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Torabi P, Hamrefors V, Sutton R, Brignole M, Fedorowski A. Definitive aetiology of unexplained syncope after cardiovascular autonomic tests in a tertiary syncope unit. Europace 2023; 25:euad247. [PMID: 37589189 PMCID: PMC10505743 DOI: 10.1093/europace/euad247] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/24/2023] [Accepted: 08/13/2023] [Indexed: 08/18/2023] Open
Abstract
AIMS Syncope is a common condition with many possible causes, ranging from benign to life-threatening aetiologies. Establishing a diagnosis can be difficult, and specialized syncope units, using cardiovascular autonomic tests (CATs), including a head-up tilt test, can increase the diagnostic yield. However, up to one-fifth of examined patients have inconclusive CAT results. The aim of the present study was to investigate the predictive value of history, and clinical findings for unexplained syncope after CAT and characterize the group with negative results. METHODS AND RESULTS Consecutive syncope patients [n = 2663, 61% women, median age 52 (32-69) years] were evaluated and CAT explained aetiology of syncope in 79% of cases, whereas 21% remained unexplained. Predictors of negative CAT were older age at first syncope (+8% higher odds per 10-year increment, P = 0.042), higher supine heart rate (HR; +12% per 10 b.p.m.; P = 0.003), absence of prodromes (+48%; P < 0.001), hypertension (+45%; P = 0.003), diabetes (+82%; P < 0.001), heart failure (+98%; P = 0.014), and coronary artery disease (+51%; P = 0.027). Compared with vasovagal syncope, patients with negative CAT were older, reported more often the absence of prodromes, and had a higher burden of cardiovascular comorbidities. CONCLUSION A cardiovascular autonomic test established the cause of syncope in 79% of patients evaluated in a syncope unit. Syncope without prodromes and cardiovascular comorbidities were significant predictors of failure to reveal an aetiology from assessment by CAT. These are known risk factors for cardiac syncope and patients with inconclusive CAT warrant further investigation.
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Affiliation(s)
- Parisa Torabi
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Clinical Physiology, Skåne University Hospital, Malmö, Sweden
| | - Viktor Hamrefors
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Richard Sutton
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- National Heart and Lung Institute, Imperial College, Hammersmith Hospital Campus, Du Cane Road, London W12 0HS, UK
| | - Michele Brignole
- IRCCS Istituto Auxologico Italiano, Faint and Fall Research Centre, Ospedale San Luca, Milano, Italy
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
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2
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Marrazzo G, Palermi S, Pastore F, Ragni M, De Luca M, Gambardella M, Quaranta G, Messalli G, Riegler L, Pergola V, Manto A, D’Andrea A. Multimodality Imaging Approach to Spontaneous Coronary Artery Dissection. J Clin Med 2022; 12:jcm12010154. [PMID: 36614955 PMCID: PMC9821637 DOI: 10.3390/jcm12010154] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/12/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
Spontaneous Coronary Artery Dissection (SCAD) refers to the spontaneous separation of the layers of the vessel wall caused by intramural hemorrhage, with or without an intimal tear. The "typical" SCAD patient is a middle-aged woman with few traditional cardiovascular risk factors, and it's frequently associated with pregnancy. Because of its low incidence, its pathophysiology is not fully understood. SCAD presents as an acute coronary syndrome, with chest pain, dyspnea, syncope, or heartbeat, even if diagnosis and clinical handling are different: coronary angiography is currently the main tool to diagnose SCAD; however, in doubtful cases, the use of both invasive and noninvasive cardiovascular imaging methods such as intravascular ultrasound or optical coherence tomography may be necessary. This paper aims to review the current state of knowledge on SCAD to address its demographic features, clinical characteristics, management, and outcomes, focusing on diagnostic algorithms and main multimodality imaging techniques.
