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Reed MJ, Karuranga S, Kearns D, Alawiye S, Clarke B, Möckel M, Karamercan M, Janssens K, Riesgo LGC, Torrecilla FM, Golea A, Fernández Cejas JA, Lupan-Muresan EM, Zaimi E, Nuernberger A, Rennét O, Skjaerbaek C, Polyzogopoulou E, Imecz J, Groff P, Camilleri R, Cimpoesu D, Jovic M, Miró Ò, Anderson R, Laribi S. Management of syncope in the Emergency Department: a European prospective cohort study (SEED). Eur J Emerg Med 2024; 31:136-146. [PMID: 38015745 DOI: 10.1097/mej.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
BACKGROUND AND IMPORTANCE In 2018, the European Society of Cardiology (ESC) produced syncope guidelines that for the first-time incorporated Emergency Department (ED) management. However, very little is known about the characteristics and management of this patient group across Europe. OBJECTIVES To examine the prevalence, clinical presentation, assessment, investigation (ECG and laboratory testing), management and ESC and Canadian Syncope Risk Score (CSRS) categories of adult European ED patients presenting with transient loss of consciousness (TLOC, undifferentiated or suspected syncope). DESIGN Prospective, multicentre, observational cohort study. SETTINGS AND PARTICIPANTS Adults (≥18 years) presenting to European EDs with TLOC, either undifferentiated or thought to be of syncopal origin. MAIN RESULTS Between 00:01 Monday, September 12th to 23:59 Sunday 25 September 2022, 952 patients presenting to 41 EDs in 14 European countries were enrolled from 98 301 ED presentations (n = 40 sites). Mean age (SD) was 60.7 (21.7) years and 487 participants were male (51.2%). In total, 379 (39.8%) were admitted to hospital and 573 (60.2%) were discharged. 271 (28.5%) were admitted to an observation unit first with 143 (52.8%) of these being admitted from this. 717 (75.3%) participants were high-risk according to ESC guidelines (and not suitable for discharge from ED) and 235 (24.7%) were low risk. Admission rate increased with increasing ESC high-risk factors; 1 ESC high-risk factor; n = 259 (27.2%, admission rate=34.7%), 2; 189 (19.9%; 38.6%), 3; 106 (11.1%, 54.7%, 4; 62 (6.5%, 60.4%), 5; 48 (5.0%, 67.9%, 6+; 53 (5.6%, 67.9%). Furthermore, 660 (69.3%), 250 (26.3%), 34 (3.5%) and 8 (0.8%) participants had a low, medium, high, and very high CSRS respectively with respective admission rates of 31.4%, 56.0%, 76.5% and 75.0%. Admission rates (19.3-88.9%), use of an observation/decision unit (0-100%), and percentage high-risk (64.8-88.9%) varies widely between countries. CONCLUSION This European prospective cohort study reported a 1% prevalence of syncope in the ED. 4 in 10 patients are admitted to hospital although there is wide variation between country in syncope management. Three-quarters of patients have ESC high-risk characteristics with admission percentage rising with increasing ESC high-risk factors.
