Prevalence of Cardioinhibitory Carotid Sinus Hypersensitivity in Patients 50 Years or over Presenting to the Accident and Emergency Department with “Unexplained” or “Recurrent” Falls
Abstract
To study the prevalence of Cardioinhibitory Carotid Sinus Hypersensitivity (CICSH) in patients 50 years or over presenting to casualty with "unexplained" or "recurrent" falls. The prospective study was from October 1, 1995 to April 30, 1996 in the Inner City Accident and Emergency Departments, Newcastle Upon Tyne, U.K. Ten thousand four hundred forty-three patients 50 years and over presented, of which 4,051 (39%) were fallers. Fallers were excluded if they lived over 15 miles from the hospital (81), were registered blind (17), were unable to speak English (22), were unable to previously walk (27), if there was a history of only one accidental fall (1,659) or were cognitively impaired (776: Mini Mental State Examination < 24 [30]) or if there was a clear attributable medical diagnosis for the fall (871). Five hundred ninety-eight "unexplained" or "recurrent" fallers (defined as three or more falls in the previous 12 months) were assessed for carotid sinus massage (CSM). One hundred forty-five patients declined CSM (24%), 70 (12%) had relative contraindications to CSM and 13 already had pacemakers in situ (2%). Two hundred seventy-nine underwent CSM, of whom 65 had CICSH (23%), which might be amenable to treatment with pacemakers. The prevalence of CICSH (a potentially treatable condition) in "unexplained" or "recurrent" fallers who present to the accident and emergency department is 23%. A randomized control study to assess benefit from pacemaker intervention in these patient…
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The incidence of syncope in older adults is high.
“The management of syncope in older adults is particularly challenging: The incidence is high; the differential diagnosis is broad; the diagnosis is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy; and secondary morbidity is high because of comorbidities, physical injury, and frailty (35,45,666–675).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [667]
The diagnosis of syncope in older adults is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy.
“The management of syncope in older adults is particularly challenging: The incidence is high; the differential diagnosis is broad; the diagnosis is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy; and secondary morbidity is high because of comorbidities, physical injury, and frailty (35,45,666–675).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [667]
The differential diagnosis of syncope in older adults is broad.
“The management of syncope in older adults is particularly challenging: The incidence is high; the differential diagnosis is broad; the diagnosis is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy; and secondary morbidity is high because of comorbidities, physical injury, and frailty (35,45,666–675).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [667]
Secondary morbidity from syncope in older adults is high because of comorbidities, physical injury, and frailty.
“The management of syncope in older adults is particularly challenging: The incidence is high; the differential diagnosis is broad; the diagnosis is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy; and secondary morbidity is high because of comorbidities, physical injury, and frailty (35,45,666–675).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [667]
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References 14 · Cited by 100
- Authors
- RICHARDSON, D. A., BEXTON, R. S., SHAW, F. E., & KENNY, R. A.
- Affiliations
- Royal Victoria Infirmary (GB)
- Corresponding author
- KENNY, R.A.
- Venue
- Pacing and Clinical Electrophysiology
- Publisher
- Wiley
- Published
- 1997-03
- Volume
- 20
- Issue
- 3
- Pages
- 820-823
- ISSN
- 0147-8389 (ISSN-L)
- 1540-8159
- OpenAlex
- W2087960118
- Cited by
- 100
- References
- 14
- Citations by year
- 2023: 1 · 2021: 1 · 2019: 1 · 2018: 1 · 2017: 8 · 2016: 2 · 2015: 4 · 2014: 5 · 2013: 3 · 2012: 4
- FWCI
- 4.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pacing and Clinical Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- 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 › Heart Rate Variability and Autonomic Control
- Keywords
- carotid sinus massage, recurrent falls, unexplained falls, prevalence, pacemaker implantation, elderly patients, emergency department
- MeSH terms
- Accidental Falls, Carotid Sinus, England, Humans, Middle Aged, Pacemaker, Artificial, Pressure, Prospective Studies, Recurrence, Syndrome, Urban Health, Vagus Nerve, Vasomotor System, Prevalence, Randomized Controlled Trials as Topic, Baroreflex, Syncope, Vasovagal
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