Nationwide Trends in Syncope Hospitalizations and Outcomes From 2004 to 2014

We examined the prevalence, comorbidity burden, and outcomes of patients who presented to acute care hospitals with a primary diagnosis of syncope over a 10-year period in Canada.

The Canadian Institute for Health Information Discharge Abstract Database (which contains detailed health information from all Canadian provinces and territories except Quebec) was used to identify hospitalizations of patients with a primary diagnosis of syncope (International Classification of Diseases-10th Revision code R55) 20 years of age or older in Canada from 2004 to 2014. Annual age- and sex-standardized hospital discharge rates were calculated. Logistic regression was used to examine patient factors associated with in-hospital mortality, 30-day readmission for any cause, and syncope.

During the 10-year study period, 98,730 hospitalizations occurred for syncope. The age- and sex-standardized hospitalization rate was 0.54 per 1000 population and decreased over time (P < 0.0001). Most patients (63%) were low-risk (Charlson comorbidity index = 0), although the proportion of patients with a Charlson comorbidity index ≥ 3 increased over time. Less than 1% of patients died in-hospital; however, among patients discharged alive, 30-day readmission rates for syncope and any cause were 1.1% and 9.0%, respectively. In-hospital mortality increased with each decade in age (odd ratio, 1.63; 95% confidence interval, 1.48-1.79), was higher in men (odds ratio, 1.37; 95% confidence interval, 1.16-1.63), and in patients with greater comorbidity (P < .0001).

The hospitalization rate for syncope is decreasing over time in Canada. Although the comorbidity burden of hospitalized patients is increasing, most syncope patients are low-risk. Future studies are needed to help understand how standardized diagnostic testing pathways and discharge planning might lead to more efficient and cost-effective syncope management.