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Long-term follow-up after syncope. A group of 183 patients observed for 5 years
F Racco1, C Sconocchini, C Alesi
1Servizio di Cardiologia, UTIC, ASL 5, Jesi, Ancona, Italy. fraracco@tin.it
Insights
Recurrent syncope is common, especially in the first year after hospitalization. Cardiovascular causes, particularly arrhythmias, and underlying conditions like hypertension significantly increase mortality risk.
Area of Science:
- Cardiology
- Neurology
- Geriatrics
Background:
- Syncope, a transient loss of consciousness, poses diagnostic and prognostic challenges.
- Understanding the incidence of recurrent syncope and associated mortality is crucial for patient management.
Purpose of the Study:
- To determine the incidence of recurrent syncope and mortality rates in patients hospitalized for syncope.
- To identify etiological factors and risk factors associated with syncope recurrence and mortality.
Main Methods:
- A 5-year prospective follow-up study of 183 patients hospitalized for syncope.
- Collaborative effort between Cardiology and Neurology departments.
- Analysis of etiological diagnoses, recurrence rates, and mortality, stratified by age and cause.
Main Results:
- Cardiovascular causes accounted for the majority of syncope (72.67%), with arrhythmias being prevalent.
- The overall mortality rate was 26.77%, significantly higher in patients aged 70 years and older (51.94%).
- Recurrent syncope occurred in 24.59% of patients, predominantly within the first year, with higher rates in unknown and reflex syncope causes.
Conclusions:
- Syncope etiology is often determined by history and clinical examination.
- Cardiac syncope carries the worst prognosis, necessitating close monitoring and prompt treatment.
- Underlying conditions like hypertension and ischemic heart disease are major mortality risk factors, rather than syncope itself.
Background:
To determine the incidence of recurrent syncope and mortality rate in a group of patients hospitalized for syncope.
Methods:
A 5 years follow-up of 183 patients hospitalized for syncope. A collaborative study between the Departments of Cardiology and Neurology.
Results:
The etiological diagnosis of syncope was the following: unknown causes 21.86%, cardiovascular causes 72.67%, non-cardiovascular cause 5.46%. The general mortality rate was 26.77% (51.94% in those aged > = 70 years, 8.49% in < 70 years). The mortality rate of syncope of unknown causes was 30% among all patients (61.11% in those aged > = 70 years and 4.54% < 70 years). Syncope of cardiac cause (prevalent arrhythmias) and syncope of iatrogenic cause had a high mortality rate (respectively 63.33% and 42.10%); both in young people (28.53%, 26.53%) and in old people (66.66%, 50%). Syncope of reflex cause has a mortality rate of 5.79% (4/69) among all patients (14.28% in those aged > = 70 years, 3.63 in < 70 years). Age, arterial hypertension, ischemic heart disease and cerebrovascular events are significantly associated with mortality rate. Recurrences were quite common: 24.59% of all patients (45/183); 29/45 syncope (64.44%) were observed in the first year of follow-up with a prevalence for patients with a syncope of reflex cause (26.09%) and for those with a syncope of unknown cause (37.56%). Recurrences were less common among patients with syncope of cardiac cause, however more frequent during the first year of follow-up, with an increased risk of mortality.
Conclusions:
A. The cause of syncope is most frequently established on the basis of history and clinical examination. B. A collaboration between Departments with a common interest for this pathology is recommended. C. Cardiac syncope has the worst prognosis and therefore needs recurrent clinical examinations and prompt treatment. D. Syncope itself is not a risk factor for increased overall and cardiac mortality or cardiovascular events. E. Underlying diseases such as hypertension, ischemic heart diseases, congestive heart failure, cerebrovascular events are the major risk factors for mortality.