Evaluating the Impact of Orthostatic Syncope and Presyncope on Quality of Life: A Systematic Review and Meta-Analysis

Hockin, Brooke C. D.; Heeney, Natalie D.; Whitehurst, David G T; Claydon, Victoria E.

doi:10.3389/fcvm.2022.834879

Cited by 8 publications

(14 citation statements)

References 67 publications

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“…Intriguingly, general fatigue severity was not related to disease severity in patients with POTS, inferred from the magnitude of the heart rate increment observed during head up tilt. This is in keeping with previous observations that the orthostatic heart rate response is also not a good predictor of quality of life in patients with POTS [8,75]. Healthcare providers should not overlook the possibility for severe fatigue in patients with POTS, even those with less severe orthostatic tachycardia.…”

Section: Fatigue Severity Scale Scoressupporting

confidence: 90%

“…The association between fatigue and mental health is not clear, but it has been suggested that it reflects that many people with POTS suffer from sleep disturbance, pain, fatigue and brain fog, which can severely diminish quality of life and lead to suicidal ideation [42]. Psychiatric comorbidities are also noted in patients with VVS, with a higher prevalence than healthy controls [8,73]. Whether this also reflects an association between fatigue and mental health concerns in patients with other orthostatic syncope disorders is unclear.…”

Section: Fatigue Severity Scale Scoresmentioning

confidence: 99%

“…A second peak of symptoms occurs in later life (~ 70 years of age), with incidence rates increasing to 11.1 per 1000 person-years in older adults [3]. Orthostatic syncope is typically considered to be a benign condition because it is not immediately life-threatening, but in both younger and older patients it has a profound negative impact on quality of life and the ability to participate in activities of daily living [7,8]. Syncope is also associated with significant injuries, resulting in increased hospitalizations, and costing patients US $1.7 billion and CAD $50 million annually within the USA and Canada, respectively [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Faintly tired: a systematic review of fatigue in patients with orthostatic syncope

Khan

Hockin

et al. 2022

Clin Auton Res

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Background Orthostatic syncope (transient loss of conscious when standing—fainting) is common and negatively impacts quality of life. Many patients with syncope report experiencing fatigue, sometimes with “brain fog”, which may further impact their quality of life, but the incidence and severity of fatigue in patients with syncope remain unclear. In this systematic review, we report evidence on the associations between fatigue and conditions of orthostatic syncope. Methods We performed a comprehensive literature search of four academic databases to identify articles that evaluated the association between orthostatic syncope [postural orthostatic tachycardia syndrome (POTS), vasovagal syncope (VVS), orthostatic hypotension (OH)] and fatigue. Studies were independently screened using a multi-stage approach by two researchers to maintain consistency and limit bias. Results Our initial search identified 2797 articles, of which 13 met our inclusion criteria (POTS n = 10; VVS n = 1; OH n = 1; VVS and POTS n = 1). Fatigue scores were significantly higher in patients with orthostatic syncope than healthy controls, and were particularly severe in those with POTS. Fatigue associated with orthostatic syncope disorders spanned multiple domains, with each dimension contributing equally to increased fatigue. “Brain fog” was an important symptom of POTS, negatively affecting productivity and cognition. Finally, fatigue was negatively associated with mental health in patients with POTS. Conclusion In conditions of orthostatic syncope, fatigue is prevalent and debilitating, especially in patients with POTS. The consideration of fatigue in patients with orthostatic disorders is essential to improve diagnosis and management of symptoms, thus improving quality of life for affected individuals.

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Section: Fatigue Severity Scale Scoressupporting

confidence: 90%

Section: Fatigue Severity Scale Scoresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Faintly tired: a systematic review of fatigue in patients with orthostatic syncope

Khan

Hockin

et al. 2022

Clin Auton Res

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“…This is especially noteworthy, as the role of CPM in syncope management is not necessarily to eliminate episodes all together. Patient quality of life is inversely related to episode frequency ( 12 ), therefore reducing episodes could still lower syncope burden, bringing a substantial benefit to the patient ( 90 , 96 ). Over a 1-year follow up, Romme et al reported that while 49% of patients experienced a syncopal recurrence, disease-specific quality of life improved most in patients with the largest reductions in syncope burden (as quantified by episode frequency over time) ( 96 ).…”

Section: Counter Pressure Maneuversmentioning

confidence: 99%

“…Up to 30% of those who have fainted will experience recurrent and severe episodes (7). Living with recurrent syncope presents many challenges to daily living, and can profoundly impact patient independence, and quality of life (8)(9)(10)(11)(12). Patients with syncope also face greater fatigue in daily living (13), and an increased risk of fall-related injury associated with their loss of consciousness, particularly in older adults with increased frailty (14,15).…”

Section: Introductionmentioning

confidence: 99%

Counter pressure maneuvers for syncope prevention: A semi-systematic review and meta-analysis

Williams

Khan

Claydon

2022

Front. Cardiovasc. Med.

