1
|
Corvino AR, Russo V, Monaco MGL, Garzillo EM, Guida D, Comune A, Parente E, Lamberti M, Miraglia N. Vasovagal Syncope at Work: A Narrative Review for an Occupational Management Proposal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5460. [PMID: 37107742 PMCID: PMC10138125 DOI: 10.3390/ijerph20085460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/29/2023] [Accepted: 04/07/2023] [Indexed: 05/11/2023]
Abstract
Syncope is a complex clinical manifestation that presents considerable diagnostic difficulties and, consequently, numerous critical issues regarding fitness for work, especially for high-risk tasks. To date, it is impossible to quantify the exact impact of syncope on work and public safety since it is highly improbable to identify loss of consciousness as the fundamental cause of work or driving-related accidents, especially fatal injuries. Working at high-risk jobs such as public transport operators, in high elevations, or with exposure to moving parts, construction equipment, fireworks, or explosives demand attention and total awareness. Currently, no validated criteria or indicators are available for occupational risk stratification of a patient with reflex syncope to return to work. By drawing inspiration from the updated literature, this narrative review intends to summarise the leading knowledge required regarding the return to work for subjects affected by syncope. According to the available data, the authors highlighted some key findings, summarised in macro-items, such as defined risk stratification for vasovagal accidents, return to work after a critical event, and a focus on pacemaker (PM) implementation. Lastly, the authors proposed a flowchart for occupational physicians to help them manage the cases of workers affected by syncope and exposed to levels of risk that could represent a danger to the workers' health.
Collapse
Affiliation(s)
- Anna Rita Corvino
- Experimental Medicine Department-Hygiene, Occupational, and Forensic Medicine Division-Occupational Forensic Area, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.R.C.); (D.G.); (M.L.); (N.M.)
| | - Vincenzo Russo
- Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, 80131 Naples, Italy; (V.R.); (A.C.); (E.P.)
| | | | | | - Daniele Guida
- Experimental Medicine Department-Hygiene, Occupational, and Forensic Medicine Division-Occupational Forensic Area, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.R.C.); (D.G.); (M.L.); (N.M.)
| | - Angelo Comune
- Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, 80131 Naples, Italy; (V.R.); (A.C.); (E.P.)
| | - Erika Parente
- Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, 80131 Naples, Italy; (V.R.); (A.C.); (E.P.)
| | - Monica Lamberti
- Experimental Medicine Department-Hygiene, Occupational, and Forensic Medicine Division-Occupational Forensic Area, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.R.C.); (D.G.); (M.L.); (N.M.)
| | - Nadia Miraglia
- Experimental Medicine Department-Hygiene, Occupational, and Forensic Medicine Division-Occupational Forensic Area, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.R.C.); (D.G.); (M.L.); (N.M.)
| |
Collapse
|
2
|
Barbic F, Minonzio M, Cairo B, Shiffer D, Cerina L, Verzeletti P, Badilini F, Vaglio M, Porta A, Santambrogio M, Gatti R, Rigo S, Bisoglio A, Furlan R. Effects of a cool classroom microclimate on cardiac autonomic control and cognitive performances in undergraduate students. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 808:152005. [PMID: 34871696 DOI: 10.1016/j.scitotenv.2021.152005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/09/2021] [Accepted: 11/23/2021] [Indexed: 06/13/2023]
Abstract
An inverted U-shape relationship between cognitive performance and indoor temperature with best performance peaking at 21.6 °C was previously described. Little is known on classroom temperature reduction effects on cognitive performances and cardiac autonomic profile, during the cold season. Fifteen students underwent electrocardiogram recording during a lecture in two days in December when classroom temperatures were set as neutral (NEUTRAL, 20-22 °C) and cool (COOL, 16-18 °C). Cognitive performance (memory, verbal ability, reasoning, overall cognitive C-score) was assessed by Cambridge Brain Science cognitive evaluation tool. Cardiac autonomic control was evaluated via the analysis of spontaneous fluctuations of heart period, as the temporal distance between two successive R-wave peaks (RR). Spectral analysis provided the power in the high frequency (HF, 0.15-0.40 Hz) and low frequency (LF, 0.04-0.15 Hz) bands of RR variability. Sympatho-vagal interaction was assessed by LF to HF ratio (LF/HF). Symbolic analysis provided the fraction of RR patterns composed by three heart periods with no variation (0 V%) and two variations (2 V%), taken as markers of cardiac sympathetic and vagal modulations, respectively. The students' thermal comfort was assessed during NEUTRAL and COOL trials. Classroom temperatures were 21.5 ± 0.8 °C and 18.4 ± 0.4 °C during NEUTRAL and COOL. Memory, verbal ability, C-Score were greater during COOL (13.01 ± 3.43, 12.32 ± 2.58, 14.29 ± 2.90) compared to NEUTRAL (9.98 ± 2.26, p = 0.002; 8.57 ± 1.07, p = 0.001 and 10.35 ± 3.20, p = 0.001). LF/HF (2.4 ± 1.7) and 0 V% (23.2 ± 11.1%) were lower during COOL compared to NEUTRAL (3.7 ± 2.8, p = 0.042; 28.1 ± 12.2.1%, p = 0.031). During COOL, 2 V% was greater (30.5 ± 10.9%) compared to NEUTRAL (26.2 ± 11.3, p = 0.047). The students' thermal comfort was slightly reduced during COOL compared to NEUTRAL trial. During cold season, a better cognitive performance was obtained in a cooler indoor setting enabling therefore energy saving too.
