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[Syncope: epidemiological characteristics of a hospital series]
Insights
Syncope patients often have underlying diseases and advanced age. Arrhythmia is the most common cause of syncope, especially when initial evaluations do not yield a diagnosis.
Area of Science:
- Cardiology
- Internal Medicine
- Neurology
Background:
- Syncope is a common clinical problem, particularly in older adults.
- A significant portion of syncope cases remain undiagnosed after initial evaluation.
- Comorbidities are prevalent in patients presenting with syncope.
Purpose of the Study:
- To prospectively evaluate hospital patients with syncope.
- To identify the causes of syncope and factors influencing diagnosis.
- To determine the diagnostic yield of standard evaluation protocols.
Main Methods:
- Prospective evaluation of 300 hospital patients with syncope using a standard protocol.
- Analysis of patient demographics, associated diseases, and diagnostic outcomes.
- Categorization of syncope causes, including arrhythmias and cardiac non-arrhythmic causes.
Main Results:
- The study included 300 patients (mean age 61 years), with 76.7% having associated diseases.
- A diagnosis was reached in 84% of patients; 33% were diagnosed during initial evaluation.
- Arrhythmia was the most frequent cause of syncope (57.6%), particularly in undiagnosed cases (40.7%).
Conclusions:
- Hospitalized syncope patients are typically older with significant comorbidities.
- Diagnostic challenges persist, with a notable percentage remaining undiagnosed.
- Arrhythmia is the predominant cause of syncope, underscoring the need for thorough cardiac investigation.
Abstract:
Three hundred hospital patients with syncope (193 males and 107 females, mean age 61 +/- 17 years) were prospectively evaluated with a standard protocol. Associated diseases were found in 76.7% of cases. The incidence of heart diseases was 50.8% in males vs 32.7% in females (p less than 0.003). The cause of syncope was diagnosed in 250 patients (84%). The diagnosis was made at initial evaluation in 101 patients (group A); in the remaining patients (group B), no diagnosis was made in 25% (16.6% of the overall series) despite a wide array of investigations. Syncope due to arrhythmia was diagnosed in 57.6% (group A: 91.1% group B: 40.7; p less than 0.0001); cardiac syncope not due to arrhythmia was diagnosed in 4%, and other types of syncope in 21.6% (group A; 6.9%; group B: 29.1%; p less than 0.0001). It is concluded that a) the hospital population of patients with syncope represents a subgroup of advanced age and a high incidence of associated diseases; b) one third of patients were diagnosed at the initial evaluation, whereas in 25% of the remaining ones no diagnosis was obtained, and c) in these patients, arrhythmia is the most likely cause of syncope.