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

J Am Coll Cardiol. 2001 Nov 1;38(5):1491-6. doi: 10.1016/s0735-1097(01)01537-6.


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.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Falls / prevention & control*
  • Accidental Falls / statistics & numerical data*
  • Activities of Daily Living
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Cardiac Pacing, Artificial / standards*
  • Decision Trees
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Geriatric Assessment
  • Humans
  • Logistic Models
  • Male
  • Mass Screening
  • Pacemaker, Artificial / standards*
  • Recurrence
  • Referral and Consultation
  • Risk Factors
  • Syncope / complications*
  • Syncope / prevention & control*
  • Treatment Outcome