Lack of benefit from hospitalization in patients with syncope: A propensity analysis

Abstract

Study Objective Patients with syncope are frequently admitted to the hospital, but whether this improves outcome is unknown. We tested whether hospitalization reduced mortality in patients who presented to emergency departments (EDs) with syncope. Methods We conducted a propensity analysis of the outcomes of patients ≥18 years old presenting to EDs with a primary diagnosis of syncope in April 2004–March 2013. The model used 1:1 nearest‐neighbor matching to predicted admission using age, sex, urban residence, household income, and 14 significant comorbidities from 4 administrative databases of the province of Alberta. The primary outcome was death. Results There were 57,417 ED patients with a primary diagnosis of syncope; 8864 were admitted, and 48,553 were discharged in <24 hours. Admitted patients were older (median 76 vs 49 years), male (53% vs 45%), rural (23% vs 18%), and had lower income (median $58,599 vs $61,422); all P < 0.001. All comorbidities were higher in admitted patients (mean Charlson scores, 1.9 vs 0.7; P < 0.001). The propensity‐matched hospitalized patients had higher 30‐day mortality (3.5% vs 1.0%) and 1‐year mortality (14.1% vs 8.6%); both P < 0.001. Mortality in all propensity quintiles was higher in the hospitalized group (all P < 0.001). The most common causes of death in 2719 patients included chronic ischemic heart disease, 14%; lung cancer, 7.1%; acute myocardial infarction, 6.9%; stroke, 3.7%; chronic obstructive pulmonary disease, 3.6%; dementia, 2.6%; and heart failure, 2.5%. Conclusions Hospital admission did not reduce early or late mortality in patients who presented to the ED with syncope. Mortality is associated with comorbidities.

Pediatric Syncope: Is the Diagnostic Guideline Implemented and Adhered to?

“…It is well known that lack of adherence to guidelines increases admission rates and costs [26] without additional useful information [23]. Hospitalization in patients with syncope does not reduce early or late mortality [27]. According to Krishnan et al, the benefit of hospital admission is low for patients at low risk of serious adverse events [28].…”

Syncope Time Frames for Adverse Events after Emergency Department Presentation: An Individual Patient Data Meta-Analysis

“…Indeed, knowing the type and timing of short-term adverse events is essential for deciding how long and in which setting we should observe patients [7]. Knowledge of short and medium-term outcomes might aid decision making with respect to hospital admission and syncope units [8][9][10]. Previous attempts have been made to describe the incidence of adverse events after syncope by using meta-analyses [14,24].…”

“…Indeed, knowing the type and timing of short-term adverse events is essential in order to decide how long and in which setting we should observe patients [7]. Furthermore, it might aid decision making with respect to hospital admission and syncope units [8][9][10]. Moreover, assessing long-term outcomes after syncope might better inform differences between short and long-term risk factors and the possible role of different approaches (e.g., hospital admission and proper follow-up) for improving patients' outcomes [10,11].…”

A Rational Evaluation of the Syncope Patient: Optimizing the Emergency Department Visit

“…Probst et al found no significant difference after 30 days in serious events in syncope patients more than 60 years old with no serious ED diagnosis in American patients who are admitted to hospital when compared to the discharged group (propensity analysis) [ 60 ]. In a province-wide analysis from Alberta, Canada, hospitalized syncope patients had higher 30-day (3.6% vs. 0.3%) and one-year (14.3% vs. 3.0%) mortality rates when compared to discharged patients [ 11 ]. Upon discharge, 43% of the patients were discharged with a primary diagnosis of syncope, while the rest were discharged with an alternate diagnosis.…”

“…Of note, almost half of admitted patients in this study were older than 65 years and had significant cardiac comorbidities. In a propensity score analysis of 8864 patients admitted from the ED within 48 h, Kaul et al found that admitted patients were significantly older, lived in rural areas, were mostly males, and had lower income [ 11 ]. Neither short- nor long-term mortality was reduced in hospitalized patients compared to a matched cohort.…”