Key result
Carotid sinus hypersensitivity occurs in ~67% of hip fracture patients with unexplained falls versus controls.
Why the study?
The prevalence of carotid sinus hypersensitivity in patients with hip fractures with and without a clear history of accidental falls was unclear.
Is carotid sinus hypersensitivity more common in patients presenting with hip fracture and unexplained falls compared to accidental falls or controls?
Case-Control (n=102)
Is carotid sinus hypersensitivity more common in patients presenting with hip fracture and unexplained falls compared to accidental falls or controls?
Absolute Event Rate: 66.7% vs 18.2%
p-value: p=< 0.001
Carotid sinus hypersensitivity is highly prevalent in elderly patients presenting with hip fractures following an unexplained fall, suggesting a need for cardiovascular evaluation in this population.
Supports evaluating CSH in unexplained fall-related hip fractures; leaves open whether detection improves outcomes.
BACKGROUND: We tried to determine the prevalence of carotid sinus hypersensitivity (CSH) in patients with hip fractures with and without a clear history of an accidental fall. METHODS: We studied 51 patients hospitalized for a hip fracture and 51 matched controls from our outpatients department. All patients were subjected to a carotid sinus massage in the supine and upright position. Patients were categorized in accidental (Group A) and unexplained (Group B) fallers. RESULTS: Six of 33 (18.2%) patients in Group A and 12 of 18 (66.7%) patients in Group B (P < 0.001) had a positive response to the carotid sinus massage. Nine controls (17.6%) also demonstrated CSH. Patients in Group B were older (A: 75.5 +/- 8.5 years vs B: 80.1 +/- 5.9 years, P =0.029) and were more likely to have a history of unexplained falls or syncope in the past (A: 0% vs B: 66.7%, P < 0.0001) than individuals in group A. Vasodepressor/mixed forms accounted for the majority of CSH responses in Group B (75%). When compared with the control group, CSH was still more common in Group B (B: 66.7% vs control: 17.6%, P < 0.0001) but not in Group A (A: 18.2% vs control: 17.6%, P =1.000). CONCLUSIONS: The prevalence of CSH is increased in elderly patients with hip fractures, only in those who present with an unexplained fall and report a history of syncope or unexplained falls in the past. The vasodepressor/mixed forms account for the majority of CSH responses in the group of unexplained fallers.
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Sachpekidis et al. (2009) conducted a case-control in Hip fracture (n=102). Unexplained falls vs. Accidental falls and matched controls was evaluated on Positive response to carotid sinus massage (carotid sinus hypersensitivity) (p=< 0.001). Carotid sinus hypersensitivity was significantly more prevalent in hip fracture patients with unexplained falls (66.7%) compared to those with accidental falls (18.2%, P<0.001) or controls (17.6%).
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