Collapse
Affiliation(s)
- Franca Barbic
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Internal Medicine, Rozzano, Milan, Italy.
| | - Maura Minonzio
- IRCCS Humanitas Research Hospital, Internal Medicine, Rozzano, Milan, Italy
| | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Dana Shiffer
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Internal Medicine, Rozzano, Milan, Italy
| | | | | | | | | | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marco Santambrogio
- Dipartimento di Informazione, Elettronica e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Roberto Gatti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Internal Medicine, Rozzano, Milan, Italy
| | - Stefano Rigo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Andrea Bisoglio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Raffaello Furlan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Internal Medicine, Rozzano, Milan, Italy
| |
Collapse
|
3
|
Abstract
This article deals with the treatment and application of cardiac biosignals, an excited accelerometer, and a gyroscope in the prevention of accidents on the road. Previously conducted studies say that the seismocardiogram is a measure of cardiac microvibration signals that allows for detecting rhythms, heart valve opening and closing disorders, and monitoring of patients' breathing. This article refers to the seismocardiogram hypothesis that the measurements of a seismocardiogram could be used to identify drivers' heart problems before they reach a critical condition and safely stop the vehicle by informing the relevant departments in a nonclinical manner. The proposed system works without an electrocardiogram, which helps to detect heart rhythms more easily. The estimation of the heart rate (HR) is calculated through automatically detected aortic valve opening (AO) peaks. The system is composed of two micro-electromechanical systems (MEMSs) to evaluate physiological parameters and eliminate the effects of external interference on the entire system. The few digital filtering methods are discussed and benchmarked to increase seismocardiogram efficiency. As a result, the fourth adaptive filter obtains the estimated HR = 65 beats per min (bmp) in a still noisy signal (SNR = −11.32 dB). In contrast with the low processing benefit (3.39 dB), 27 AO peaks were detected with a 917.56-ms peak interval mean over 1.11 s, and the calculated root mean square error (RMSE) was 0.1942 m/s2 when the adaptive filter order is 50 and the adaptation step is equal to 0.933.
Collapse
|
4
|
Zamunér AR, Minonzio M, Shiffer D, Fornerone R, Cairo B, Porta A, Rigo S, Furlan R, Barbic F. Relationships Between Cardiovascular Autonomic Profile and Work Ability in Patients With Pure Autonomic Failure. Front Hum Neurosci 2022; 15:761501. [PMID: 35002654 PMCID: PMC8733607 DOI: 10.3389/fnhum.2021.761501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
Pure autonomic failure (PAF) is a rare disorder belonging to the group of synucleinopathies, characterized by autonomic nervous system degeneration. Severe orthostatic intolerance with recurrent syncope while standing are the two most disabling manifestations. Symptoms may start at middle age, thus affecting people at their working age. The aims of this study were to evaluate the autonomic and work ability impairment of a group of PAF patients and assess the relationships between cardiovascular autonomic control and work ability in these patients. Eleven PAF patients (age 57.3 ± 6.7 years), engaged in work activity, participated in the study. They completed the Composite Autonomic Symptom Score (COMPASS-31, range 0 no symptom-100 maximum symptom intensity) and Work Ability questionnaires (Work Ability Index, WAI, range 7-49; higher values indicate better work ability and lower values indicating unsatisfactory or jeopardized work ability). Electrocardiogram, blood pressure and respiratory activity were continuously recorded for 10 min while supine and during 75° head-up tilt (HUT). Autoregressive spectral analysis of cardiac cycle length approximated as the time distance between two consecutive R-wave peaks (RR) and systolic arterial pressure (SAP) variabilities provided the power in the high frequency (HF, 0.15-0.40 Hz) and low frequency (LF, 0.04-0.15 Hz) bands of RR and SAP variabilities. Cardiac sympatho-vagal interaction was assessed by LF to HF ratio (LF/HF), while the LF power of SAP (LFSAP) quantified the vascular sympathetic modulation. Changes in cardiovascular autonomic indexes induced by HUT were calculated as the delta (Δ) between HUT and supine resting positions. Spearman correlation analysis was applied. PAF patients were characterized by a moderate autonomic dysfunction (COMPASS-31 total score 47.08 ± 20.2) and by a reduction of work ability (WAI 26.88 ± 10.72). Direct significant correlations were found between WAI and ΔLFRR (r = 0.66, p = 0.03) and ΔLF/HFRR (r = 0.70, p = 0.02). Results indicate that patients who were better able to modulate heart rate, as revealed by a greater cardiac sympathetic increase and/or vagal withdrawal during the orthostatic stimulus, were those who reported higher values of WAI. This finding could be relevant to propose new strategies in the occupational environment to prevent early retirement or to extend the working life of these patients.
