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Ungar A, Ceccofiglio A, Mussi C, Bo M, Rivasi G, Rafanelli M, Martone AM, Bellelli G, Nicosia F, Riccio D, Boccardi V, Tonon E, Curcio F, Landi F, Abete P, Mossello E. Truly unexplained falls after evaluation for syncope: A new diagnostic entity with severe prognosis. Eur J Intern Med 2022; 98:93-97. [PMID: 35172944 DOI: 10.1016/j.ejim.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/18/2022] [Accepted: 02/08/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare one-year mortality risk associated with syncope and unexplained fall in older adults with dementia. METHODS 522 patients (aged >65 years) with dementia and history of transient loss of consciousness and/or unexplained falls were evaluated. The diagnosis of syncope was based on European Society of Cardiology guidelines. A "Syncopal Fall" was defined in patients with an initial clinical presentation of unexplained fall, but a final diagnosis of syncope after complete assessment. A "Truly Unexplained Fall" was defined in patients with an initial clinical presentation of unexplained fall, in whom a diagnosis of syncope had been excluded after the diagnostic work-up. One-year follow-up was assessed by phone interview. RESULTS Follow-up data were available for 501 participants (mean age 83 ± 6 years, 65% female). After a mean follow-up of 324 ± 93 days, death from any cause was reported in 188 participants (24%). Advanced age, male sex, cognitive and functional impairment were associated with a higher mortality rate. Patients with "Truly Unexplained Falls" had a higher mortality risk compared with syncope and "Syncopal Fall". A diagnosis of "Truly Unexplained Falls" remained an independent predictor of one-year all-cause mortality in multivariate model. CONCLUSIONS We propose the novel diagnostic category of "Truly Unexplained Fall", resulting from the application of syncope guidelines to subjects with unexplained falls. This condition in older adults with dementia is a predictor of one-year all-cause mortality. For this new high risk profile, we advice a comprehensive geriatric assessment focused on risk factors for fall, aimed at a possible improvement of prognosis.
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Affiliation(s)
- Andrea Ungar
- Department of Medicine and Geriatrics, Syncope Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Largo Brambilla, Florence 50139, Italy.
| | - Alice Ceccofiglio
- Department of Medicine and Geriatrics, Syncope Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Largo Brambilla, Florence 50139, Italy
| | - Chiara Mussi
- Centro di Valutazione e Ricerca Gerontologica, Chair of Geriatrics, University of Modena and Reggio Emilia, Modena, Italy
| | - Mario Bo
- SCDU Geriatria e Malattie Metaboliche dell'Osso, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Giulia Rivasi
- Department of Medicine and Geriatrics, Syncope Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Largo Brambilla, Florence 50139, Italy
| | - Martina Rafanelli
- Department of Medicine and Geriatrics, Syncope Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Largo Brambilla, Florence 50139, Italy
| | - Anna Maria Martone
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Giuseppe Bellelli
- Department of Health Sciences, University of Milano Bicocca and Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - Franco Nicosia
- Medicine and Geriatric Unit - Spedali Civili of Brescia, Brescia, Italy
| | - Daniela Riccio
- Geriatric Department, SS. Trinità Hospital, Cagliari, Italy
| | - Virginia Boccardi
- Department of Medicine, Institute of Gerontology and Geriatrics, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | | | - Francesco Curcio
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Enrico Mossello
- Department of Medicine and Geriatrics, Syncope Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Largo Brambilla, Florence 50139, Italy
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Prognosis among healthy individuals discharged with a primary diagnosis of syncope. J Am Coll Cardiol 2012; 61:325-32. [PMID: 23246392 DOI: 10.1016/j.jacc.2012.08.1024] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 08/07/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study sought to examine the risk of major cardiac adverse events and death in a nationwide cohort of patients without previous comorbidity admitted for syncope. BACKGROUND Syncope is a common clinical event, but knowledge of prognosis is not fully elucidated in healthy individuals. METHODS Patients without previous comorbidity admitted for syncope in Denmark from 2001 to 2009 were identified in nationwide administrative registries and matched by sex and age with 5 control subjects from the Danish population. The risk of death or recurrent syncope, implantation of pacemaker or implantable cardioverter-defibrillator, and cardiovascular hospitalization were analyzed with multivariable Cox proportional hazard models. RESULTS We identified 37,017 patients with a first-time diagnosis of syncope and 185,085 control subjects; their median age was 47 years (interquartile range, 32 to 63 years) and 47% were male. A total of 3,023 (8.2%) and 14,251 (7.1%) deaths occurred in the syncope and the control population, respectively, yielding an event rate of 14.3 per 1,000 person-years (PY) in the syncope population. Multivariable Cox regression analysis demonstrated a significantly increased risk of all-cause mortality (hazard ratio [HR]: 1.06; 95% confidence interval [CI]: 1.02 to 1.10), cardiovascular hospitalization event rate of 26.5 per 1,000 PY (HR: 1.74; 95% CI: 1.68 to 1.80), recurrent syncope event rate of 45.1 per 1,000, stroke event rate of 6.8 per 1,000 PY (HR: 1.35; 95% CI: 1.27 to 1.44), and pacemaker or implantable cardioverter-defibrillator event rate of 4.2 per 1,000 PY (HR: 5.52; 95% CI: 4.67 to 5.73; p < 0.0001). CONCLUSIONS The first admission for syncope among healthy individuals significantly predicts the risk of all-cause mortality, stroke, cardiovascular hospitalization, device implantation, and recurrent syncope.
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