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Affiliation(s)
- Matthew J Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Suvi Karuranga
- European Society for Emergency Medicine, Antwerp, Belgium
| | - David Kearns
- University of Edinburgh Medical School, Edinburgh, UK
| | - Salma Alawiye
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh
| | - Ben Clarke
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh
| | - Martin Möckel
- Department of Emergency and Acute Medicine, Campus Mitte and Virchow, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Mehmet Karamercan
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Kelly Janssens
- St Vincents University Healthcare Group, Dublin, Ireland
| | | | | | - Adela Golea
- Emergency Unit, University of Medicine and Pharmacy Cluj, University Emergency County Hospital, Cluj Napoca, Romania
| | | | - Eugenia Maria Lupan-Muresan
- Emergency Medicine Discipline, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Edmond Zaimi
- University Hospital Centre, Mother Teresa of Tirana, Tirana, Albania
| | | | | | | | | | | | - Paolo Groff
- Santa Maria della Misericordia Hospital, Perugia, Italy
| | | | - Diana Cimpoesu
- University of Medicine and Pharmacy Grigore T Popa, Iasi, Romania
| | - Miljan Jovic
- General Hospital, Health Centre, Zaječar, Serbia
| | - Òscar Miró
- Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | | | - Said Laribi
- Emergency Medicine Department, CHU Tours, Tours University, Tours, France
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Staples JA, Erdelyi S, Merchant K, Yip C, Khan M, Maclure KM, Redelmeier DA, Chan H, Brubacher JR. Syncope and Traffic Crash: A Population-Based Case-Crossover Analysis. Can J Cardiol 2024; 40:554-561. [PMID: 37290537 DOI: 10.1016/j.cjca.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/05/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Among individuals with recent syncope, recurrence of syncope while driving might incapacitate a driver and cause a motor vehicle crash. Current driving restrictions assume that some forms of syncope transiently increase crash risk. We evaluated whether syncope is associated with a transient increase in crash risk. METHODS We performed a case-crossover analysis of linked administrative health and driving data from British Columbia, Canada (2010 to 2015). We included licensed drivers who visited an emergency department with "syncope and collapse" and who were involved as a driver in an eligible motor vehicle crash, both within the study interval. Using conditional logistic regression, we compared the rate of emergency visits for syncope in the 28 days before crash (the "pre-crash interval") with the rate of emergency visits for syncope in 3 self-matched 28-day control intervals (ending 6, 12, and 18 months before the crash). RESULTS Among eligible crash-involved drivers, 47 of 3026 pre-crash intervals and 112 of 9078 control intervals had emergency visits for syncope, indicating syncope was not significantly associated with subsequent crash (1.6% vs 1.2%; adjusted odds ratio [OR], 1.27; 95% confidence interval [CI], 0.90-1.79; P = 0.18). There was no significant association between syncope and crash in subgroups at higher risk for adverse outcomes after syncope (eg, age > 65 years, cardiovascular disease, cardiac syncope). CONCLUSIONS In the context of prevailing modifications of driving behaviour after syncope, an emergency department visit for syncope did not transiently increase the risk of subsequent traffic collision. Overall crash risks after syncope appear to be adequately addressed by current driving restrictions.
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Affiliation(s)
- John A Staples
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, British Columbia, Canada.
| | - Shannon Erdelyi
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ketki Merchant
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Candace Yip
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mayesha Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - K Malcolm Maclure
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald A Redelmeier
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Herbert Chan
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey R Brubacher
- Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Vogel M, Fischer T. [Syncopes - differential diagnoses and treatment]. Dtsch Med Wochenschr 2024; 149:521-531. [PMID: 38621687 DOI: 10.1055/a-2186-1100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Syncope is a sudden loss of consciousness (transient loss of consciousness, TLOC) caused by a lack of cerebral perfusion that resolves spontaneously and completely after a short period of time 1. With a lifetime prevalence of 40% and constituting about 1% of all emergency department admissions, syncope is a common and medically relevant problem 2 3. The underlying causes of syncope are diverse and associated with significantly different prognoses. A structured approach is essential to identify high-risk patients and ensure appropriate treatment. This article aims at providing an overview of the current recommendations for the diagnosis and treatment of syncope.
