What is the evidence for cardiovascular disorders as a risk factor for non-syncopal falls? Scope for future research

Background: Guidelines cite the importance of cardiovascular assessment in falls prevention, however there has been no systematic review of the role of cardiovascular disorders as risk factors for non-syncopal falls. Aim: Our objective was to carry out a systematic review of the evidence for cardiovascular disorders as risk factors for non-syncopal falls. Methods: We performed an electronic database search from January 1980 to February 2009 for studies of cardiovascular disorders and non-syncopal falls. The cardiovascular disorders reviewed were orthostatic hypotension, postprandial hypotension, low blood pressure, hypertension, carotid sinus hypersensitivity, arrhythmias, cardiovascular disease other than stroke and vasovagal syndrome. Eligible studies included randomised controlled trials, prospective cohort studies and cross sectional studies of persons 60 years and older. We excluded studies with syncope as the outcome. Results: Of a total of 3560 studies identified in our initial search, 61 papers were reviewed in detail, 26 of which met the criteria for inclusion in this review. The evidence for orthostatic hypotension as an independent risk factor for non-syncopal falls is weak. The evidence for postprandial hypotension and carotid sinus hypersensitivity as independent risk factors for non-syncopal falls is more robust. There is little data available on the association between arrhythmias and non-syncopal falls. Discussion: Few studies have explored cardiovascular disorders as risk factors for non-syncopal falls despite well founded physiological rationale for a causal association. Conclusion: Further research in this area is required.