Collapse
Affiliation(s)
- Antonio R Zamunér
- Laboratory of Clinical Research in Kinesiology, Department of Kinesiology, Universidad Católica del Maule, Talca, Chile
| | - Maura Minonzio
- Internal Medicine, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Dana Shiffer
- Internal Medicine, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Stefano Rigo
- Internal Medicine, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Raffaello Furlan
- Internal Medicine, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Franca Barbic
- Internal Medicine, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| |
Collapse
|
5
|
Magnavita N, Di Prinzio RR, Arnesano G, Cerrina A, Gabriele M, Garbarino S, Gasbarri M, Iuliano A, Labella M, Matera C, Mauro I, Barbic F. Association of Occupational Distress and Low Sleep Quality with Syncope, Presyncope, and Falls in Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312283. [PMID: 34886008 PMCID: PMC8657064 DOI: 10.3390/ijerph182312283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 11/16/2022]
Abstract
Syncope and presyncope episodes that occur during work could affect one's safety and impair occupational performance. Few data are available regarding the prevalence of these events among workers. The possible role of sleep quality, mental stress, and metabolic disorders in promoting syncope, presyncope, and falls in workers is unknown. In the present study, 741 workers (male 35.4%; mean age 47 ± 11 years), employed at different companies, underwent clinical evaluation and blood tests, and completed questionnaires to assess sleep quality, occupational distress, and mental disorders. The occurrence of syncope, presyncope, and unexplained falls during working life was assessed via an ad hoc interview. The prevalence of syncope, presyncope, and falls of unknown origin was 13.9%, 27.0%, and 10.3%, respectively. The occurrence of syncope was associated with an increased risk of occupational distress (adjusted odds ratio aOR: 1.62, confidence intervals at 95%: 1.05-2.52), low sleep quality (aOR: 1.79 CI 95%: 1.16-2.77), and poor mental health (aOR: 2.43 CI 95%: 1.52-3.87). Presyncope was strongly associated with occupational distress (aOR: 1.77 CI 95%: 1.25-2.49), low sleep quality (aOR: 2.95 CI 95%: 2.08-4.18), and poor mental health (aOR: 2.61 CI 95%: 1.78-3.84), while no significant relationship was found between syncope or presyncope and metabolic syndrome. These results suggest that occupational health promotion interventions aimed at improving sleep quality, reducing stressors, and increasing worker resilience might reduce syncope and presyncope events in the working population.
Collapse
Affiliation(s)
- Nicola Magnavita
- Postgraduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.R.D.P.); (G.A.); (S.G.); (A.I.); (I.M.); (F.B.)
- Department of Woman, Child & Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Local Sanitary Unit Roma4, 00053 Civitavecchia, Italy; (A.C.); (M.G.); (M.G.); (M.L.); (C.M.)
- Correspondence: ; Tel.: +39-3473300367
| | - Reparata Rosa Di Prinzio
- Postgraduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.R.D.P.); (G.A.); (S.G.); (A.I.); (I.M.); (F.B.)
| | - Gabriele Arnesano
- Postgraduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.R.D.P.); (G.A.); (S.G.); (A.I.); (I.M.); (F.B.)
| | - Anna Cerrina
- Local Sanitary Unit Roma4, 00053 Civitavecchia, Italy; (A.C.); (M.G.); (M.G.); (M.L.); (C.M.)
| | - Maddalena Gabriele
- Local Sanitary Unit Roma4, 00053 Civitavecchia, Italy; (A.C.); (M.G.); (M.G.); (M.L.); (C.M.)
| | - Sergio Garbarino
- Postgraduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.R.D.P.); (G.A.); (S.G.); (A.I.); (I.M.); (F.B.)
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Infantile Sciences (DINOGMI), 16132 Genoa, Italy
| | - Martina Gasbarri
- Local Sanitary Unit Roma4, 00053 Civitavecchia, Italy; (A.C.); (M.G.); (M.G.); (M.L.); (C.M.)
| | - Angela Iuliano
- Postgraduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.R.D.P.); (G.A.); (S.G.); (A.I.); (I.M.); (F.B.)
| | - Marcella Labella
- Local Sanitary Unit Roma4, 00053 Civitavecchia, Italy; (A.C.); (M.G.); (M.G.); (M.L.); (C.M.)
| | - Carmela Matera
- Local Sanitary Unit Roma4, 00053 Civitavecchia, Italy; (A.C.); (M.G.); (M.G.); (M.L.); (C.M.)
| | - Igor Mauro
- Postgraduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.R.D.P.); (G.A.); (S.G.); (A.I.); (I.M.); (F.B.)
