Causes and Predictors of 30‐Day Readmission in Patients With Syncope/Collapse: A Nationwide Cohort Study

Abstract

BackgroundSyncope accounts for 0.6% to 1.5% of hospitalizations in the United States. We sought to determine the causes and predictors of 30‐day readmission in patients with syncope.Methods and ResultsWe identified 323 250 encounters with a primary diagnosis of syncope/collapse in the 2013–2014 Nationwide Readmissions Database. We excluded patients younger than 18 years, those discharged in December, those who died during hospitalization, hospital transfers, and those whose length of stay was missing. We used multivariable logistic regression analysis to evaluate the association between baseline characteristics and 30‐day readmission. A total of 282 311 syncope admissions were included. The median age was 72 years (interquartile range, 58–83), 53.9% were women, and 9.3% had 30‐day readmission. The most common cause of 30‐day readmissions was syncope/collapse, followed by cardiac, neurological, and infectious causes. Characteristics associated with 30‐day readmissions were age 65 years and older (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.6–0.7), female sex (OR, 0.9; 95% CI, 0.8–0.9), congestive heart failure (OR, 1.5; 95% CI, 1.2–1.9), atrial fibrillation/flutter (OR, 1.3; 95% CI, 1.3–1.4), diabetes mellitus (OR, 1.2; 95% CI, 1.2–1.3), coronary artery disease (OR, 1.2; 95% CI, 1.2–1.3), anemia (OR, 1.4; 95% CI, 1.4–1.5), chronic obstructive pulmonary disease (OR, 1.4; 95% CI, 1.3–1.4), home with home healthcare disposition (OR, 1.5; 95% CI, 1.5–1.6), leaving against medical advice (OR, 1.7; 95% CI, 1.6–1.9), length of stay of 3 to 5 days (OR, 1.5; 95% CI, 1.4–1.6) or >5 days (OR, 2; 95% CI, 1.8–2), and having private insurance (OR, 0.6; 95% CI, 0.6–0.7).ConclusionsThe 30‐day readmission rate after syncope/collapse was 9.3%. We identified causes and risk factors associated with readmission. Future prospective studies are needed to derive risk‐stratification models to reduce the high burden of readmissions.

Diagnostic utility and outcomes of inpatient investigations for syncope in a regional setting

“…In our study, 5.4% of patients were readmitted for syncope within the 2‐year period. This is less than the rate of 9.3% demonstrated in a similar retrospective, cohort study on the outcomes of patients with syncope 18 . In our study, 9.6% of patients died within the study period; however, notably all deaths occurred for reasons unrelated to the syncopal event.…”

“…This is less than the rate of 9.3% demonstrated in a similar retrospective, cohort study on the outcomes of patients with syncope. 18 In our study, 9.6% of patients died within the study period; however, notably all deaths occurred for reasons unrelated to the syncopal event. A comparable observational study found the all-cause mortality rate of patients presenting to the ED for syncope to be 7.6% at 12 months, 19 which is slightly below the findings of this study.…”

The Impact of a Nurse‐Led Syncope Clinic: Experience from a single UK tertiary center

“…We found that COPD was independently associated with increased mortality risk in patients hospitalized with syncope in this cohort; this risk was similar to patients with HF. Recently COPD has been shown to predict increased risk of hospitalization for syncope, however, mortality outcomes were not reported 23 . Potential mechanisms of syncope in COPD include cough syncope, orthostatic hypotension because of medications used for associated comorbidities, presence of pulmonary hypertension and secondary adrenal insufficiency because of corticosteroid use.…”

Novel Machine Learning Approach to Predict and Personalize Length of Stay for Patients Admitted with Syncope from the Emergency Departmen

“…Such approaches consume hospital resources and often lead to prolonged and unnecessary hospital length of stay (LoS) [ 1 , 3 , 4 , 5 , 6 ]. Long initial hospital stays (>3 days) are associated with greater expense, higher readmission rates within 30 days and resource utilization [ 7 ].…”