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Affiliation(s)
- Gemma Marrazzo
- Department of Cardiology, Umberto I° Hospital, 84014 Salerno, Italy
| | - Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Fabio Pastore
- Department of Cardiology, Umberto I° Hospital, 84014 Salerno, Italy
| | - Massimo Ragni
- Department of Cardiology, Umberto I° Hospital, 84014 Salerno, Italy
| | - Mariarosaria De Luca
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Michele Gambardella
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Gaetano Quaranta
- Department of Cardiology, Umberto I° Hospital, 84014 Salerno, Italy
| | | | - Lucia Riegler
- Department of Cardiology, Umberto I° Hospital, 84014 Salerno, Italy
| | - Valeria Pergola
- Department of Cardiology, Padua University Hospital, 35128 Padua, Italy
| | - Andrea Manto
- Department of Neuroradiology, Umberto I° Hospital, 84014 Salerno, Italy
| | - Antonello D’Andrea
- Department of Cardiology, Umberto I° Hospital, 84014 Salerno, Italy
- Correspondence:
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3
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Galron E, Kehat O, Weiss-Meilik A, Furlan R, Jacob G. Diagnostic approaches to syncope in Internal Medicine Departments and their effect on mortality. Eur J Intern Med 2022; 102:97-103. [PMID: 35599110 DOI: 10.1016/j.ejim.2022.05.015] [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: 02/02/2022] [Revised: 05/02/2022] [Accepted: 05/12/2022] [Indexed: 11/18/2022]
Abstract
Most data on mortality and investigational approaches to syncope comes from patients presented to emergency departments (ED). The aim of this study is to report intermediate term mortality in syncope patients admitted to Internal Medicine Departments and whether different diagnostic approaches to syncope affect mortality. Methods and results A single-center retrospective-observational study conducted at the Tel Aviv "Sourasky" Medical Center. Data was collected from electronic medical records (EMRs), from January 2010 to December 2020. We identified 24,021 patients, using ICD-9-CM codes. Only 7967 syncope patients were admitted to Internal Medicine Departments and evaluated. Logistic regression models were used to determine the effects of diagnostic testing per patient in each department on 30-day mortality and readmission rates. All-cause 30-day mortality rate was 4.1%. There was a significant difference in the number of diagnostic tests performed per patient between the different departments, without affecting 30-day mortality. The 30-day readmission rate was 11.4%, of which 4.4% were a result of syncope. Conclusion Syncope patients admitted to Internal Medicine Departments show a 30-day all-cause mortality rate of ∼4%. Despite the heterogeneity in the approach to the diagnosis of syncope, mortality is not affected. This novel information about syncope patients in large Internal Medicine Departments is further proof that the diagnosis of syncope requires a logic, personalized approach that focuses on medical history and a few tailored, diagnostic tests.
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Affiliation(s)
- Ehud Galron
- Department of Medicine F. Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel; Recanati Autonomic Research Center, Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Orli Kehat
- I-Medata AI Center, Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Ahuva Weiss-Meilik
- I-Medata AI Center, Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Raffaello Furlan
- Internal Medicine, Humanitas Research Hospital, Humanitas University, Rozzano, Italy
| | - Giris Jacob
- Department of Medicine F. Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel; Recanati Autonomic Research Center, Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
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4
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Barón-Esquivias G, Quintanilla M, Díaz-Martín AJ, Barón-Solís C, Almeida-González CV, García-Romero C, Paneque I, Rubio-Guerrero C, Rodríguez-Corredor R, Valle-Racero JI, Ordóñez A, Morillo CA. Long-term recurrences and mortality in patients with noncardiac syncope. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:568-575. [PMID: 34969644 DOI: 10.1016/j.rec.2021.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/07/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES There are no in-depth studies of the long-term outcome of patients with syncope after exclusion of cardiac etiology. We therefore analyzed the long-term outcome of this population. METHODS For 147 months, we included all patients with syncope referred to our syncope unit after exclusion of a cardiac cause. RESULTS We included 589 consecutive patients. There were 313 (53.1%) women, and the median age was 52 [34-66] years. Of these, 405 (68.8%) were diagnosed with vasovagal syncope (VVS), 65 (11%) with orthostatic hypotension syncope (OHS), and 119 (20.2%) with syncope of unknown etiology (SUE). During a median follow-up of 52 [28-89] months, 220 (37.4%) had recurrences (21.7% ≥ 2 recurrences), and 39 died (6.6%). Syncope recurred in 41% of patients with VVS, 35.4% with OHS, and 25.2% with SUE (P=.006). In the Cox multivariate analysis, recurrence was correlated with age (P=.002), female sex (P <.0001), and the number of previous episodes (< 5 vs ≥ 5; P <.0001). Death occurred in 15 (3.5%) patients with VVS, 11 (16.9%) with OHS, and 13 (10.9%) with SUE (P=.001). In the multivariate analysis, death was associated with age (P=.0001), diabetes (P=.007), and diagnosis of OHS (P=.026) and SUE (P=.020). CONCLUSIONS In patients with noncardiac syncope, the recurrence rate after 52 months of follow-up was 37.4% and mortality was 6.6% per year. Recurrence was higher in patients with a neuromedial profile and mortality was higher in patients with a nonneuromedial profile.