| | - Franca Barbic
- Postgraduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.R.D.P.); (G.A.); (S.G.); (A.I.); (I.M.); (F.B.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Internal Medicine, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| |
Collapse
|
6
|
Ferreira FC, Vaz Padilha MCS, Tobadini E, Carandina A, Montano N, Soares PPDS, Rodrigues GD. The interplay between heated environment and active standing test on cardiovascular autonomic control in healthy individuals. Physiol Meas 2021; 42. [PMID: 34261052 DOI: 10.1088/1361-6579/ac1497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/14/2021] [Indexed: 01/03/2023]
Abstract
Objective.To investigate the interplay between active standing and heat stress on cardiovascular autonomic modulation in healthy individuals.Approach.Blood pressure (BP) and ECG were continuously recorded during 30 min in supine (SUP) and 6 min in orthostatic position (ORT) under thermal reference (TC; ∼24 °C) or heated environment (HOT; ∼36 °C) conditions, in a randomized order. All data collection was performed during the winter and spring seasons when typical outdoor temperatures are ∼23 °C. Spectral analysis was employed by the autoregressive model of R-R and systolic blood pressure (SBP) time series and defined, within each band, in low (LF, 0.04 to 0.15 Hz) and high (0.15-0.40 Hz) frequencies. The indices of cardiac sympathetic (LF) and cardiac parasympathetic (HF) were normalized (nu) dividing each band power by the total power subtracted the very-low component (<0.04 Hz), obtaining the cardiac autonomic balance (LF/HF) modulation. The gain of the relationship between SBP and R-R variabilities within the LF band was utilized for analysis of spontaneous baroreflex sensitivity (alpha index;αLF). Nonlinear analysis was employed through symbolic dynamics of R-R, which provided the percentage of sequences of three heart periods without changes in R-R interval (0V%; cardiac sympathetic modulation) and two significant variations (2UV% and 2LV%; cardiac vagal modulation).Main results.HOT increased 0V% and HR, and decreasedαLF and 2UV% during SUP compared to TC. During ORT, HOT provokes a greater increment on HR, LF/HF and 0V%, indexes compared to ORT under TC.Significance.At rest, heat stress influences both autonomic branches, increasing sympathetic and decreasing vagal modulation and spontaneous baroreflex sensitivity. The augmented HR during active standing under heat stress seems to be mediated by a greater increment in cardiac sympathetic modulation, showing an interplay between gravitational and thermal stimulus.
Collapse
Affiliation(s)
- Felipe Castro Ferreira
- Laboratory of Experimental and Applied Exercise Physiology, Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil
| | | | - Eleonora Tobadini
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, I-20122 Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, I-20122 Milan, Italy
| | - Angelica Carandina
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, I-20122 Milan, Italy
| | - Nicola Montano
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, I-20122 Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, I-20122 Milan, Italy
| | - Pedro Paulo da Silva Soares
- Laboratory of Experimental and Applied Exercise Physiology, Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil
| | - Gabriel Dias Rodrigues
- Laboratory of Experimental and Applied Exercise Physiology, Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil.,Department of Clinical Sciences and Community Health, University of Milan, I-20122 Milan, Italy
| |
Collapse
|
7
|
Sinclair DC, Hegmann KT, Holland JP. Acceptable Risk of Sudden Incapacitation Among Safety Critical Transportation Workers: A Comprehensive Synthesis. J Occup Environ Med 2021; 63:329-342. [PMID: 33769399 DOI: 10.1097/jom.0000000000002140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Identify a risk threshold for sudden incapacitation for safety critical positions in transportation industries supporting medical fitness for duty standards. METHODS Systematic literature searches were performed examining acceptable risk criteria for medically related incapacitation using PubMed Central and Google Scholar databases. Websites for professional societies and national and international governmental agencies were also accessed. Article abstracts were reviewed and exhaustive searches were performed. RESULTS International regulatory bodies have adopted definitions of acceptable risk typically with a threshold of 1% to 2% absolute risk of sudden incapacitation per annum. Several "risk-of-harm" models have been proposed that incorporate factors modulating an absolute risk constant derived from epidemiological studies. CONCLUSION A 1% absolute annual risk of sudden incapacitation should be adopted as the threshold for determining medical fitness for duty among employees in safety critical positions in transportation industries.
Collapse
Affiliation(s)
- Donald C Sinclair
- Steptoe & Johnson PLLC, 1233 Main St., Ste. 3000, Wheeling, West Virginia (Mr Sinclair); Director Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Salt Lake City, Utah (Dr Hegmann); Puyallup, Washington (Dr Holland)
| | | | | |
Collapse
|
8
|
McCarthy K, Ward M, Romero Ortuño R, Kenny RA. Syncope, Fear of Falling and Quality of Life Among Older Adults: Findings From the Irish Longitudinal Study on Aging (TILDA). Front Cardiovasc Med 2020; 7:7. [PMID: 32118045 PMCID: PMC7020746 DOI: 10.3389/fcvm.2020.00007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/16/2020] [Indexed: 11/23/2022] Open
Abstract
Objective: Syncope is a prevalent condition that has a marked impact on quality of life. We examined the association between syncope and quality of life (QoL) and whether this association was explained by fear of falling (FoF). Methods: We examined data from Wave 3 of The Irish Longitudinal Study on Aging (TILDA), of adults aged ≥50 years (n = 4,946) who were asked to report syncope and who completed the CASP-12 QoL instrument. Analyses were stratified by age and gender. Results: Over 20% of participants reported having a previous syncopal episode, while 8% reported a faint, blackout or unexplained fall in the last year. QoL scores decreased as the burden of syncope increased: linear regression models adjusted for covariates showed that those having had two or more syncopal episodes in the last year reported a significantly lower CASP-12 score compared to those with none (p = 0.011). FoF partially mediated the association between syncope and QoL, particularly among younger participants. Conclusions: Syncope is a common condition among older adults that has a deleterious effect on QoL, with ≥2 recent syncopal episodes having a particularly adverse impact on QoL. FoF is a potential pathway which may both explain this association and allow therapeutic interventions by health practitioners.
