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Rivasi G, Fedorowski A. Harm vs. benefit of antihypertensive treatment in very old and frail people - do not miss the forest for the trees. J Hypertens 2023; 41:1551-1553. [PMID: 37642590 DOI: 10.1097/hjh.0000000000003519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- Giulia Rivasi
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Artur Fedorowski
- Department of Cardiology, Karolinska University Hospital, and Department of Medicine, Karolinska Institute, Stockholm
- Department of Clinical Sciences, Lund University, Malmö, Sweden
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Sharad B, Rivasi G, Hamrefors V, Johansson M, Ungar A, Sutton R, Brignole M, Parati G, Fedorowski A. Twenty-Four-Hour Ambulatory Blood Pressure Profile in Patients With Reflex Syncope and Matched Controls. J Am Heart Assoc 2023; 12:e028704. [PMID: 37026553 PMCID: PMC10227244 DOI: 10.1161/jaha.122.028704] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/26/2023] [Accepted: 03/03/2023] [Indexed: 04/08/2023]
Abstract
Background Ambulatory blood pressure (BP) monitoring has long been used to monitor BP in hypertension and lately emerged as a useful tool to detect hypotensive susceptibility in reflex syncope. However, hemodynamic characteristics in reflex syncope have not been sufficiently explored. The present study investigated the differences between ambulatory BP monitoring profiles associated with reflex syncope and normal population. Methods and Results This is an observational study comparing ambulatory BP monitoring data from 50 patients with reflex syncope and 100 controls without syncope, age- and sex-matched 1:2. Mean 24-hour systolic (SBP) and diastolic BP, pulse pressure (24-hour PP), dipping status, and number of daytime SBP drops <90 to 100 mm Hg were analyzed. Variables associated with reflex syncope were investigated using multivariable logistic regression. Patients with reflex syncope displayed significantly lower 24-hour SBP (112.9±12.6 versus 119.3±11.5 mm Hg, P=0.002), higher 24-hour diastolic BP (85.2±9.6 versus 79.1±10.6 mm Hg, P<0.001), and markedly lower 24-hour PP (27.7±7.6 versus 40.3±9.0 mm Hg, P<0.001) compared with controls. Daytime SBP drops <90 mm Hg were more prevalent in patients with syncope (44% versus 17%, P<0.001). Daytime SBP drops <90 mm Hg, 24-hour PP <32 mm Hg, 24-hour SBP ≤110 mm Hg, and 24-hour diastolic BP ≥82 mm Hg were independently associated with reflex syncope, with 24-hour PP <32 mm Hg achieving the highest sensitivity (80%) and specificity (86%). Conclusions Patients with reflex syncope have lower 24-hour SBP but higher 24-hour diastolic BP and more frequent daytime SBP drops <90 mm Hg than individuals without syncope. Our results support the presence of lower SBP and PP in reflex syncope and suggest a role for ambulatory BP monitoring in the diagnostic work-up of this condition.
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Affiliation(s)
- Bashaaer Sharad
- Department of Clinical SciencesLund University, and Skåne University HospitalMalmöSweden
| | - Giulia Rivasi
- Division of Geriatric and Intensive Care MedicineUniversity of Florence and Azienda Ospedaliero Universitaria CareggiFlorenceItaly
| | - Viktor Hamrefors
- Department of Clinical SciencesLund University, and Skåne University HospitalMalmöSweden
- Department of CardiologySkåne University HospitalMalmöSweden
| | - Madeleine Johansson
- Department of Clinical SciencesLund University, and Skåne University HospitalMalmöSweden
- Department of CardiologySkåne University HospitalMalmöSweden
| | - Andrea Ungar
- Division of Geriatric and Intensive Care MedicineUniversity of Florence and Azienda Ospedaliero Universitaria CareggiFlorenceItaly
| | - Richard Sutton
- Department of Clinical SciencesLund University, and Skåne University HospitalMalmöSweden
- Department of Cardiology, National Heart & Lung Institute, Imperial CollegeHammersmith Hospital CampusLondonUnited Kingdom
| | - Michele Brignole
- IRCCS, Istituto Auxologico Italiano, Cardiology UnitS.Luca HospitalMilanItaly
- Department of Cardiovascular, Neural and Metabolic SciencesS.Luca HospitalMilanItaly
| | - Gianfranco Parati
- IRCCS, Istituto Auxologico Italiano, Cardiology UnitS.Luca HospitalMilanItaly
- Department of Cardiovascular, Neural and Metabolic SciencesS.Luca HospitalMilanItaly
| | - Artur Fedorowski
- Department of Clinical SciencesLund University, and Skåne University HospitalMalmöSweden
- Department of CardiologyKarolinska University HospitalStockholmSweden
- Department of MedicineKarolinska InstituteStockholmSweden
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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.
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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.)