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Bjelic M, Goldenberg I, Younis A, Chen AY, Huang DT, Yoruk A, Aktas MK, Rosero S, Cutter K, McNitt S, Sotoodehnia N, Kudenchuk PJ, Rea TD, Arking DE, Zareba W, Ackerman MJ, Goldenberg I. Risk Prediction in Male Adolescents With Congenital Long QT Syndrome: Implications for Sex-Specific Risk Stratification in Potassium Channel-Mediated Long QT Syndrome. J Am Heart Assoc 2024; 13:e028902. [PMID: 38240206 DOI: 10.1161/jaha.122.028902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 07/06/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Sex-specific risk management may improve outcomes in congenital long QT syndrome (LQTS). We recently developed a prediction score for cardiac events (CEs) and life-threatening events (LTEs) in postadolescent women with LQTS. In the present study, we aimed to develop personalized risk estimates for the burden of CEs and LTEs in male adolescents with potassium channel-mediated LQTS. METHODS AND RESULTS The prognostic model was derived from the LQTS Registry headquartered in Rochester, NY, comprising 611 LQT1 or LQT2 male adolescents from age 10 through 20 years, using the following variables: genotype/mutation location, QTc-specific thresholds, history of syncope, and β-blocker therapy. Anderson-Gill modeling was performed for the end point of CE burden (total number of syncope, aborted cardiac arrest, and appropriate defibrillator shocks). The applicability of the CE prediction model was tested for the end point of the first LTE (excluding syncope and adding sudden cardiac death) using Cox modeling. A total of 270 CEs occurred during follow-up. The genotype-phenotype risk prediction model identified low-, intermediate-, and high-risk groups, comprising 74%, 14%, and 12% of the study population, respectively. Compared with the low-risk group, high-risk male subjects experienced a pronounced 5.2-fold increased risk of recurrent CEs (P<0.001), whereas intermediate-risk patients had a 2.1-fold (P=0.004) increased risk . At age 20 years, the low-, intermediate-, and high-risk adolescent male patients had on average 0.3, 0.6, and 1.4 CEs per person, respectively. Corresponding 10-year adjusted probabilities for a first LTE were 2%, 6%, and 8%. CONCLUSIONS Personalized genotype-phenotype risk estimates can be used to guide sex-specific management in male adolescents with potassium channel-mediated LQTS.
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Affiliation(s)
- Milica Bjelic
- Clinical Cardiovascular Research Center, Division of Cardiology University of Rochester Medical Center Rochester NY USA
- Department of Anesthesiology St. Elizabeth's Medical Center Boston University School of Medicine Boston MA USA
| | - Ido Goldenberg
- Clinical Cardiovascular Research Center, Division of Cardiology University of Rochester Medical Center Rochester NY USA
- Department of Medicine, Rochester Regional Health Rochester NY USA
| | - Arwa Younis
- Clinical Cardiovascular Research Center, Division of Cardiology University of Rochester Medical Center Rochester NY USA
- Department of Cardiovascular Medicine Cleveland Clinic Cleveland OH USA
| | - Anita Y Chen
- Department of Biostatistics and Computational Biology University of Rochester Medical Center Rochester NY USA
| | - David T Huang
- Department of Medicine, Division of Cardiology University of Rochester Medical Center Rochester NY USA
| | - Ayhan Yoruk
- Division of Cardiology The University of California, San Francisco Medical Center San Francisco CA USA
| | - Mehmet K Aktas
- Department of Medicine, Division of Cardiology University of Rochester Medical Center Rochester NY USA
| | - Spencer Rosero
- Department of Medicine, Division of Cardiology University of Rochester Medical Center Rochester NY USA
| | - Kristina Cutter
- Clinical Cardiovascular Research Center, Division of Cardiology University of Rochester Medical Center Rochester NY USA
| | - Scott McNitt
- Clinical Cardiovascular Research Center, Division of Cardiology University of Rochester Medical Center Rochester NY USA
| | - Nona Sotoodehnia
- Department of Medicine, Division of Cardiology University of Washington Seattle WA USA
| | | | - Thomas D Rea
- Department of Medicine University of Washington Seattle WA USA
| | - Dan E Arking
- The McKusick-Nathans Institute, Department of Genetic Medicine John Hopkins University School of Medicine Baltimore MD USA
| | - Wojciech Zareba
- Clinical Cardiovascular Research Center, Division of Cardiology University of Rochester Medical Center Rochester NY USA
| | - Michael J Ackerman
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Genetic Heart Rhythm Clinic and Windland Smith Rice Sudden Death Genomics Laboratory Mayo Clinic Rochester MN USA