Collapse
Affiliation(s)
- Kevin McCarthy
- The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland.,Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - Mark Ward
- The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - Román Romero Ortuño
- The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland.,Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland.,Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| |
Collapse
|
9
|
Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, Fedorowski A, Furlan R, Kenny RA, Martín A, Probst V, Reed MJ, Rice CP, Sutton R, Ungar A, van Dijk JG. Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2019; 39:e43-e80. [PMID: 29562291 DOI: 10.1093/eurheartj/ehy071] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
|
10
|
Barbic F, Dipaola F, Casazza G, Borella M, Minonzio M, Solbiati M, Raj SR, Sheldon R, Quinn J, Costantino G, Furlan R. Syncope in a Working-Age Population: Recurrence Risk and Related Risk Factors. J Clin Med 2019; 8:jcm8020150. [PMID: 30699893 PMCID: PMC6406660 DOI: 10.3390/jcm8020150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 11/16/2022] Open
Abstract
Syncope in a worker undertaking risky tasks may result in fatalities for the individual or for third parties. We aimed at assessing the rate of syncope recurrence and the risk factors underlying the likelihood of syncope relapse in a working-age population. A prospective cohort of all patients aged 18–65 years consecutively admitted to the Emergency Department for syncope was enrolled. Risk of syncope relapse was assessed at a six-month, 1-year, and 5-year follow-up. Predictors of syncope recurrence have been evaluated at six months and 1 year from the syncope index by a multivariable logistic regression analysis. 348 patients were enrolled. Risk of syncope relapse was 9.2% at 6 months, 11.8% at 1 year, and 23.4% at 5 years. At 6-month follow-up, predictor of syncope recurrence was ≥3 prior lifetime syncope episodes. At 1-year, ≥3 prior lifetime syncope episodes, diabetes mellitus, and anaemia were risk factors for syncope relapse. There was an exceeding risk of recurrence in the first 6 months and a reduced risk of 3.5% per year after the first year. Anaemia, diabetes mellitus, and prior lifetime syncope burden are of importance when giving advice about the resumption of “high risk” jobs following a syncope episode.
Collapse
Affiliation(s)
- Franca Barbic
- Internal Medicine, Humanitas Clinical and Research Center, Biomedical Sciences Department, Humanitas University, 20089 Rozzano, Italy.
| | - Franca Dipaola
- Internal Medicine, Humanitas Clinical and Research Center, Biomedical Sciences Department, Humanitas University, 20089 Rozzano, Italy.
| | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco"-Università degli Studi di Milano, 20157 Milan, Italy.
| | - Marta Borella
- Emergency Department, Ospedale di Rho, ASST Rhodense, 20017 Rho, Italy.
| | - Maura Minonzio
- Internal Medicine, Humanitas Clinical and Research Center, Biomedical Sciences Department, Humanitas University, 20089 Rozzano, Italy.
| | - Monica Solbiati
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy.
| | - Satish R Raj
- Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary, Calgary, AB T2N 4Z6, Canada.
| | - Robert Sheldon
- Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary, Calgary, AB T2N 4Z6, Canada.
| | - James Quinn
- Division of Emergency Medicine, Stanford University, Stanford, CA 94305, USA.
| | - Giorgio Costantino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy.
| | - Raffaello Furlan
- Internal Medicine, Humanitas Clinical and Research Center, Biomedical Sciences Department, Humanitas University, 20089 Rozzano, Italy.
| |
Collapse
|
11
|
Sumiyoshi M. Driving restrictions for patients with reflex syncope. J Arrhythm 2017; 33:590-593. [PMID: 29255506 PMCID: PMC5728707 DOI: 10.1016/j.joa.2017.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/17/2017] [Accepted: 03/30/2017] [Indexed: 11/17/2022] Open
Abstract
Reflex syncope is the most common form of syncope that occurs while driving. The 2014 revision of Japanese Road Traffic Laws placed stricter driving restrictions, along with some associated legal penalties, on individuals with recurrent syncope. "Recurrent syncope" is defined as the occurrence of more than two episodes of syncope over a period of 5 years. No restrictions are recommended for private drivers unless they experience syncope without a reliable prodrome while driving or sitting. For commercial drivers, a driving restriction is recommended unless the efficacy of treatment can be confirmed. The "risk of harm" (RH) to other road users appears to be particularly high when commercial driving is involved. The RH formula is calculated using the time of driving, the type of vehicle driven, the risk of sudden cardiac incapacitation, and the probability of a fatal or injury-producing accident. Reducing the driving time or driving a lighter vehicle can reduce the RH. Physicians should talk to their patients about driving and advise their high-risk patients to refrain from driving.
