Carotid sinus hypersensitivity - a modifiable risk factor for fractured neck of femur

Background: the potential impact on morbidity, mortality and health care ec onomics makes it important to identify patients at risk of fracture, in par ticular fractured neck of femur (FNOF). Older patients with carotid sinus h ypersensitivity (CSH) are more likely to have unexplained falls and to expe rience fractures, particularly FNOE Our objective was to determine the prev alence of CSH in patients with FNOE. Design: case-controlled prospective series. Methods: consecutive cases were admissions over 65 years with FNOE Controls were consecutive patients admitted for elective hip surgery, frail elderly people admitted to hospital medical wards and day-hospital patients. All p atients had a clinical assessment of cognitive function, physical abilities and history of previous syncope, falls and dizziness, in addition to repea ted carotid sinus massage with continuous heart rate and phasic blood press ure measurement. Results: heart rate slowing and fall in systolic blood pressure was greater for patients with FNOF than those admitted for elective hip surgery (P < 0 .05 and P < 0.001). CSH was present in 36% of the FNOF group, none of the e lective surgery group, 13% of the acutely ill controls and 17% of the outpa tients. It was more likely to be present in FNOF patients with a previous h istory of unexplained falls or an unexplained fall causing the index fractu re. The heart rate and systolic blood pressure responses to carotid sinus s timulation were reproducible. Conclusion: older patients with an acute neck of femur fracture who do not give a clear history of an accidental fall or who have had previously unexp lained falls are likely to have CSH. CSH may be a modifiable risk factor fo r older patients at risk of hip fracture.