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Magnavita N. Workplace Health Promotion Embedded in Medical Surveillance: The Italian Way to Total Worker Health Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3659. [PMID: 36834352 PMCID: PMC9968016 DOI: 10.3390/ijerph20043659] [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: 01/13/2023] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
In 2011, NIOSH launched the Total Worker Health (TWH) strategy based on integrating prevention and health promotion in the workplace. For several years now, in Italy, this integration has led to the creation of workplace health promotion embedded in medical surveillance (WHPEMS). WHPEMS projects, which are also implemented in small companies, focus each year on a new topic that emerges from the needs of workers. During their regular medical check-up in the workplace, workers are invited to fill in a questionnaire regarding the project topic, its outcome, and some related factors. Workers receive advice on how to improve their lifestyles and are referred to the National Health Service for any necessary tests or treatments. Results collected over the past 12 years from more than 20,000 participants demonstrate that WHPEMS projects are economical, sustainable, and effective. The creation of a network of occupational physicians who are involved in WHPEMS projects could help to improve the work culture, health, and safety of workers.
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Affiliation(s)
- Nicola Magnavita
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; ; Tel.: +39-347-330-0367
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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Rivasi G, Groppelli A, Brignole M, Soranna D, Zambon A, Bilo G, Pengo M, Sharad B, Hamrefors V, Rafanelli M, Testa GD, Rice C, Kenny RA, Sutton R, Ungar A, Fedorowski A, Parati G. Association between hypotension during 24 h ambulatory blood pressure monitoring and reflex syncope: the SynABPM 1 study. Eur Heart J 2022; 43:3765-3776. [PMID: 35766175 PMCID: PMC9553097 DOI: 10.1093/eurheartj/ehac347] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 04/25/2022] [Accepted: 06/15/2022] [Indexed: 01/06/2023] Open
Abstract
AIMS Diagnostic criteria for ambulatory blood pressure monitoring (ABPM) in patients with suspected reflex syncope are lacking. The study hypothesis was that patients with reflex syncope have a higher prevalence of systolic blood pressure (SBP) drops on ABPM. METHODS AND RESULTS ABPM data from reflex syncope patients and controls, matched by average 24 h SBP, age, sex, and hypertension were compared. Patients with constitutional hypotension, orthostatic hypotension, and predominant cardioinhibition during carotid sinus massage or prolonged electrocardiogram monitoring or competing causes of syncope were excluded. Daytime and nighttime SBP drops (<110, 100, 90, 80 mmHg) were assessed. Findings were validated in an independent sample. In the derivation sample, daytime SBP drops were significantly more common in 158 syncope patients than 329 controls. One or more daytime drops <90 mmHg achieved 91% specificity and 32% sensitivity [odds ratio (OR) 4.6, P < 0.001]. Two or more daytime drops <100 mmHg achieved 84% specificity and 40% sensitivity (OR 3.5, P = 0.001). Results were confirmed in the validation sample of 164 syncope patients and 164 controls: one or more daytime SBP drops <90 mmHg achieved 94% specificity and 29% sensitivity (OR 6.2, P < 0.001), while two or more daytime SBP drops <100 mmHg achieved 83% specificity and 35% sensitivity (OR 2.6, P < 0.001). CONCLUSION SBP drops during ABPM are more common in reflex syncope patients than in controls. Cut-off values that may be applied in clinical practice are defined. This study expands the current indications for ABPM to patients with reflex syncope.
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Affiliation(s)
- Giulia Rivasi
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy
| | - Antonella Groppelli
- IRCCS, Istituto Auxologico Italiano, Cardiology Unit and Department of Cardiology, S.Luca Hospital, 20149 Milan, Italy
| | - Michele Brignole
- IRCCS, Istituto Auxologico Italiano, Cardiology Unit and Department of Cardiology, S.Luca Hospital, 20149 Milan, Italy
| | - Davide Soranna
- IRCCS Istituto Auxologico Italiano, Biostatistics Unit, 20149 Milan, Italy
| | - Antonella Zambon
- IRCCS Istituto Auxologico Italiano, Biostatistics Unit, 20149 Milan, Italy.,Department of Statistics and quantitative methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Grzegorz Bilo
- IRCCS, Istituto Auxologico Italiano, Cardiology Unit and Department of Cardiology, S.Luca Hospital, 20149 Milan, Italy
| | - Martino Pengo
- IRCCS, Istituto Auxologico Italiano, Cardiology Unit and Department of Cardiology, S.Luca Hospital, 20149 Milan, Italy
| | - Bashaaer Sharad
- Department of Clinical Sciences, Lund University, and Skåne University Hospital, 50332 Malmö, Sweden
| | - Viktor Hamrefors
- Department of Clinical Sciences, Lund University, and Skåne University Hospital, 50332 Malmö, Sweden
| | - Martina Rafanelli
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy
| | - Giuseppe Dario Testa
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy
| | - Ciara Rice
- Falls and Syncope Unit, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin 8, Ireland
| | - Rose Anne Kenny
- Falls and Syncope Unit, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin 8, Ireland.,Department of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
| | - Richard Sutton
- Department of Clinical Sciences, Lund University, and Skåne University Hospital, 50332 Malmö, Sweden.,Department of Cardiology, National Heart & Lung Institute, Imperial College, Hammersmith Hospital Campus, London W12 0HS, UK
| | - Andrea Ungar
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, and Skåne University Hospital, 50332 Malmö, Sweden.,Department of Cardiology, Karolinska University Hospital, and Department of Medicine, Karolinska Institute, 171 77 Stockholm, Sweden
| | - Gianfranco Parati
- IRCCS, Istituto Auxologico Italiano, Cardiology Unit and Department of Cardiology, S.Luca Hospital, 20149 Milan, Italy
