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The authors explored the differences in clinical presentation, etiology, mortality, and recurrences of new-onset syncope in 502 patients across 3 age groups: middle-aged (36-60 years), older (61-75 years), and elderly (older than 75 years). Clinical features of syncopal episodes were similar except for more frequent presyncopal episodes in patients older than 75 years. Yield of diagnostic tests was similarly low except for higher incidence of positive tilt-table test (60%) in older patients. Syncope remained unexplained more frequently in the elderly (54% vs 37% in middle-aged and 43% in older adults, P=.01). Syncope recurrence was higher in the middle-aged and elderly groups. Overall mortality for the 3 age groups was similar to that recorded in the general population after adjustment for age and comorbidities. Etiology of syncope was not associated with age- and comorbidity-adjusted all-cause mortality. Cardiovascular mortality was significantly higher in patients with cardiogenic syncope (adjusted hazard ratio, 2.44; P=.044).

The objective of this study was to determine whether syncope of unknown etiology (SUE) influences mortality in the elderly. Patients with SUE at 65 years or older were identified retrospectively and their outcomes were compared with an age-, sex-, and comorbidity-matched group of patients drawn from the same population. All-cause 3-year mortality was analyzed using the Kaplan-Meier method and the log-rank test. SUE was identified in 150 of 304 patients (49%) with syncope. Patients with SUE and controls experienced mortality rates (1/1000 person-years [95% confidence interval]) of 147.8 (112.6-193.9) and 153.4 (117.5-200.3), P=.7, respectively. Of all the recorded characteristics of SUE, only the inpatient status was associated with higher all-cause mortality (Cox model adjusted hazard ratio [95% confidence interval] of inpatients vs outpatients with SUE: 2.2 [1.1-4.1], P=.017). New-onset SUE is not an independent predictor of mortality in elderly patients.

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