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Affiliation(s)
- Gonzalo Barón-Esquivias
- Servicio de Cardiología y Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain; Unidad Cardiovascular, Instituto de Biotecnología de Sevilla (IBIS), Seville, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Macarena Quintanilla
- Servicio de Cardiología y Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain
| | - Antonio J Díaz-Martín
- Servicio de Cardiología y Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain
| | - Carmen Barón-Solís
- Servicio de Cardiología y Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain
| | - Carmen V Almeida-González
- Unidad de Metodología, Estadística e Investigación, Instituto de Biotecnología de Sevilla (IBIS), Seville, Spain
| | - Carmen García-Romero
- Servicio de Cardiología y Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain
| | - Inmaculada Paneque
- Servicio de Cardiología y Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain
| | - Carmen Rubio-Guerrero
- Servicio de Cardiología y Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain
| | - Rosario Rodríguez-Corredor
- Servicio de Cardiología y Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain
| | - Juan I Valle-Racero
- Servicio de Cardiología y Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain
| | - Antonio Ordóñez
- Servicio de Cardiología y Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain; Unidad Cardiovascular, Instituto de Biotecnología de Sevilla (IBIS), Seville, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Carlos A Morillo
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
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Barón-Esquivias G, Quintanilla M, Díaz-Martín AJ, Barón-Solís C, Almeida-González CV, García-Romero C, Paneque I, Rubio-Guerrero C, Rodríguez-Corredor R, Valle-Racero JI, Ordóñez A, Morillo CA. Recurrencia y mortalidad a largo plazo de los pacientes con síncope no cardiogénico. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sutton R, Ricci F, Fedorowski A. Risk stratification of syncope: Current syncope guidelines and beyond. Auton Neurosci 2022; 238:102929. [PMID: 34968831 DOI: 10.1016/j.autneu.2021.102929] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/27/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022]
Abstract
Syncope is an alarming event carrying the possibility of serious outcomes, including sudden cardiac death (SCD). Therefore, immediate risk stratification should be applied whenever syncope occurs, especially in the Emergency Department, where most dramatic presentations occur. It has long been known that short- and long-term syncope prognosis is affected not only by its mechanism but also by presence of concomitant conditions, especially cardiovascular disease. Over the last two decades, several syncope prediction tools have been developed to refine patient stratification and triage patients who need expert in-hospital care from those who may receive nonurgent expert care in the community. However, despite promising results, prognostic tools for syncope remain challenging and often poorly effective. Current European Society of Cardiology syncope guidelines recommend an initial syncope workup based on detailed patient's history, physical examination supine and standing blood pressure, resting ECG, and laboratory tests, including cardiac biomarkers, where appropriate. Subsequent risk stratification based on screening of features aims to identify three groups: high-, intermediate- and low-risk. The first should immediately be hospitalized and appropriately investigated; intermediate group, with recurrent or medium-risk events, requires systematic evaluation by syncope experts; low-risk group, sporadic reflex syncope, merits education about its benign nature, and discharge. Thus, initial syncope risk stratification is crucial as it determines how and by whom syncope patients are managed. This review summarizes the crucial elements of syncope risk stratification, pros and cons of proposed risk evaluation scores, major challenges in initial syncope management, and how risk stratification impacts management of high-risk/recurrent syncope.
