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OBJECTIVE:To describe the etiologies of syncope in hospitalized patients and determine the factors that influence survival after discharge. lation-based studies from the 1980s underscored the importance of diagnosing the cause of syncope. 2-6 Individuals with syncope of cardiovascular origin had a higher 1-year mortality (18%-33%) than individuals with noncardiovascular or unexplained syncope (6%-12%), 2-6 and this increased risk continued for 5 years. 7 However, determining the etiology of a syncopal event was a diagnostic challenge that was unsuccessful in up to 47% of cases. [2][3][4][5][6] This discordance between a physician's ability to establish a diagnosis for a syncopal event and the prognostic importance of doing so has inspired much research on evaluating syncopal events. This literature on syncope, often involving single-center referral populations and a single diagnostic test, [8][9][10][11][12][13] was summarized by a recent consensus conference. 14,15 However, the use of these newer diagnostic testing modalities and the ability to identify etiologies of syncope, have not been described in an unselected population. Furthermore, the prognostic significance of cardiovascular syncope has been questioned in patients with heart disease and in the elderly, 9,16 but has not been reevaluated in more broadly defined populations during the current era of diagnostic testing. DESIGN:The goals of this study were to characterize the epidemiology of individuals hospitalized with syncope in a broad range of health care delivery settings. We wanted to describe the diagnostic testing and the results of diagnostic evaluations, and to determine if the etiology of syncope continued to predict mortality in an unselected communitybased population. METHODS Study Design and Source of PatientsThis study used an observational cohort design. To minimize referral and institutional bias, we selected populations served by three diverse health care systems in Oregon: a tertiary-care VA hospital, a group-model HMO, and Medicare. The Medicare population was drawn from all hospitals in Oregon. We reviewed the hospitalization databases of these organizations from January 1, 1992, through December 31, 1994, identifying patients with ICD-9-CM code 780.2 (syncope and collapse) as an admission diagnosis or as any one of the discharge diagnoses. This method of retrospectively identifying individuals with syncope on the basis of coded diagnoses is similar to methods used in several previous studies. 3,5,17,18 The first admission for a patient during the study time frame was identified for review; subsequent admissions were not included. There were 324 patients identified at the VA (0.98% of all admissions), 818 at the HMO (0.92%), and

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