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Syncope and All-Cause Mortality in Heart Failure: A Propensity Score-Matched Analysis
Pattara Rattanawong1, Chieh-Ju Chao2, Anil Sriramoju3,4
1Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ.
Summary
Syncope in heart failure (HF) patients generally does not increase mortality risk. However, syncope significantly predicts mortality in HF patients with reduced ejection fraction and cardiac implantable electronic devices.
Area of Science:
- Cardiology
- Clinical Medicine
- Morbidity and Mortality Studies
Background:
- Syncope is a common and concerning symptom in patients with heart failure (HF).
- Understanding the prognostic implications of syncope in HF is crucial for patient management and risk stratification.
Purpose of the Study:
- To investigate the association between syncope and all-cause mortality in a large cohort of heart failure patients.
- To determine if syncope is an independent predictor of mortality across different HF phenotypes and in specific subgroups.
Main Methods:
- Retrospective cohort study of 3449 patients with HF and syncope, matched 1:1 with HF patients without syncope.
- Propensity score matching and multivariable Cox regression analysis were used to assess the association between syncope and all-cause mortality.
Main Results:
- Overall, syncope was not an independent risk factor for all-cause mortality in patients with heart failure (HF) across various ejection fraction categories.
- A significant increase in all-cause mortality risk was observed in the subgroup of HF patients with reduced ejection fraction who also experienced syncope and had cardiac implantable electronic devices (HR, 1.28; P=.038).
Conclusions:
- Syncope is not an independent predictor of all-cause mortality in the general heart failure population.
- Syncope is a significant predictor of all-cause mortality specifically in heart failure patients with reduced ejection fraction who are equipped with cardiac implantable electronic devices.
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