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Pronk AC, Wang L, van Poelgeest EP, Leeflang MMG, Daams JG, Hoekstra AG, van der Velde N. The impact of cardiovascular diagnostics and treatments on fall risk in older adults: a scoping review and evidence map. GeroScience 2024; 46:153-169. [PMID: 37864713 PMCID: PMC10828261 DOI: 10.1007/s11357-023-00974-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/07/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND We aimed to summarize the published evidence on the fall risk reducing potential of cardiovascular diagnostics and treatments in older adults. METHODS Design: scoping review and evidence map. DATA SOURCES Medline and Embase. ELIGIBILITY CRITERIA all available published evidence; Key search concepts: "older adults," "cardiovascular evaluation," "cardiovascular intervention," and "falls." Studies reporting on fall risk reducing effect of the diagnostic/treatment were included in the evidence map. Studies that investigated cardiovascular diagnostics or treatments within the context of falls, but without reporting a fall-related outcome, were included in the scoping review for qualitative synthesis. RESULTS Two articles on cardiovascular diagnostics and eight articles on cardiovascular treatments were included in the evidence map. Six out of ten studies concerned pacemaker intervention of which one meta-analyses that included randomized controlled trials with contradictory results. A combined cardiovascular assessment/evaluation (one study) and pharmacotherapy in orthostatic hypotension (one study) showed fall reducing potential. The scoping review contained 40 articles on cardiovascular diagnostics and one on cardiovascular treatments. It provides an extensive overview of several diagnostics (e.g., orthostatic blood pressure measurements, heart rhythm assessment) useful in fall prevention. Also, diagnostics were identified, that could potentially provide added value in fall prevention (e.g., blood pressure variability and head turning). CONCLUSION Although the majority of studies showed a reduction in falls after the intervention, the total amount of evidence regarding the effect of cardiovascular diagnostics/treatments on falls is small. Our findings can be used to optimize fall prevention strategies and develop an evidence-based fall prevention care pathway. Adhering to the World guidelines on fall prevention recommendations, it is crucial to undertake a standardized assessment of cardiovascular risk factors, followed by supplementary testing and corresponding interventions, as effective components of fall prevention strategies. In addition, accompanying diagnostics such as blood pressure variability and head turning can be of added value.
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Affiliation(s)
- Anouschka C Pronk
- Department of Internal Medicine, Section of Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands
| | - Liping Wang
- Department of Internal Medicine, Section of Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands
| | - Eveline P van Poelgeest
- Department of Internal Medicine, Section of Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands.
| | - Mariska M G Leeflang
- Department of Epidemiology and Data Science Section of Methodology, Amsterdam University Medical Centres, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Joost G Daams
- Medical Library, University of Amsterdam, Amsterdam, The Netherlands
| | - Alfons G Hoekstra
- Computational Science Lab, Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine, Section of Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands
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Brignole M, Croci F, Solano A, Donateo P, Maggi R, Solari D, Bertolone C, Fontana D, Oddone D. Reproducibility of carotid sinus massage. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1190-1193. [PMID: 32364652 DOI: 10.1111/pace.13934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 11/29/2022]
Abstract
AIMS The reproducibility of carotid sinus massage (CSM) is debated. The aim of this study was to assess the reproducibility according to the methodology and diagnostic criteria defined by the guidelines on syncope of the European Society of Cardiology. METHOD Among 2800 patients with syncope who underwent CSM in the years 2005-2019, 109 patients (62 males; mean age 76 ± 10 years) had performed a second CSM after a median of 28 months. Carotid sinus hypersensitivity (CSH) was diagnosed when CSM elicited a pause of >3 s and/or a fall in systolic blood pressure >50 mm Hg without reproduction of spontaneous symptoms. Carotid sinus syndrome (CSS) was established when spontaneous symptoms were reproduced in the presence of bradycardia and/or hypotension. RESULTS The reproducibility of CSM was 78% for 18 CSS patients, 41% for 29 CSH patients, and 77% for 62 negative patients. The corresponding interrater agreement was good for CSS (kappa = 0.66), moderate for negative CSM (kappa = 0.42), and poor for CSH (kappa = 0.30). Combining CSH and negative tests, their reproducibility rose to 90% with kappa = 0.66. CONCLUSION CSS but not CSH has a good reproducibility. About half of patients with CSH had a negative response at the second test, thus suggesting a great overlap between them.
