Compression stockings for treating vasovagal syncope (COMFORTS-II) trial: Rationale and design of a triple-blind, multi-center, randomized controlled trial

• Published in: The American heart journal 2022-07, Vol.249, p.57-65
• Main Authors: Tavolinejad, Hamed, Poopak, Amirhossein, Sadeghian, Saeed, Bozorgi, Ali, Oraii, Alireza, Mollazadeh, Reza, Emkanjoo, Zahra, Kiarsi, Mohamadreza, Shahabi, Javad, Jalali, Arash, Alaeddini, Farshid, Ariannejad, Hamid, Yadangi, Somayeh, Oraii, Saeed, Kheirkhah, Jalal, Assadianrad, Mohammad, Aminorroaya, Arya, Tajdini, Masih
• Format: Article
• Language: English
• Subjects: Blood; Brochures; Clinical trials; Compression; Compression stocking; Compression therapy; Consciousness; Educational films; Enrollments; Fainting; Foot diseases; Heart; Hosiery; Intervention; Orthostatic hypotension; Patients; Randomization; Randomized Controlled Trial; Statistical analysis; Syncope; Vasovagal; Vasovagal syncope; Websites
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2022.04.002

Reduced venous return is an important trigger of vasovagal syncope (VVS). Elastic compression stockings (ECS) can modify venous return and be of therapeutic interest; however, evidence for ECS efficacy in VVS is scarce. This randomized controlled trial was designed to address the issue. COMFORTS-II is a multicenter, triple-blind, parallel design, randomized controlled trial aimed to assess the efficacy of ECS in preventing VVS recurrences. Using central online randomization, 268 participants will be allocated to 2 arms (1:1 ratio), wearing intervention ECS (25-30 mm Hg pressure) or sham ECS (≤10 mm Hg pressure). All participants will receive standard VVS treatment in the form of education, and lifestyle modification recommendations (drinking 2-3 l/d of fluids and consuming 10 g/d—roughly half a tablespoon—of table salt). Adherence to ECS treatment will be evaluated through diary sheets, and compared between study arms. Follow-up continues for 1 year, and is conducted via a 24/7 phone line available to patients and trimonthly visits. The co-primary outcomes are proportion of participants with any syncopal recurrence and time to first syncopal episode. Secondary outcomes include frequency of VVS spells, time intervals between recurrences, and incidence of any patient-reported adverse effects. To the best of our knowledge, COMFORTS-II is the first clinical trial to assess ECS efficacy among patients with VVS, addressing an important gap in evidence for VVS treatments.