The older patient with syncope: Practicalities and controversies

Marrison, V.K.; Fletcher, Andrew; Parry, Steve W.

doi:10.1016/j.ijcard.2010.10.055

Cited by 33 publications

(16 citation statements)

References 60 publications

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“…To date, the efficacy of pacemaker therapy for treating syncope in SSS has not been established on a large scale in a contemporary setting. Furthermore, although SSS is perceived as a relatively benign condition,9 10 it is unclear whether the subgroup of patients with SSS who experience syncope after pacemaker implantation have a poorer prognosis.…”

Section: Introductionmentioning

confidence: 99%

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

Chuen

Kirkfeldt

Andersen

et al. 2014

Heart

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Section: Introductionmentioning

confidence: 99%

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

Chuen

Kirkfeldt

Andersen

et al. 2014

Heart

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“…Syncope of cardiac etiology is responsible for onethird of the cases in older population [5][6] and should be promptly excluded given the high morbidity and mortality. 5 The primary responsibility of the emergency clinician is to assess whether a life-threatening cause of syncope is present, and to provide appropriate management and disposition: cardiac syncope, blood loss, pulmonary embolism, and subarachnoid hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Individualized and Multidisciplinary Approach of Syncope in the elderly: a case report

Correia

Pereira

Ribeiro

2019

RPMGF

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Syncope is a frequent reason for emergency room visits. In the elderly, multiple chronic conditions can difficult the diagnosis. In this case, an unexpected association between symptoms and the final diagnosis was a clinical challenge. An 80-year-old Caucasian man presents with syncopal episodes after a cough. Dizziness and visual changes were the only preceding complaints. Structured assessment is needed to face any patient, but is particularly important in the older patient because there are several constraints that hinder the approach: chronic diseases, different physiology, and clinical history sometimes more nonspecific. Thus, a diagnostic approach is discussed, with special focus in carotid sinus syndrome.due to atypical presentations, amnesia for events and the overlap with falls.For a correct clinical approach, broad knowledge is required: from the multiple chronic conditions and the polypharmacy involved to the appreciation of the diverse clinical presentation. 3 FUNDINGNo specific funding was obtained for this study. RESUMO ABORDAGEM INDIVIDUALIZADA E MULTIDISCIPLINAR DE UM CASO DE SÍNCOPE NO IDOSOUma causa muito frequente de ida ao serviço de urgência é a síncope. No idoso, as patologias crónicas e a polimedicação dificultam a abordagem diagnóstica. No caso clínico que se apresenta a abordagem foi um desafio para a equipa médica, dada a história clínica ser tão frustre. Assim, apresenta-se o caso de um homem de 80 anos que recorre ao serviço de urgência por síncope desencadeada pela tosse. Referia apenas tonturas e alterações visuais antes da perda de consciência. É discutida a abordagem diagnóstica da síncope e os diagnósticos diferenciais, em especial a síndroma do seio carotídeo.

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“…The role of age is a further aspect of uncertainty. The American College of Emergency Physicians (ACEP) Clinical Policy considers age > 70 years as an isolate criterion for hospitalization while it has been demonstrated that the most frequent causes of syncope in the geriatric population are not cardiac and advanced age alone is not a predictor of adverse outcome in syncopal patients …”

Section: Cardiovascular Variables Comorbidities and Age As Risk Facmentioning

confidence: 99%

Short‐term Prognosis and Current Management of Syncopal Patients at Intermediate Risk: Results from the IRiS (Intermediate‐Risk Syncope) Study

Numeroso

Mossini

Giovanelli

et al. 2016

Academic Emergency Medicine

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Objectives: Despite guidelines, admission rates and expenditures for syncope remain high. This may be caused by an imprecise definition of cardiovascular disease considered at risk and an overestimation of the role of comorbidities and advanced age. In a cohort of patients with undetermined syncope, we prospectively compared the short-term prognosis of patients at intermediate risk (i.e., with stable heart diseases or comorbidities, of any age) versus those at high risk for cardiogenic syncope and identified factors associated with serious events. Secondarily, we analyzed the current management of intermediate-risk patients.Methods: In a cohort of patients with undetermined syncope, we analyzed personal data, the presence of stable heart diseases or comorbidities, destination, length of hospitalization, incidence of serious events at 30 days, and costs.Results: In a 6-month period, 347 patients (185 male and 162 female, age 72.8 years) with undetermined syncope were enrolled, 250 at intermediate risk and 97 at high risk. Intermediate-risk patients were younger, with less frequent comorbidities and with a drastically lower incidence of serious events (0.8% vs. 27.8%, p < 0.001). Risk factors for cardiogenic syncope were the unique variable associated with serious events. Intermediate-risk patients were mostly admitted (62.8%) in an ordinary ward or into an emergency department observation unit; in the case of ordinary admission we observed a mean prolonged hospitalization (8.8 days), elevated costs ($270,183), and a high rate of unexplained syncope (51%).Conclusions: According to the results of this study, the authors believe that intermediate-risk patients could be safely discharged, with potentially significant costs saving. In prognostic stratification, priority is to seek risk factors for cardiogenic syncope while advanced age, stable heart diseases, or comorbidities likely lead to inappropriate hospitalization. ACADEMIC EMERGENCY MEDICINE 2016;23:941-948

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The older patient with syncope: Practicalities and controversies

Cited by 33 publications

References 60 publications

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

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

Individualized and Multidisciplinary Approach of Syncope in the elderly: a case report

Short‐term Prognosis and Current Management of Syncopal Patients at Intermediate Risk: Results from the IRiS (Intermediate‐Risk Syncope) Study

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