Collapse
Affiliation(s)
- Masataka Sumiyoshi
- Department of Cardiology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-9521, Japan
| |
Collapse
|
12
|
Numé AK, Kragholm K, Carlson N, Kristensen SL, Bøggild H, Hlatky MA, Torp-Pedersen C, Gislason G, Ruwald MH. Syncope and Its Impact on Occupational Accidents and Employment. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003202. [DOI: 10.1161/circoutcomes.116.003202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 03/07/2017] [Indexed: 11/16/2022]
Abstract
Background—
First-time syncopal episodes usually occur in adults of working age, but their impact on occupational safety and employment remains unknown. We examined the associations of syncope with occupational accidents and termination of employment.
Methods and Results—
Through linkage of Danish population-based registers, we included all residents 18 to 64 years from 2008 to 2012. Among 3 410 148 eligible individuals, 21 729 with a first-time diagnosis of syncope were identified, with a median age 48.4 years (first to third quartiles, 33.0–59.5), and 10 757 (49.5%) employed at time of the syncope event. Over a median follow-up of 3.2 years (first to third quartiles, 2.0–4.5), 622 people with syncope had an occupational accident requiring hospitalization (2.1/100 person-years). In multiple Poisson regression analysis, the incidence rate ratio in the employed syncope population was higher than in the employed general population (1.44; 95% confidence interval [CI], 1.33–1.55) and more pronounced in people with recurrences (2.02; 95% CI, 1.47–2.78). The 2-year risk of termination of employment was 31.3% (95% CI, 30.4%–32.3%), which was twice the risk of the reference population (15.2%; 95% CI, 14.7%–15.7%), using the Aalen–Johansen estimator. Factors associated with termination of employment were age <40 years (incidence rate ratio, 1.48; 95% CI, 1.37–1.59), cardiovascular disease (1.20; 95% CI, 1.06–1.36), depression (1.72; 95% CI, 1.55–1.90), and low educational level (2.61; 95% CI, 2.34–2.91).
Conclusions—
In this nationwide cohort, syncope was associated with a 1.4-fold higher risk of occupational accidents and a 2-fold higher risk of termination of employment compared with the employed general population.
Collapse
Affiliation(s)
- Anna-Karin Numé
- From the Department of Cardiology (A.N., N.C., S.L.K., G.G., M.H.R.) and Department of Nephrology (N.C.), Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark; the Departments of Cardiology and Clinical Epidemiology, Aalborg University Hospital, Denmark (K.K., H.B., C.T.-P.); the Department of Health Research and Policy (M.A.H.) and Department of Medicine (M.A.H.), Stanford University School of Medicine, CA; The National Institute of Public Health, University of Southern Denmark,
| | - Kristian Kragholm
- From the Department of Cardiology (A.N., N.C., S.L.K., G.G., M.H.R.) and Department of Nephrology (N.C.), Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark; the Departments of Cardiology and Clinical Epidemiology, Aalborg University Hospital, Denmark (K.K., H.B., C.T.-P.); the Department of Health Research and Policy (M.A.H.) and Department of Medicine (M.A.H.), Stanford University School of Medicine, CA; The National Institute of Public Health, University of Southern Denmark,
| | - Nicolas Carlson
- From the Department of Cardiology (A.N., N.C., S.L.K., G.G., M.H.R.) and Department of Nephrology (N.C.), Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark; the Departments of Cardiology and Clinical Epidemiology, Aalborg University Hospital, Denmark (K.K., H.B., C.T.-P.); the Department of Health Research and Policy (M.A.H.) and Department of Medicine (M.A.H.), Stanford University School of Medicine, CA; The National Institute of Public Health, University of Southern Denmark,
| | - Søren L. Kristensen
- From the Department of Cardiology (A.N., N.C., S.L.K., G.G., M.H.R.) and Department of Nephrology (N.C.), Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark; the Departments of Cardiology and Clinical Epidemiology, Aalborg University Hospital, Denmark (K.K., H.B., C.T.-P.); the Department of Health Research and Policy (M.A.H.) and Department of Medicine (M.A.H.), Stanford University School of Medicine, CA; The National Institute of Public Health, University of Southern Denmark,
| | - Henrik Bøggild
- From the Department of Cardiology (A.N., N.C., S.L.K., G.G., M.H.R.) and Department of Nephrology (N.C.), Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark; the Departments of Cardiology and Clinical Epidemiology, Aalborg University Hospital, Denmark (K.K., H.B., C.T.-P.); the Department of Health Research and Policy (M.A.H.) and Department of Medicine (M.A.H.), Stanford University School of Medicine, CA; The National Institute of Public Health, University of Southern Denmark,
| | - Mark A. Hlatky
- From the Department of Cardiology (A.N., N.C., S.L.K., G.G., M.H.R.) and Department of Nephrology (N.C.), Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark; the Departments of Cardiology and Clinical Epidemiology, Aalborg University Hospital, Denmark (K.K., H.B., C.T.-P.); the Department of Health Research and Policy (M.A.H.) and Department of Medicine (M.A.H.), Stanford University School of Medicine, CA; The National Institute of Public Health, University of Southern Denmark,