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Affiliation(s)
- Richard Sutton
- National Heart & Lung Institute, Imperial College, Dept. of Cardiology, Hammersmith Hospital, Du Cane Road, London W12 0HS, United Kingdom
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G.d'Annunzio" University of Chieti-Pescara, Via Luigi Polacchi, 11, 66100 Chieti, Italy; Casa di Cura Villa Serena, Città Sant'Angelo, Italy
| | - Artur Fedorowski
- Dept. of Cardiology, Karolinska University Hospital, and Department of Medicine, Karolinska Institute, Stockholm, Sweden.
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Palermi S, Serio A, Vecchiato M, Sirico F, Gambardella F, Ricci F, Iodice F, Radmilovic J, Russo V, D'Andrea A. Potential role of an athlete-focused echocardiogram in sports eligibility. World J Cardiol 2021; 13:271-297. [PMID: 34589165 PMCID: PMC8436685 DOI: 10.4330/wjc.v13.i8.271] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/27/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023] Open
Abstract
Sudden cardiac death (SCD) of an athlete is a rare but tragic event and sport activity might play a trigger role in athletes with underlying structural or electrical heart diseases. Preparticipation screenings (PPs) have been conceived for the potential to prevent SCD in young athletes by early identification of cardiac diseases. The European Society of Cardiology protocol for PPs includes history collection, physical examination and baseline electrocardiogram, while further examinations are reserved to individuals with abnormalities at first-line evaluation. Nevertheless, transthoracic echocardiography has been hypothesized to have a primary role in the PPs. This review aims to describe how to approach an athlete-focused echocardiogram, highlighting what is crucial to focus on for the different diseases (cardiomyopathies, valvulopathies, congenital heart disease, myocarditis and pericarditis) and when is needed to pay attention to overlap diagnostic zone ("grey zone") with the athlete's heart. Once properly tested, focused echocardiography by sports medicine physicians may become standard practice in larger screening practices, potentially available during first-line evaluation.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | - Alessandro Serio
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | - Marco Vecchiato
- Sport and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Padova 35128, Italy
| | - Felice Sirico
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | | | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti 66100, Italy
| | - Franco Iodice
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy
| | - Juri Radmilovic
- Unit of Cardiology and Intensive Coronary Care, "Umberto I" Hospital, Nocera Inferiore 84014, Italy
| | - Vincenzo Russo
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy
| | - Antonello D'Andrea
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy.
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Perings C, Wolff C, Wilk A, Witthohn A, Voss R, Rybak K. Do implantable loop recorders impact the survival of patients with recurrent unexplained syncope? J Comp Eff Res 2021; 10:285-294. [PMID: 33499667 DOI: 10.2217/cer-2020-0242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study compares the outcomes of patients who receive an implantable loop recorder (ILR) for unexplained syncope to a control group without the diagnostic device in German claims data. Methods and materials: Patients with ILR were matched to a control group based on prior syncope events, age, gender and Charlson Comorbidity index (CCI). Survival, syncope hospitalizations, treatment and costs were compared. Results/conclusion: Four hundred and twelve ILR patients were matched with controls, mean age was 68, mean CCI was 2.7, 42% females. ILR patients lived on average 1.2 years longer than patients in the control group. Twenty-five percent of ILR patients received a therapeutic device compared with 5% in the control group. ILRs might help to diagnose and treat patients with positive impact on survival.
