Carotid sinus syndrome: a modifiable risk factor for nonaccidental falls in older adults (SAFE PACE)
Open accessAbstract
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.
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Orthostatic blood pressure measurements, carotid sinus massage, and tilt testing are well tolerated, even in the frail elderly with cognitive impairment.
“Orthostatic BP measurements, CSM, and tilt testing are well tolerated, even in the frail elderly with cognitive impairment. 96,396,397”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [396]
The Methods describe carotid sinus massage with blood-pressure monitoring and head-up tilting, and Clinical investigations reports no persistent neurological symptoms after massage, though 0.8% had transient symptoms (page numbers unavailable). The Methods explicitly exclude people with cognitive impairment. The paper therefore offers limited support for tolerability of carotid sinus massage in selected older adults, but not for the claim about frail adults with cognitive impairment or the tolerability of all three tests. (LLM, conf=0.86)
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- Authors
- Kenny, R. A. M., Richardson, D. A., Steen, N., Bexton, R. S., Shaw, F. E., & Bond, J.
- Affiliations
- Royal Victoria Infirmary (GB)
- Newcastle University (GB)
- Freeman Hospital (GB)
- Corresponding author
- Kenny, Rose Anne M
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2001-11
- Volume
- 38
- Issue
- 5
- Pages
- 1491-1496
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2102093657
- Cited by
- 344
- References
- 29
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 4 · 2023: 4 · 2022: 8 · 2021: 6 · 2020: 10 · 2019: 8 · 2018: 15 · 2017: 16 · 2016: 6 · 2015: 7 · 2014: 12 · 2013: 16 · 2012: 18
- FWCI
- 14.84
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- carotid sinus syndrome, carotid sinus hypersensitivity, cardioinhibitory syncope, cardiac pacing, pacemaker implantation, falls in older adults, fall prevention, syncope
- MeSH terms
- Accidental Falls, Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Algorithms, Cardiac Pacing, Artificial, Decision Trees, Emergency Service, Hospital, Female, Follow-Up Studies, Humans, Male, Mass Screening, Pacemaker, Artificial, Recurrence, Referral and Consultation, Risk Factors, Syncope, Geriatric Assessment, Logistic Models, Treatment Outcome
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