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Carotid sinus syndrome: A modifiable risk factor for nonaccidental falls in older adults (SAFE PACE)

Lookup NU author(s): Professor Rose Anne Kenny, David Richardson, Dr Nick Steen, Dr Rodney Bexton, Dr Fiona Shaw, Professor John Bond

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Abstract

OBJECTIVES: The aim of the study was to determine whether cardiac pacing reduces falls in older adults with cardioinhibitory carotid sinus hypersensitivity (CSH). BACKGROUND: Cardioinhibitory carotid sinus syndrome causes syncope, and symptoms respond to cardiac pacing. There is circumstantial evidence for an association between falls and the syndrome. METHODS: A randomized controlled trial was done of consecutive older patients (>50 years) attending an accident and emergency facility because of a non-accidental fall. Patients were randomized to dual-chamber pacemaker implant (paced patients) or standard treatment (controls). The primary outcome was the number of falls during one year of follow-up. RESULTS: One hundred seventy-five eligible patients (mean age 73 ± 10 years; 60% women) were randomized to the trial: pacemaker 87; controls 88. Falls (without loss of consciousness) were reduced by two-thirds: controls reported 669 falls (mean 9.3; range 0 to 89), and paced patients 216 falls (mean 4.1; range 0 to 29). Thus, paced patients were significantly less likely to fall (odds ratio 0.42; 95% confidence interval: 0.23, 0.75) than were controls. Syncopal events were also reduced during the follow-up period, but there were much fewer syncopal events than falls - 28 episodes in paced patients and 47 in controls. Injurious events were reduced by 70% (202 in controls compared to 61 in paced patients). CONCLUSIONS: There is a strong association between non-accidental falls and cardioinhibitory CSH. These patients would not usually be referred for cardiovascular assessment: Carotid sinus hypersensitivity should be considered in all older adults who have non-accidental falls. © 2001 by the American College of Cardiology.

Publication metadata

Author(s): Bexton RS; Richardson DA; Kenny RAM; Bond J; Shaw FE; Steen N

Publication type: Article

Publication status: Published

Journal: Journal of the American College of Cardiology

Year: 2001

Volume: 38

Issue: 5

Pages: 1491–1496

ISSN (print): 0735-1097

ISSN (electronic):

Publisher: Elsevier Inc.

URL: http://dx.doi.org/10.1016/S0735-1097(01)01537-6

DOI: 10.1016/S0735-1097(01)01537-6

PubMed id: 11691528

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