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Affiliation(s)
- Christian Perings
- Department of Cardiology, St. Marien-Hospital, Altstadtstraße 23, 44534 Lünen, Germany
| | - Claudia Wolff
- Medtronic International Trading Sarl, Route du Molliau 31,1131 Tolochenaz, Switzerland
| | - Adrian Wilk
- Team Gesundheit, Gesellschaft für Gesundheitsmanagement GmbH, Rellinghauser Str. 93, 45128 Essen, Germany
| | | | - Rainer Voss
- Medtronic GmbH, Earl-Bakken-Platz 1, 40670 Meerbusch, Germany
| | - Karin Rybak
- Kardiologische Praxis, Kochstedter Kreisstraße 11, 06847 Dessau-Roßlau, Germany
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Adlan AM, Eftekhari H, Paul G, Hayat S, Osman F. The Impact of a Nurse-Led Syncope Clinic: Experience from a single UK tertiary center. J Arrhythm 2020; 36:854-862. [PMID: 33024463 PMCID: PMC7532277 DOI: 10.1002/joa3.12420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/30/2020] [Accepted: 08/06/2020] [Indexed: 12/02/2022] Open
Abstract
Background Syncope is a leading cause of hospital admission and is associated with significant morbidity and mortality. Our Syncope Clinic commenced in 2014 and we sought to evaluate its impact on outcomes (1‐yr mortality and syncope re‐hospitalization) in patients discharged following syncope admission. Methods A single‐center study of all consecutive patients discharged with syncope (ICD‐10 R55) between April 2012 and 2017. Patient demographics, comorbidities, hospital stay, syncope re‐hospitalization, and mortality at one‐year were collected. Those subsequently referred and seen in Syncope Clinic were compared with those who were not and predictors of poor outcome were evaluated. Results In total 2950 patients were discharged from hospital with syncope (median age: 73years, 51% male) with 1220 (41%) discharged same‐day; after commencement of Syncope Clinic 231were subsequently reviewed here. Overall mortality was 11%, which was lower in the Syncope Clinic group (3% vs 12%, P < .001). Temporal analysis revealed reduced re‐hospitalization following commencement of Syncope Clinic (2% vs 6%, P = .027). Independent predictors of mortality were increasing age (HR 1.03, 95% CI 1.03‐1.04), AF (HR 1.6, 95% CI 1.2‐2.1), HF (HR 2.2, 95% CI 1.6‐3.0), COPD (HR 1.9, 95% CI 1.4‐2.7), and CHADS2 score ≥ 1 (HR 1.45, 95% CI 1,12‐1.87). Syncope Clinic attendance was associated with reduced mortality (HR 0.3, 95% CI 0.1‐0.6). Conclusions Syncope patients discharged from hospital had reduced 1yr mortality if seen in subsequent Syncope Clinic. Independent predictors of mortality were COPD, HF, AF, and CHADS2 ≥1. Prospective randomized trials of Syncope Clinics are warranted.
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Affiliation(s)
- Ahmed M Adlan
- Department of Cardiology University Hospitals Coventry & Warwickshire NHS Trust Coventry UK
| | - Helen Eftekhari
- Department of Cardiology University Hospitals Coventry & Warwickshire NHS Trust Coventry UK
| | - Geeta Paul
- Department of Cardiology University Hospitals Coventry & Warwickshire NHS Trust Coventry UK
| | - Sajad Hayat
- Department of Cardiology University Hospitals Coventry & Warwickshire NHS Trust Coventry UK.,Department of Adult Cardiology Heart Hospital Hamad Medical Corporation Doha Qatar
| | - Faizel Osman
- Department of Cardiology University Hospitals Coventry & Warwickshire NHS Trust Coventry UK.,University of Warwick (Medical School) Coventry UK
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10
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Wolff C, Petkar S. Burden of recurrent syncope and injuries and the usefulness of implantable cardiac monitors: insights from a nationwide longitudinal cohort analysis. J Comp Eff Res 2020; 9:659-666. [PMID: 32639168 DOI: 10.2217/cer-2020-0059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The study assesses the burden and costs of recurring unexplained syncope and injuries and the effectiveness of implantable loop recorders. Methods: The English national hospital database (Hospital Episode Statistics) was retrospectively analyzed. Results: 12,002 patients were identified with repeated syncope hospitalizations. 25% of patients were hospitalized at least once again for syncope, 9% of the patients were hospitalized at least once for an injury, causing substantial costs. In the second analysis: 10,902 patients implanted with an implantable cardiac monitor were tracked. By year 3, hospitalizations due to syncope had dropped by 60% versus pre-implantable cardiac monitor (ICM) levels. Conclusion: This study shows a high rate of recurrent syncope admissions and a parallel burden of hospitalizations for injuries. Use of an ICM appears to reduce syncope hospitalizations.