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Physical counter pressure maneuvers (CPM) are movements that are recommended to delay or prevent syncope (fainting) by recruiting the skeletal muscle pump to augment cardiovascular control. However, these recommendations are largely based on theoretical benefit, with limited data evaluating the efficacy of CPM to prevent syncope in the real-world setting. We conducted a semi-systematic literature review and meta-analysis to assess CPM efficacy, identify literature gaps, and highlight future research needs. Articles were identified through a literature search (PubMed, April 2022) of peer-reviewed publications evaluating the use of counter pressure or other lower body maneuvers to prevent syncope. Two team members independently screened records for inclusion and extracted data. From 476 unique records identified by the search, 45 met inclusion criteria. Articles considered various syncopal conditions (vasovagal = 12, orthostatic hypotension = 8, postural orthostatic tachycardia syndrome = 1, familial dysautonomia = 2, spinal cord injury = 1, blood donation = 10, healthy controls = 11). Maneuvers assessed included hand gripping, leg fidgeting, stepping, tiptoeing, marching, calf raises, postural sway, tensing (upper, lower, whole body), leg crossing, squatting, “crash” position, and bending foreword. CPM were assessed in laboratory-based studies (N = 28), the community setting (N = 4), both laboratory and community settings (N = 3), and during blood donation (N = 10). CPM improved standing systolic blood pressure (+ 14.8 ± 0.6 mmHg, p < 0.001) and heart rate (+ 1.4 ± 0.5 bpm, p = 0.006), however, responses of total peripheral resistance, stroke volume, or cerebral blood flow were not widely documented. Most patients experienced symptom improvement following CPM use (laboratory: 60 ± 4%, community: 72 ± 9%). The most prominent barrier to employing CPM in daily living was the inability to recognize an impending faint. Patterns of postural sway may also recruit the skeletal muscle pump to enhance cardiovascular control, and its potential as a discrete, proactive CPM needs further evaluation. Physical CPM were successful in improving syncopal symptoms and producing cardiovascular responses that may bolster against syncope; however, practical limitations may restrict applicability for use in daily living.

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Poor health-related quality of life in postural orthostatic tachycardia syndrome in comparison with a sex- and age-matched normative population

et al. 2023

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Purpose The effect of postural orthostatic tachycardia syndrome (POTS) on health-related quality of life (HrQoL) remains poorly studied. Here, we sought to compare the HrQoL in individuals with POTS to a normative age-/sex-matched population. Methods Participants enrolled in the Australian POTS registry between 5 August 2021 and 30 June 2022 were compared with propensity-matched local normative population data from the South Australian Health Omnibus Survey. The EQ-5D-5L instrument was used to assess HrQoL across the five domains (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) with global health rating assessed with a visual analog scale (EQ-VAS). A population-based scoring algorithm was applied to the EQ-5D-5L data to calculate utility scores. Hierarchical multiple regression analyses were undertaken to explore predictors of low utility scores. Results A total of 404 participants (n = 202 POTS; n = 202 normative population; median age 28 years, 90.6% females) were included. Compared with the normative population, the POTS cohort demonstrated significantly higher burden of impairment across all EQ-5D-5L domains (all P < 0.001), lower median EQ-VAS (p < 0.001), and lower utility scores (p < .001). The lower EQ-VAS and utility scores in the POTS cohort were universal in all age groups. Severity of orthostatic intolerance symptoms, female sex, fatigue scores, and comorbid diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome were independent predictors of reduced HrQoL in POTS. The disutility in those with POTS was lower than many chronic health conditions. Conclusions This is the first study to demonstrate significant impairment across all subdomains of EQ-5D-5L HrQoL in the POTS cohort as compared with a normative population. Trial registration ACTRN12621001034820

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Evaluating the Impact of Orthostatic Syncope and Presyncope on Quality of Life: A Systematic Review and Meta-Analysis

Cited by 8 publications

References 67 publications

Faintly tired: a systematic review of fatigue in patients with orthostatic syncope

Faintly tired: a systematic review of fatigue in patients with orthostatic syncope

Counter pressure maneuvers for syncope prevention: A semi-systematic review and meta-analysis

Poor health-related quality of life in postural orthostatic tachycardia syndrome in comparison with a sex- and age-matched normative population

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