| | - Christian Torp-Pedersen
- From the Department of Cardiology (A.N., N.C., S.L.K., G.G., M.H.R.) and Department of Nephrology (N.C.), Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark; the Departments of Cardiology and Clinical Epidemiology, Aalborg University Hospital, Denmark (K.K., H.B., C.T.-P.); the Department of Health Research and Policy (M.A.H.) and Department of Medicine (M.A.H.), Stanford University School of Medicine, CA; The National Institute of Public Health, University of Southern Denmark,
| | - Gunnar Gislason
- From the Department of Cardiology (A.N., N.C., S.L.K., G.G., M.H.R.) and Department of Nephrology (N.C.), Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark; the Departments of Cardiology and Clinical Epidemiology, Aalborg University Hospital, Denmark (K.K., H.B., C.T.-P.); the Department of Health Research and Policy (M.A.H.) and Department of Medicine (M.A.H.), Stanford University School of Medicine, CA; The National Institute of Public Health, University of Southern Denmark,
| | - Martin H. Ruwald
- From the Department of Cardiology (A.N., N.C., S.L.K., G.G., M.H.R.) and Department of Nephrology (N.C.), Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark; the Departments of Cardiology and Clinical Epidemiology, Aalborg University Hospital, Denmark (K.K., H.B., C.T.-P.); the Department of Health Research and Policy (M.A.H.) and Department of Medicine (M.A.H.), Stanford University School of Medicine, CA; The National Institute of Public Health, University of Southern Denmark,
| |
Collapse
|
13
|
Ali NJ, Grossman SA. Geriatric Syncope and Cardiovascular Risk in the Emergency Department. J Emerg Med 2017; 52:438-448.e3. [DOI: 10.1016/j.jemermed.2016.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/27/2016] [Accepted: 12/02/2016] [Indexed: 11/16/2022]
|
14
|
Hogan TM, Constantine ST, Crain AD. Evaluation of Syncope in Older Adults. Emerg Med Clin North Am 2016; 34:601-27. [PMID: 27475017 DOI: 10.1016/j.emc.2016.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The older adult patient with syncope is one of the most challenging evaluations for the emergency physician. It requires clinical skill, patience, and knowledge of specific older adult issues. It demands care in the identification of necessary resources, such as medication review, and potential linkage with several multidisciplinary follow-up services. Excellent syncope care likely requires reaching out to ensure institutional resources are aligned with emergency department patient needs, thus asking emergency physicians to stretch their administrative talents. This is likely best done as preset protocols prior to individual patient encounters. Emergency physicians evaluate elders with syncope every day and should rise to the challenge to do it well.
Collapse
Affiliation(s)
- Teresita M Hogan
- Geriatric Emergency Medicine, University of Chicago Medicine, 5841 S Maryland Avenue, Chicago, IL 60637, USA.
| | | | - Aoko Doris Crain
- University of Chicago Medicine, 5841 S Maryland Avenue, Chicago, IL 60637, USA
| |
Collapse
|
15
|
Costantino G, Sun BC, Barbic F, Bossi I, Casazza G, Dipaola F, McDermott D, Quinn J, Reed MJ, Sheldon RS, Solbiati M, Thiruganasambandamoorthy V, Beach D, Bodemer N, Brignole M, Casagranda I, Del Rosso A, Duca P, Falavigna G, Grossman SA, Ippoliti R, Krahn AD, Montano N, Morillo CA, Olshansky B, Raj SR, Ruwald MH, Sarasin FP, Shen WK, Stiell I, Ungar A, Gert van Dijk J, van Dijk N, Wieling W, Furlan R. Syncope clinical management in the emergency department: a consensus from the first international workshop on syncope risk stratification in the emergency department. Eur Heart J 2015; 37:1493-8. [PMID: 26242712 DOI: 10.1093/eurheartj/ehv378] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 07/21/2015] [Indexed: 02/01/2023] Open
Affiliation(s)
- Giorgio Costantino
- Dipartimento di Medicina Interna, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Portland, Italy
| | - Benjamin C Sun
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Franca Barbic
- BIOMETRA Department - Humanitas Research Hospital, Università degli Studi di Milano, Rozzano, MI, Italy
| | - Ilaria Bossi
- Emergency Medicine Department, S. Anna Hospital, Como, Italy
| | - Giovanni Casazza
- Department of Biomedical and Clinical Sciences 'L. Sacco', Università degli Studi di Milano, Milan, Italy
| | - Franca Dipaola
- BIOMETRA Department - Humanitas Research Hospital, Università degli Studi di Milano, Rozzano, MI, Italy
| | - Daniel McDermott
- School of Medicine, University of California- San Francisco, San Francisco, CA, USA
| | - James Quinn
- Division of Emergency Medicine, Stanford University, Stanford, CA, USA
| | - Matthew J Reed
- Emergency Medicine Research Group Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Robert S Sheldon
- Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Monica Solbiati
- Dipartimento di Medicina Interna, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Portland, Italy
| | | | | | | | | | - Ivo Casagranda
- Department of Emergency Medicine, Ospedale di Alessandria, Alessandria, Italy
| | - Attilio Del Rosso
- Electrophysiology Unit, Cardiology Division, Department of Medicine, Ospedale S. Giuseppe, Empoli, Italy
| | - Piergiorgio Duca
- Department of Biomedical and Clinical Sciences 'L. Sacco', Università degli Studi di Milano, Milan, Italy