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Affiliation(s)
- Claudia Wolff
- Department of Health Economics, Medtronic, Route du Molliau 31, Tolochenaz 1131, Switzerland
| | - Sanjiv Petkar
- Department of Cardiology, New Cross Hospital, Wolverhampton Rd, Heath Town, Wolverhampton WV10 0QP, UK
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Yasa E, Ricci F, Holm H, Persson T, Melander O, Sutton R, Hamrefors V, Fedorowski A. Pacing therapy in the management of unexplained syncope: a tertiary care centre prospective study. Open Heart 2019; 6:e001015. [PMID: 30997138 PMCID: PMC6443123 DOI: 10.1136/openhrt-2019-001015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/18/2019] [Accepted: 03/04/2019] [Indexed: 12/22/2022] Open
Abstract
Objective Pacemaker (PM) therapy is effective when syncope is associated with bradycardia, but syncope recurrences and fall injuries after PM implantation may occur. We aimed to survey indications and outcomes of PM implantation, following evaluation of unexplained syncope. Methods Among 1666 consecutive unpaced patients investigated in a tertiary syncope unit by carotid-sinus massage (CSM), head-up tilt test (HUT) and ECG monitoring, 106 (6.4%; age, 65 ± 17 years) received a PM. We assessed bradycardia detection methods, PM implantation indications, and explored incidence of recurrent syncope, fall-related fractures and mortality. Results Indications for PM therapy were met in 32/106 patients (30%) by CSM, in 41/106 (39%) by HUT, in 14/106 patients (13%) by implantable loop-recorder (ILR) and in 19/106 (18%) by standard ECG. Sinus arrest with asystole was the predominant PM indication during CSM/HUT and external ECG monitoring, whereas ILR detected proportionally the same numbers o f asystole due to sinus arrest and atrioventricular block. During follow-up (median, 4.3 years), 15 patients (14%) had syncope recurrence, 15 suffered fall-related fractures and 9 died. Neither syncope recurrence nor fall-related fractures were dependent on initial PM indication. The composite endpoint of recurrent syncope/fall-related fracture was associated with treated hypertension (OR 2.45; 95% CI 1.00 to 6.0), reduced glomerular filtration rate (OR 1.63 per 10 mL/min↓; 95% CI 1.22 to 2.19) and atrial fibrillation (OR 3.98; 95% CI 1.11 to 14.3). Recurrent syncope predicted increased mortality (OR 9.20; 95% CI 1.89 to 44.8). Conclusions Cardiovascular autonomic testing and ECG monitoring effectively identify pacing indications in patients with unexplained syncope. After PM implantation, treated hypertension, renal failure and atrial fibrillation predict syncope recurrence and fall-related injury. Recurrent syncope predicts increased mortality.
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Affiliation(s)
- Ekrem Yasa
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Fabrizio Ricci
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Neuroscience, Imaging and Clinical Sciences, Universita degli Studi Gabriele d'Annunzio Chieti e Pescara, Chieti Scalo, Italy
| | - Hannes Holm
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Torbjörn Persson
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Richard Sutton
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom
| | - Viktor Hamrefors
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden
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