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Affiliation(s)
- Michele Brignole
- Department of Cardiology, Arrhythmology Centre and Syncope Unit, Ospedali del Tigullio, Lavagna, Italy.,IRCCS Istituto Auxologico Italiano, Faint & Fall Programme, Ospedale San Luca, Milano, Italy
| | - Francesco Croci
- Department of Cardiology, Arrhythmology Centre and Syncope Unit, Ospedali del Tigullio, Lavagna, Italy
| | - Alberto Solano
- Department of Cardiology, Arrhythmology Centre and Syncope Unit, Ospedali del Tigullio, Lavagna, Italy
| | - Paolo Donateo
- Department of Cardiology, Arrhythmology Centre and Syncope Unit, Ospedali del Tigullio, Lavagna, Italy
| | - Roberto Maggi
- Department of Cardiology, Arrhythmology Centre and Syncope Unit, Ospedali del Tigullio, Lavagna, Italy
| | - Diana Solari
- Department of Cardiology, Arrhythmology Centre and Syncope Unit, Ospedali del Tigullio, Lavagna, Italy
| | - Cristina Bertolone
- Department of Cardiology, Arrhythmology Centre and Syncope Unit, Ospedali del Tigullio, Lavagna, Italy
| | - Daniele Fontana
- Department of Cardiology, Arrhythmology Centre and Syncope Unit, Ospedali del Tigullio, Lavagna, Italy
| | - Daniele Oddone
- Department of Cardiology, Arrhythmology Centre and Syncope Unit, Ospedali del Tigullio, Lavagna, Italy
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Zhao Z, Pan S, Yan N, Wang D, Li Z. Severe bradycardia caused by the deviation of the laryngeal mask airway Supreme: A case report. Medicine (Baltimore) 2019; 98:e15904. [PMID: 31192924 PMCID: PMC6587568 DOI: 10.1097/md.0000000000015904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Classic laryngeal mask airway (LMA) has long been used for airway management. The LMA Supreme is a modified single-use version of the LMA Proseal, but it still remains some deficits such as the instable positioning that lead to easily sliding and the mask bowl full of air might lead to the reduced blood flow of the internal carotid artery. The carotid sinus is a baroreceptor that responds to the stretching of the arterial wall. Manual pressure of the carotid artery at the upper margin of the sternocleidomastoid muscle provoked bradycardia and hypotension. PATIENT CONCERNS A previously fit and well 42-year-old woman presented with breast fibroma on the left side. No other disease history could be recorded. Her family history was negative for neuromuscular and autoimmune disease. DIAGNOSES The patient suffered from a severe bradycardia and hypotension when the LMA showed a shift. We presented with a hypothetical that the dislocated LMA may cause carotid sinus syndrome (CSS). INTERVENTIONS The patient's heart rate (HR) gradually rosed up as soon as the LMA adjusted back to the normal position. OUTCOMES The patient was comfortable in the post anesthesia care unit (PACU) and had no adverse sequelae. LESSONS The position of LMA Supreme should be confirmed throughout the surgery especially for the ones who has changed the position and the head was covered by surgical drapes.