| | | | - Shamai A Grossman
- Department of Emergency Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Andrew D Krahn
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Nicola Montano
- Dipartimento di Medicina Interna, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Portland, Italy
| | - Carlos A Morillo
- McMaster University, Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Brian Olshansky
- Division of Cardiology, University of Iowa Medical Center, Iowa City, IA, USA
| | - Satish R Raj
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Martin H Ruwald
- Division of Cardiology, Gentofte Hospital, Copenhagen, Denmark
| | - Francois P Sarasin
- Division of Emergency Medicine, Hopital Cantonal, University of Geneva Medical School, Geneva, Switzerland
| | | | - Ian Stiell
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - Andrea Ungar
- Syncope Unit, Geriatric Medicine and Cardiology, Careggi University Hospital, Firenze, Italy
| | - J Gert van Dijk
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Nynke van Dijk
- Department of General Practice/Family Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - Wouter Wieling
- Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - Raffaello Furlan
- BIOMETRA Department - Humanitas Research Hospital, Università degli Studi di Milano, Rozzano, MI, Italy
| |
Collapse
|
16
|
Solbiati M, Casazza G, Dipaola F, Rusconi AM, Cernuschi G, Barbic F, Montano N, Sheldon RS, Furlan R, Costantino G. Syncope recurrence and mortality: a systematic review. Europace 2014; 17:300-8. [PMID: 25476868 DOI: 10.1093/europace/euu327] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Data on adverse events and death rates following syncope are heterogeneous among studies, and knowledge of syncope prognosis could help to better define the correct management of patients. METHODS AND RESULTS We performed a systematic review of literature by searching for prospective observational studies enrolling consecutive patients presenting to the Emergency Department because of syncope. The outcomes considered were syncope recurrence and short- and long-term mortality. Morbidity and a composite of morbidity and mortality were also assessed. Pooled event rates and 95% confidence intervals (CI) were calculated for each outcome using the random effects model. Twenty-five studies (11 158 patients) were included. The incidence of syncope relapse linearly increased from 0.3% at 30 days to 22% at 2 years follow-up. One-year mortality rate varied between 5.7 and 15.5%; the pooled estimate was 8.4% (95% CI: 6.7-10.2%). The incidence of adverse events (morbidity) varied between 6.1 and 25.2% at 10 days and 2 years, respectively. The short-term (10 days) pooled incidence of the composite of morbidity and mortality was 9.1% (95% CI: 6.6-12.5%). We found a high statistical heterogeneity between studies. CONCLUSION This meta-analysis of prospective observational studies shows that the chance of being asymptomatic linearly progressively decreased over time after the first syncope. Short-term (10-30 days) mortality after syncope was <2% and that the overall 10-day rate of the composite endpoint of death and major events was ∼9%. The knowledge of syncope prognosis could help clinicians to understand syncope patients' prognosis and researchers to design future studies.
Collapse
Affiliation(s)
- Monica Solbiati
- Medicina ad Indirizzo Fisiopatologico, Dipartimento di Scienze Biomediche e Cliniche 'L. Sacco', Ospedale 'L. Sacco', Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milano, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche 'L. Sacco', Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milano, Italy
| | - Franca Dipaola
- Medicina Interna, Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, Humanitas Clinical and Research Center, Università degli Studi di Milano, Via A. Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Anna Maria Rusconi
- Medicina ad Indirizzo Fisiopatologico, Dipartimento di Scienze Biomediche e Cliniche 'L. Sacco', Ospedale 'L. Sacco', Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milano, Italy
| | - Giulia Cernuschi
- Medicina ad Indirizzo Fisiopatologico, Dipartimento di Scienze Biomediche e Cliniche 'L. Sacco', Ospedale 'L. Sacco', Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milano, Italy
| | - Franca Barbic
- Medicina Interna, Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, Humanitas Clinical and Research Center, Università degli Studi di Milano, Via A. Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Nicola Montano
- Medicina ad Indirizzo Fisiopatologico, Dipartimento di Scienze Biomediche e Cliniche 'L. Sacco', Ospedale 'L. Sacco', Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milano, Italy
| | - Robert Stanley Sheldon
- Libin Cardiovascular Institute of Alberta, University of Calgary, 1403, 29 St NW, Calgary, AB, Canada T2N 2T9
| | - Raffaello Furlan
- Medicina Interna, Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, Humanitas Clinical and Research Center, Università degli Studi di Milano, Via A. Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Giorgio Costantino
- Medicina ad Indirizzo Fisiopatologico, Dipartimento di Scienze Biomediche e Cliniche 'L. Sacco', Ospedale 'L. Sacco', Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milano, Italy
| |
Collapse
|