi-structured interviews with Dutch fall clinic professionals.</p> Results <p>Fourteen participants from eight fall clinics participated. Work-as-done related to the initial assessment of cardiovascular fall risk factors (e.g., ECG recording), was in line with work-as-imagined and implemented across the participating fall clinics. For the implementation of further cardiovascular assessments (e.g., head-up tilt testing), significant variability was observed across fall clinics, resulting in four different work-as-done FRAM models. The variations were mainly driven by the following barriers: unavailability of staff, gaps in knowledge, lack of expertise, and lack of resources.</p> Conclusion <p>This study highlights important discrepancies between recommended cardiovascular fall risk assessment protocols and current practices in Dutch fall clinics. A structured care pathway could help standardize and optimize cardiovascular fall risk practices. Addressing the identified barriers to implementation and development in standardized care pathways could facilitate the implementation of the care pathway and optimize cardiovascular fall prevention practices in older adults.</p>

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Evaluation of cardiovascular fall risk assessment and managment in Dutch fall clinics comparing current practice to guideline recommendations

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月2日

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  • A. C. Pronk,
  • R. Schroten,
  • L. J. Seppala,
  • E. P. van Poelgeest,
  • B. A. Damoiseaux-Volman,
  • J. A. H. R. Claassen,
  • F. Mattace-Raso,
  • S. C. de Ruiter,
  • J. O. Daal,
  • L. A. R. Zwart,
  • T. N. Bongers,
  • G. S. Spronk,
  • S. M. Driessen,
  • N. van der Velde

摘要

Background

Cardiovascular disorders are important fall risk factors, especially in unexplained recurrent falls. According to (international) guidelines, a standard workup of cardiovascular fall risk factors is indicated; however, its implementations is lagging. This study aimed to map the daily practice of cardiovascular fall risk assessment and management in Dutch fall clinics, comparing guideline recommendations (work-as-imagined) with actual practice (work-as-done), and to identify barriers to implementation.

Methods

The functional resonance analysis method (FRAM) was used to visualize work-as-imagined and work-as-done. Input for work-as-imagined was the Dutch guideline on fall prevention, which follows the ESC syncope guideline recommendations where applicable. Work-as done and barriers for guideline implementation were derived from semi-structured interviews with Dutch fall clinic professionals.

Results

Fourteen participants from eight fall clinics participated. Work-as-done related to the initial assessment of cardiovascular fall risk factors (e.g., ECG recording), was in line with work-as-imagined and implemented across the participating fall clinics. For the implementation of further cardiovascular assessments (e.g., head-up tilt testing), significant variability was observed across fall clinics, resulting in four different work-as-done FRAM models. The variations were mainly driven by the following barriers: unavailability of staff, gaps in knowledge, lack of expertise, and lack of resources.

Conclusion

This study highlights important discrepancies between recommended cardiovascular fall risk assessment protocols and current practices in Dutch fall clinics. A structured care pathway could help standardize and optimize cardiovascular fall risk practices. Addressing the identified barriers to implementation and development in standardized care pathways could facilitate the implementation of the care pathway and optimize cardiovascular fall prevention practices in older adults.