Document Detail

Carotid sinus syndrome: a modifiable risk factor for nonaccidental falls in older adults (SAFE PACE).
MedLine Citation:
PMID:  11691528     Owner:  NLM     Status:  MEDLINE    
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.
R A Kenny; D A Richardson; N Steen; R S Bexton; F E Shaw; J Bond
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  38     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2001 Nov 
Date Detail:
Created Date:  2001-11-05     Completed Date:  2001-12-05     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1491-6     Citation Subset:  AIM; IM    
Cardiovascular Investigation Unit, Royal Victoria Infirmary/MRC Development Centre for Clinical Brain Ageing, Newcastle General Hospital, Newcastle Upon Tyne, United Kingdom.
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MeSH Terms
Accidental Falls / prevention & control*,  statistics & numerical data*
Activities of Daily Living
Age Factors
Aged, 80 and over
Cardiac Pacing, Artificial / standards*
Decision Trees
Emergency Service, Hospital / utilization
Follow-Up Studies
Geriatric Assessment
Logistic Models
Mass Screening
Pacemaker, Artificial / standards*
Referral and Consultation
Risk Factors
Syncope / complications*,  prevention & control*
Treatment Outcome
Comment In:
J Am Coll Cardiol. 2001 Nov 1;38(5):1497   [PMID:  11691529 ]
ACP J Club. 2002 Jul-Aug;137(1):8   [PMID:  12093207 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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