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document
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 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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Intervention_Physical
cardiac pacing
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Intervention_Physical
cardiac pacing .
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Intervention_Physical
dual-chamber pacemaker implant ( paced patients )
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Intervention_Control
standard treatment ( controls )
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Intervention_Physical
pacemaker
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Intervention_Physical
controls
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Outcome_Physical
nonaccidental falls
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Outcome_Physical
falls
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Outcome_Physical
falls
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Outcome_Physical
non-accidental fall
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Outcome_Physical
number of falls during one year of follow-up
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Outcome_Physical
Falls ( without loss of consciousness )
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Outcome_Physical
fall
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Outcome_Physical
Syncopal events
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Outcome_Physical
syncopal events
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Outcome_Physical
falls-28
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Outcome_Physical
Injurious events
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Outcome_Physical
non-accidental