Epidemiology of syncope in hospitalized patients

Abstract

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

Syncope in paced patients with sick sinus syndrome from the DANPACE trial: incidence, predictors and prognostic implication

“…Whereas vasovagal syncope is associated with good prognosis,15 increased mortality for cardiac syncope and for syncope in patients with non-cardiac life-threatening illnesses17 has been demonstrated. It appears, however, that it is not the cause of syncope that imparts increased mortality risk, but age and comorbidities, including cardiovascular comorbidity 18 19. This ties in with the fact that a history of myocardial infarction, heart failure and high CCI are all predictors of syncope post pacemaker implant in our population.…”

Current Evaluation and Management of Syncope

“…11 Rather, underlying heart disease, especially congestive heart failure, was found to be the significant survival predictor. Similarly, a study of hospitalized syncope patients 12 found that the risk of dying was not associated with cardiac cause but correlated with age and comorbid illnesses, which included cardiovascular diseases. In a study of patients with advanced heart failure, poor left ventricular function was associated with high risk of sudden death regardless of the cause of syncope.…”

Collapse query cause: the management of adult syncope in the emergency department

“…Getchell et al studied elderly hospitalised patients (mean age 73 years) presenting with syncope, and showed that mortality was not associated with a cardiac cause for syncope, but rather with age and comorbid illnesses. 33 Subsequent studies controlling for cardiac mortality have showed that the higher mortality in patients with syncope due to a cardiovascular cause is largely related to underlying cardiovascular disease. 7 21 34 A study comparing patients with and without syncope, who were matched for cardiac disease, showed that syncope itself was not a significant predictor of 1 year survival, 21 however male sex, age .55 years and congestive heart failure were significant predictors.…”