The relation between age, sex, comorbidity, and pharmacotherapy and the risk of syncope: a Danish nationwide study

Ruwald, Martin H.; Hansen, Morten Lock; Lamberts, Morten; Hansen, Carolina Malta; Vinther, Michael; Køber, Lars; Torp‐Pedersen, Christian; Hansen, Jim; Gislason, Gunnar

doi:10.1093/europace/eus154

Cited by 94 publications

(63 citation statements)

References 24 publications

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“…33,34 Patients with syncope are characterized by greater burden of comorbidity and increased exposure to a greater number of medications. 2,32 In keeping with this, we noted that 1 in 5 of the working age individuals with syncope was on health-related Figure 3. Termination of employment among people with syncope.…”

Section: Termination Of Employment In the Syncope Populationsupporting

confidence: 65%

Syncope and Its Impact on Occupational Accidents and Employment

Numé

Kragholm

Carlson

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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Background— First-time syncopal episodes usually occur in adults of working age, but their impact on occupational safety and employment remains unknown. We examined the associations of syncope with occupational accidents and termination of employment. Methods and Results— Through linkage of Danish population-based registers, we included all residents 18 to 64 years from 2008 to 2012. Among 3 410 148 eligible individuals, 21 729 with a first-time diagnosis of syncope were identified, with a median age 48.4 years (first to third quartiles, 33.0–59.5), and 10 757 (49.5%) employed at time of the syncope event. Over a median follow-up of 3.2 years (first to third quartiles, 2.0–4.5), 622 people with syncope had an occupational accident requiring hospitalization (2.1/100 person-years). In multiple Poisson regression analysis, the incidence rate ratio in the employed syncope population was higher than in the employed general population (1.44; 95% confidence interval [CI], 1.33–1.55) and more pronounced in people with recurrences (2.02; 95% CI, 1.47–2.78). The 2-year risk of termination of employment was 31.3% (95% CI, 30.4%–32.3%), which was twice the risk of the reference population (15.2%; 95% CI, 14.7%–15.7%), using the Aalen–Johansen estimator. Factors associated with termination of employment were age <40 years (incidence rate ratio, 1.48; 95% CI, 1.37–1.59), cardiovascular disease (1.20; 95% CI, 1.06–1.36), depression (1.72; 95% CI, 1.55–1.90), and low educational level (2.61; 95% CI, 2.34–2.91). Conclusions— In this nationwide cohort, syncope was associated with a 1.4-fold higher risk of occupational accidents and a 2-fold higher risk of termination of employment compared with the employed general population.

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Section: Termination Of Employment In the Syncope Populationsupporting

confidence: 65%

Syncope and Its Impact on Occupational Accidents and Employment

Numé

Kragholm

Carlson

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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“…In a Danish study, the risk of syncope in patients with cardiovascular disease was significantly higher in younger age groups,24 while Sandhu et al10 found that advancing age was a risk factor for all‐cause 30‐day readmissions. However, the latter study included hospitalizations for syncope/collapse as either a primary or secondary diagnosis and the outcome was only adjusted for sex and Charlson Comorbidity Index.…”

Section: Discussionmentioning

confidence: 98%

Causes and Predictors of 30‐Day Readmission in Patients With Syncope/Collapse: A Nationwide Cohort Study

Kadri

Abuamsha

Nusairat

et al. 2018

JAHA

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BackgroundSyncope accounts for 0.6% to 1.5% of hospitalizations in the United States. We sought to determine the causes and predictors of 30‐day readmission in patients with syncope.Methods and ResultsWe identified 323 250 encounters with a primary diagnosis of syncope/collapse in the 2013–2014 Nationwide Readmissions Database. We excluded patients younger than 18 years, those discharged in December, those who died during hospitalization, hospital transfers, and those whose length of stay was missing. We used multivariable logistic regression analysis to evaluate the association between baseline characteristics and 30‐day readmission. A total of 282 311 syncope admissions were included. The median age was 72 years (interquartile range, 58–83), 53.9% were women, and 9.3% had 30‐day readmission. The most common cause of 30‐day readmissions was syncope/collapse, followed by cardiac, neurological, and infectious causes. Characteristics associated with 30‐day readmissions were age 65 years and older (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.6–0.7), female sex (OR, 0.9; 95% CI, 0.8–0.9), congestive heart failure (OR, 1.5; 95% CI, 1.2–1.9), atrial fibrillation/flutter (OR, 1.3; 95% CI, 1.3–1.4), diabetes mellitus (OR, 1.2; 95% CI, 1.2–1.3), coronary artery disease (OR, 1.2; 95% CI, 1.2–1.3), anemia (OR, 1.4; 95% CI, 1.4–1.5), chronic obstructive pulmonary disease (OR, 1.4; 95% CI, 1.3–1.4), home with home healthcare disposition (OR, 1.5; 95% CI, 1.5–1.6), leaving against medical advice (OR, 1.7; 95% CI, 1.6–1.9), length of stay of 3 to 5 days (OR, 1.5; 95% CI, 1.4–1.6) or >5 days (OR, 2; 95% CI, 1.8–2), and having private insurance (OR, 0.6; 95% CI, 0.6–0.7).ConclusionsThe 30‐day readmission rate after syncope/collapse was 9.3%. We identified causes and risk factors associated with readmission. Future prospective studies are needed to derive risk‐stratification models to reduce the high burden of readmissions.

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“…9,10 The lifetime cumulative incidence of syncope is ≥35%, with peak prevalence of the first episode between ages 10-35. 11 The incidence increases with age, especially after 70 years, 9,10 and is bimodal with peaks at 20 and 80 years.…”

Section: Epidemiologymentioning

confidence: 99%