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Finucane C, Colgan MP, O'Dwyer C, Fahy C, Collins O, Boyle G, Kenny RA. The accuracy of anatomical landmarks for locating the carotid sinus. Age Ageing 2016; 45:904-907. [PMID: 27496933 DOI: 10.1093/ageing/afw105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 04/21/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND carotid sinus massage (CSM) is a valuable clinical test for carotid sinus syndrome (CSS) and relies on accurately locating the carotid sinus (CS). OBJECTIVE in this study, we sought to examine the accuracy of using anatomical landmarks for locating the CS. METHODS consecutive patients (n = 20) were recruited prospectively. Two clinicians, trained in CSM, were asked to locate the CS using anatomical landmarks. A point on the skin overlying the CS was then marked by a vascular technician using ultrasound. Accuracy of techniques was compared using intra-class correlation coefficients and Bland-Altman statistics. RESULTS anatomical landmarks underestimated the CS location by 1.5 ± 1.3 cm. Error extremes ranged from 4 cm below to 2 cm above CS using anatomical landmarks. A moderate correlation between ultrasound and anatomical landmarks was found, r = 0.371 (P = 0.031). CONCLUSION this is the first study to characterise the accuracy of standard anatomical landmarks used in CSM. Results suggest that the point of maximal pulsation has the lowest associated error. Future work should examine CSM yield across this and a range of other methodological factors.
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Affiliation(s)
- Ciaran Finucane
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
- Department of Medical Physics and Bioengineering, St. James's Hospital, Dublin, Ireland
| | - Mary Paula Colgan
- Department of Vascular and Endovascular Surgery, St. James's Hospital, Dublin, Ireland
| | - Clodagh O'Dwyer
- Department of Medical Gerontology, St. Vincent's Hospital, Dublin, Ireland
| | - Collette Fahy
- Department of Vascular and Endovascular Surgery, St. James's Hospital, Dublin, Ireland
| | - Orla Collins
- Department of Medical Gerontology, St. Vincent's Hospital, Dublin, Ireland
| | - Gerry Boyle
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
- Department of Medical Physics and Bioengineering, St. James's Hospital, Dublin, Ireland
| | - Rose Anne Kenny
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
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Mitro P, Kirsch P, Valocik G, Murin P. A prospective study of the standardized diagnostic evaluation of syncope. Europace 2011; 13:566-71. [DOI: 10.1093/europace/eur014] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Krediet CTP, Parry SW, Jardine DL, Benditt DG, Brignole M, Wieling W. The history of diagnosing carotid sinus hypersensitivity: why are the current criteria too sensitive? Europace 2010; 13:14-22. [DOI: 10.1093/europace/euq409] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Humm AM, Mathias CJ. Abnormal cardiovascular responses to carotid sinus massage also occur in vasovagal syncope - implications for diagnosis and treatment. Eur J Neurol 2010; 17:1061-7. [DOI: 10.1111/j.1468-1331.2010.03006.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Madden KM, Lockhart C, Khan K. Arterial stiffness and the response to carotid sinus massage in older adults. Aging Clin Exp Res 2010; 22:36-41. [PMID: 20142630 DOI: 10.3275/6810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Carotid sinus hypersensitivity (CSH) is a common cause of fainting and falls in the older adult population and is diagnosed by carotid sinus massage (CSM). Previous work has suggested that age-related stiffening of blood vessels reduces afferent input from the carotid sinus leading to central upregulation of the overall arterial baroreflex response. We examined the differences in arterial stiffness and baroreflex function in older adults at high cardiovascular risk (advanced age, Type 2 diabetes, hypertension and hyperlipidemia) with and without CSH. METHODS Forty-three older adults (mean age 71.4+/-0.7) with Type 2 diabetes, hyperlipidemia and hypertension were recruited. After resting supine for 45 minutes prior to the start of data collection, each subject had arterial stiffness measured by pulse wave velocity (PWV, Complior SD), followed by spontaneous baroreflex measures (Baroreflex sensitivity, BRS) and CSM. RESULTS Of the 43 subjects tested, 10 subjects met the criteria for CSH (8 pure vasodepressor and 2 mixed CSH). CSH subjects had higher measures of arterial stiffness when compared to normal subjects for both radial PWV (11.5+/-0.6 vs 9.6+/-0.4 m/s, p=0.043) and femoral PWV (13.4+/-0.9 vs 11.0+/-0.5 m/s, p=0.036). The CSH group demonstrated significantly lower BRS as compared to the normal group (BRS, 6.73+/-0.58 vs 10.41+/-0.85 ms/mmHg, p=0.038). These results were unchanged when the analysis was repeated with only the VD subjects. CONCLUSIONS Older adults with CSH have higher arterial stiffness and reduced arterial baroreflex sensitivity. There was no evidence to support upregulation of the arterial baroreflex in patients with CSH.