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Sharma G, Ramakumar V, Sharique M, Bhatia R, Naik N, Mohanty S, Agarwal A, Meti M, Shukla A, Deepti S, Bansal R, Gupta A, Ahmed AS, Pandey RM, Narang R, Mishra S, Saxena A, Juneja R. Effect of Yoga on Clinical Outcomes and Quality of Life in Patients With Vasovagal Syncope (LIVE-Yoga). JACC Clin Electrophysiol 2022; 8:141-149. [PMID: 35210069 DOI: 10.1016/j.jacep.2021.09.007] [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: 07/12/2021] [Revised: 09/01/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This study aims to determine the impact of yoga as an adjunct to standard therapy versus standard therapy alone on the symptomatic burden in patients with recurrent vasovagal syncope (VVS). BACKGROUND There is a significant reduction in the quality of life (QoL) of patients with recurrent VVS. Existing management therapies have been largely ineffective. Recent trials have demonstrated the efficacy of yoga in diseases with autonomic imbalance, suggesting its possible utility in VVS. METHODS Patients with recurrent VVS were randomized to receive either a specialized yoga training program in addition to current guideline-based therapy (intervention arm, group 1) or current guideline-based therapy alone (control arm, group 2). The primary outcome was a composite of the number of episodes of syncope and presyncope at 12 months. Secondary outcomes included QoL assessment by World Health Organization Quality of Life Brief Field questionnaire (WHOQoL-BREF) scores and Syncope Functional Status Questionnaire scores at 12 months, head up tilt test, and heart rate variability at 6 weeks. RESULTS A total of 55 patients underwent randomization. The mean number of syncopal or presyncopal events at 12 months was 0.7 ± 0.7 in the intervention arm compared to 2.52 ± 1.93 in the control arm (P < 0.01). In the intervention arm, 13 (43.3%) patients remained free of events versus 4 (16.0%) patients in the control arm (P = 0.02). QoL at 12 months showed significant improvement of all Syncope Functional Status Questionnaire scores and 2 domains of WHOQoL-BREF scores (P < 0.05). CONCLUSIONS Yoga as adjunctive therapy is superior to standard therapy alone in reducing the symptomatic burden and improving QoL in patients with recurrent VVS.
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Affiliation(s)
- Gautam Sharma
- Department of Cardiology, Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India.
| | | | - Mohd Sharique
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Nitish Naik
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sriloy Mohanty
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Aman Agarwal
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Mohini Meti
- Department of Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Akriti Shukla
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharthan Deepti
- Department of Cardiology, Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Raghav Bansal
- Department of Cardiology, Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Anunay Gupta
- Department of Cardiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - A Shaheer Ahmed
- Department of Cardiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Rajiv Narang
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sundeep Mishra
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajnish Juneja
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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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.
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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
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8
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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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Brignole M, Rivasi G. New insights in diagnostics and therapies in syncope: a novel approach to non-cardiac syncope. Heart 2021; 107:864-873. [PMID: 33462120 DOI: 10.1136/heartjnl-2020-318261] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/29/2020] [Indexed: 12/27/2022] Open
Abstract
This article aims to give advice on how to identify and manage patients with syncope who are at risk of severe outcomes, that is, at risk of trauma, potentially life-threatening episodes or frequent recurrences reducing quality of life. The first step of syncope diagnostic assessment is to identify patients with cardiac syncope, and once established, these patients must receive the adequate mechanism-specific treatment. If cardiac syncope is unlikely, reflex (neurally mediated) syncope and orthostatic hypotension are the most frequent causes of transient loss of consciousness. For these presentations, efficacy of therapy is largely determined by the mechanism of syncope rather than its aetiology or clinical features. The identified mechanism of syncope should be carefully assessed and assigned either to hypotensive or bradycardic phenotype, which will determine the choice of therapy (counteracting hypotension or counteracting bradycardia). The results of recent trials indicate that 'mechanism-specific therapy' is highly effective in preventing recurrences. Established mechanism-specific treatment strategies include withdrawal of hypotensive drugs, applying fludrocortisone and midodrine for the hypotensive phenotype and cardiac pacing in the bradycardic phenotype.
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Affiliation(s)
- Michele Brignole
- Department of Cardiovascular, Neural and Metabolic Sciences, Faint & Fall Programme, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
| | - Giulia Rivasi
- Division of Geriatric and Intensive Care Medicine, University of Florence, Firenze, Italy
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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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11
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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.
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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.
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