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

OBJECTIVES The aim of the study was to determine whether cardiac pacing red uces falls in older adults with cardioinhibitory carotid sinus hypersensiti vity (CSH). BACKGROUND Cardioinhibitory carotid sinus syndrome causes syncope, and symp toms respond to cardiac pacing. There is circumstantial evidence for an ass ociation between falls and the syndrome. METHODS A randomized controlled trial was done of consecutive older patient s (>50 years) attending an accident and emergency facility because of a non -accidental fall. Patients were randomized to dual-chamber pacemaker implan t (paced patients) or standard treatment (controls). The primary outcome wa s the number of falls during one year of follow-up. RESULTS One hundred seventy-five eligible patients (mean age 73 +/- 10 year s; 60% women) were randomized to the trial: pacemaker 87; controls 88. Fall s (without loss of consciousness) were reduced by two-thirds: controls repo rted 669 falls (mean 9.3; range 0 to 89), and paced patients 216 falls (mea n 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 co ntrols. Syncopal events were also reduced during the follow-up period, but there were much fewer syncopal events than falls-28 episodes in paced patie nts and 47 in controls. Injurious events were reduced by 70% (202 in contro ls 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 card iovascular assessment. Carotid sinus hypersensitivity should be considered in all older adults who have non-accidental falls. (J Am Coll Cardiol 2001; 38:1491-6) (C) 2001 by the American College of Cardiology.