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Affiliation(s)
- Kenneth M Madden
- Vancouver Initiative to Add Life To Years Research Group, Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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Park WH, Kim SY, Park HG, Song DG, Kim TG, Min BY, Park JI. Carotid Sinus Syncope in an Elderly Patient With Unexplained Syncope. Korean Circ J 2008. [DOI: 10.4070/kcj.2008.38.10.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Won Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Cardiac and Vascular Center, Seoul Veterans Hospital, Seoul, Korea
| | - Soo Yeun Kim
- Division of Cardiology, Department of Internal Medicine, Cardiac and Vascular Center, Seoul Veterans Hospital, Seoul, Korea
| | - Hyun Gyung Park
- Division of Cardiology, Department of Internal Medicine, Cardiac and Vascular Center, Seoul Veterans Hospital, Seoul, Korea
| | - Dae-Geun Song
- Division of Cardiology, Department of Internal Medicine, Cardiac and Vascular Center, Seoul Veterans Hospital, Seoul, Korea
| | - Tae Gyoon Kim
- Division of Cardiology, Department of Internal Medicine, Cardiac and Vascular Center, Seoul Veterans Hospital, Seoul, Korea
| | - Bo Young Min
- Division of Cardiology, Department of Internal Medicine, Cardiac and Vascular Center, Seoul Veterans Hospital, Seoul, Korea
| | - Joong-Il Park
- Division of Cardiology, Department of Internal Medicine, Cardiac and Vascular Center, Seoul Veterans Hospital, Seoul, Korea
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van der Velde N, van den Meiracker AH, Pols HAP, Stricker BHC, van der Cammen TJM. Withdrawal of fall-risk-increasing drugs in older persons: effect on tilt-table test outcomes. J Am Geriatr Soc 2007; 55:734-9. [PMID: 17493193 DOI: 10.1111/j.1532-5415.2007.01137.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine whether outcomes of tilt-table tests improved after withdrawal of fall-risk-increasing drugs (FRIDs). DESIGN Prospective cohort study. SETTING Geriatric outpatient clinic. PARTICIPANTS Two hundred eleven new, consecutive outpatients, recruited from April 2003 until December 2004. MEASUREMENTS Tilt-table testing was performed on all participants at baseline. Subsequently, FRIDs were withdrawn in all fallers in whom it was safely possible. At a mean follow-up of 6.7 months, tilt-table testing was repeated in 137 participants. Tilt-table testing addressed carotid sinus hypersensitivity (CSH), orthostatic hypotension (OH), and vasovagal collapse (VVC). Odds ratios (ORs) of tilt-table-test normalization according to withdrawal (discontinuation or dose reduction) of FRIDs were calculated using multivariate logistic regression analysis. RESULTS After adjustment for confounders, the reduction of abnormal test outcomes (ORs) according to overall FRID withdrawal was 0.34 (95% confidence interval (CI)=0.06-1.86) for CSH, 0.35 (95% CI=0.13-0.99) for OH, and 0.27 (95% CI=0.02-3.31) for VVC. For the subgroup of cardiovascular FRIDs, the adjusted OR was 0.13 (95% CI=0.03-0.59) for CSH, 0.44 (95% CI=0.18-1.0) for OH, and 0.21 (95% CI=0.03-1.51) for VVC. CONCLUSION OH improved significantly after withdrawal of FRIDs. Subgroup analysis of cardiovascular FRID withdrawal showed a significant reduction in OH and CSH. These results imply that FRID withdrawal can cause substantial improvement in cardiovascular homeostasis. Derangement of cardiovascular homeostasis may be an important mechanism by which FRID use results in falls.
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Affiliation(s)
- Nathalie van der Velde
- Department of Internal Medicine, Section of Geriatrics, Erasmus University Medical Center, Rotterdam, The Netherlands
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