Syncope recurrence and mortality: a systematic review

Solbiati, Monica; Casazza, Giovanni; Dipaola, Franca; Rusconi, Anna Maria; Cernuschi, Giulia; Barbic, Franca; Montano, Nicola; Sheldon, Robert S.; Furlan, Raffaello; Costantino, Giorgio

doi:10.1093/europace/euu327

Cited by 71 publications

(47 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The overall in‐hospital mortality rate is lower in our study compared to the study by Alsheklee et al (0.23% vs 0.28%), consistent with the improving trends demonstrated over the observation period. This is consistent with the findings of Anand et al and in line with publications from other databases and retrospective studies, where in‐hospital mortality is reported to be around 0.2% and 10‐day mortality around 0.7% . We found that increased age and male gender were associated with a higher in‐hospital mortality which also agrees with findings from analyses of other administrative databases, as well as multiple observational studies .…”

Section: Discussionsupporting

confidence: 93%

Trends in use of echocardiography in hospitalized patients with syncope

2018

View full text Add to dashboard Cite

Purpose We sought to assess the trends in use, predictors of echocardiography, and its impact on in‐hospital mortality in patients admitted with syncope using a large national database. Methods Utilizing the Nationwide Inpatient Sample (NIS) database from 2001 to 2014, we identified adult patients (>18 years) with a primary discharge diagnosis of syncope and use of echocardiogram was ascertained. Results A total of 3 174 619 patients with a primary discharge diagnosis of syncope were identified, of which 184 167 (5.8%) underwent an echocardiogram. The rate of syncope hospitalization remained constant between 2001 and 2009 (1.1/1000 US population) but has since decreased steadily to about 0.5/1000 US population in 2014. After adjusting for patient and hospital characteristics, the rate of echocardiogram use increased significantly from 5.1% in 2001 to 6.8% in 2014 (2.7% relative increase per year [Ptrend = 0.024]). Predictors of use were cardiac disorders, hypertension, diabetes, peripheral vascular disease, and renal failure. After adjusting for baseline risk, use of echocardiography was not associated with in‐hospital mortality (OR = 0.827, P = 0.155), but was associated with a 14.6% increase in adjusted length of stay and a 22.6% increase in adjusted hospital cost compared to no echocardiography use (both P < 0.001). Conclusions The admission rates for syncope are decreasing and use of echocardiography in hospitalized patients with syncope is appropriately low. Given the lack of any favorable impact on mortality and the association with increased costs, there is a continued need to emphasize evidence‐based use of echocardiography in patients presenting with syncope.

show abstract

Section: Discussionsupporting

confidence: 93%

Trends in use of echocardiography in hospitalized patients with syncope

2018

View full text Add to dashboard Cite

show abstract

“…As previous studies have shown that recurrent syncope increases both mortality and morbidity [42], early diagnosis and timely therapeutic intervention is essential in patients presenting with unexplained syncope. ILRs have been shown to be a useful and cost-effective tool in the diagnosis for patients with unexplained syncope [41,43,44], however this method has the drawback of a prolonged period of observation with possible syncopal recurrences before diagnosis and therapeutic intervention.…”

Section: Clinical Impactmentioning

confidence: 99%

Implantable loop recorders in patients with unexplained syncope: Clinical predictors of pacemaker implantation

et al. 2019

View full text Add to dashboard Cite

show abstract

“…10 While VVS can be recurrent and impair quality of life, it is not associated with mortality. 12, 13 In patients with frequent VVS, syncope tends to cluster over time with varying lengths of duration, prolonged breaks, and high rates of spontaneous remission. 14, 15 …”

Section: Vasovagal Syncopementioning

confidence: 99%

“…Patients should be educated that VVS is itself not associated with mortality, 12, 13 to lie down at onset of prodromal symptoms, and to avoid triggers for syncopal episodes 19 . Dietary sodium and water intake should be increased in patients without renal failure, heart failure, or hypertension.…”

Section: Vasovagal Syncopementioning

confidence: 99%

Autonomic Dysfunction in Cardiology: Pathophysiology, Investigation, and Management

Arnold

Lei

et al. 2017

Canadian Journal of Cardiology

View full text Add to dashboard Cite

Presyncope and syncope are common medical findings, with greater than 40% estimated lifetime prevalence. These conditions are often elicited by postural stress and can be recurrent and accompanied by debilitating symptoms of cerebral hypoperfusion. Therefore, it is critical for physicians to become familiar with diagnosis and treatment of common underlying causes of presyncope and syncope. In some patients, altered postural hemodynamic responses are due to failure of compensatory autonomic nervous system reflex mechanisms. The most common presentations of presyncope and syncope secondary to this autonomic dysfunction include vasovagal syncope, neurogenic orthostatic hypotension, and postural tachycardia syndrome. The most sensitive method for diagnosis is a detailed initial evaluation with medical history, physical examination, and resting electrocardiogram to rule out cardiac syncope. Physical examination should include measurement of supine and standing blood pressure and heart rate, to identify the pattern of hemodynamic regulation during orthostatic stress. Additional testing may be required in patients without clear diagnosis following initial evaluation. Management of patients should focus on improving symptoms and functional status, and not targeting arbitrary hemodynamic values. An individualized structured and stepwise approach should be taken for treatment starting with patient education, lifestyle modifications, and use of physical counter-pressure maneuvers and devices to improve venous return. Pharmacological interventions should only be added when conservative approaches are insufficient to improve symptoms. There are no gold standard approaches for pharmacological treatment in these conditions, with medications often used off-label and with limited long-term data for effectiveness.

show abstract

Syncope recurrence and mortality: a systematic review

Cited by 71 publications

References 17 publications

Trends in use of echocardiography in hospitalized patients with syncope

Trends in use of echocardiography in hospitalized patients with syncope

Implantable loop recorders in patients with unexplained syncope: Clinical predictors of pacemaker implantation

Autonomic Dysfunction in Cardiology: Pathophysiology, Investigation, and Management

Contact Info

Product

Resources

About