Related Experiment Videos
Syncope: etiology, prognosis, and relationship to age
A Dougnac1, R Gonzalez, A Kychenthal
1Department of Internal Medicine, Hospital Clinico, Pontificia Universidad Catolica de Chile, Santiago.
Insights
Syncope poses a significant risk in older adults. Cardiovascular causes are frequent, and while diagnosis can be simple, mortality remains high, especially in the elderly.
Area of Science:
- Geriatrics
- Cardiology
- Neurology
Background:
- Syncope is a frequent and challenging issue, particularly in elderly individuals.
- Elderly patients (≥65 years) constituted 68% of the study cohort admitted for syncope.
Purpose of the Study:
- To investigate the etiology, diagnostic strategies, and outcomes of syncope in an acute care hospital setting.
- To assess the lethality of syncope in the elderly population.
Main Methods:
- Retrospective analysis of 146 patients admitted for syncope over a 4-year period.
- Diagnosis primarily based on history, physical examination, resting ECG, and 24-hour cardiac monitoring.
- Advanced investigations like echocardiography, electrophysiologic studies, and EEG used for confirmation.
Main Results:
- A specific etiology was identified in 62% of cases, with cardiovascular origins in 75% of those.
- In-hospital mortality was 2.1%, with a 2-year follow-up mortality of 18.1%.
- Mortality was significantly higher in elderly patients (23.9%) and those with cardiovascular syncope (28.3%).
Conclusions:
- Syncope in the elderly is associated with particularly high mortality.
- A diagnostic approach relying on clinical evaluation and basic tests is effective for most syncope patients.
- The study highlights the need for careful evaluation and management of syncope in older adults.
Abstract:
Syncope is a common and particularly troublesome problem in the elderly population. In a series of 146 patients admitted for syncope to an acute care hospital in Chile during a 4-year period, 2/3 (68%) were aged 65 years and older. A specific etiology could be established in 62%, and 3/4 of these were cardiovascular in origin. Diagnosis was established entirely on history, physical examination, resting ECG, and 24-hour cardiac monitoring in most cases but in some, more sophisticated measures (i.e., echocardiography, electrophysiologic studies, blood tests, EEG) were needed, and mostly to confirm clinically suspected problems. In-hospital mortality was 2.1% and mortality at the end of the approximately 2-year follow-up period was 18.1%. Mortality was higher for persons over age 65 than for younger persons (23.9% vs 2.3%), and for persons with cardiovascular syncope than for persons with other kinds of syncope (28.3% vs 8.9%). This study confirms the particular lethality of syncope in the elderly population and outlines a relatively simple strategy with which most syncope patients can be diagnosed without resorting to expensive procedures.