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, Division of Cardiology University of Rochester Medical Center Rochester NY USA
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Staples JA, Erdelyi S, Merchant K, Yip C, Khan M, Redelmeier DA, Chan H, Brubacher JR. Syncope While Driving and the Risk of a Subsequent Motor Vehicle Crash. Ann Emerg Med 2024; 83:147-157. [PMID: 37943207 DOI: 10.1016/j.annemergmed.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 11/10/2023]
Abstract
STUDY OBJECTIVE Syncope that occurs while driving can result in a motor vehicle crash. Whether individuals with a prior syncope-related crash exhibit an exceptional risk of subsequent crash remains uncertain. METHODS We performed a population-based retrospective observational study of patients diagnosed with 'syncope and collapse' at any of 6 emergency departments in British Columbia, Canada (2010 to 2015). Data were obtained from chart abstraction, administrative health records, insurance claims and police crash reports. We compared crash-free survival among individuals with crash-associated syncope (a crash and an emergency visit for syncope on the same date) to that among controls with syncope alone (no crash on date of emergency visit for syncope). RESULTS In the year following their index emergency visit, 13 of 63 drivers with crash-associated syncope and 852 of 9,160 controls with syncope alone experienced a subsequent crash as a driver (crash risk 21% versus 9%). After accounting for censoring and potential confounders, crash-associated syncope was not associated with a significant increase in the risk of subsequent crash (adjusted hazard ratio [aHR] 1.38, 95% confidence interval [CI] 0.78 to 2.47). Individuals with crash-associated syncope were 31-fold more likely to have physician driving advice documented during their index visit (prevalence ratio 31.0, 95% CI, 21.3 to 45.1). In the subgroup without documented driving advice, crash-associated syncope was associated with a significant increase in subsequent crash risk (aHR 1.88, 95% CI 1.06 to 3.36). CONCLUSIONS Crash risk after crash-associated syncope appears similar to crash risk after syncope alone.
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Affiliation(s)
- John A Staples
- Department of Medicine, University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, Canada.
| | - Shannon Erdelyi
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Ketki Merchant
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Candace Yip
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Mayesha Khan
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Donald A Redelmeier
- Sunnybrook Research Institute, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada
| | - Herbert Chan
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Jeffrey R Brubacher
- Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
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Jansen S, van der Velde N. Syncope in older adults: challenges, approach and treatment. Age Ageing 2024; 53:afad245. [PMID: 38331395 DOI: 10.1093/ageing/afad245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Indexed: 02/10/2024] Open
Abstract
Syncope can have devastating consequences, resulting in injuries, accidents or even death. In our ageing society, the subsequent healthcare usage, such as emergency room presentations, surgeries and hospital admissions, forms a significant and growing socioeconomic burden. Causes of syncope in the older adult include orthostatic hypotension, carotid sinus syndrome, vasovagal syncope, structural cardiac abnormalities, cardiac arrhythmias and conduction abnormalities. As stated in the recently published World Falls Guidelines, syncope in older adults often presents as falls, which is either due to amnesia for loss of consciousness, or pre-syncope leading to a fall, especially in those prone to falls with several other risk-factors for falls present. This difference in presentation can hinder the recognition of syncope. In patients with unexplained falls, or in whom the history comprises red flags for potential syncope, special attention to (pre)syncope is therefore warranted. When syncope is mistaken for other causes of a transient loss of consciousness, such as epileptic seizures, or when syncope presents as falls, patients are often referred to multiple specialists, which may in turn lead to excessive and unnecessary diagnostic testing and costs. Specialist services that are able to provide a comprehensive assessment can improve diagnostic yield and minimise diagnostic testing, thus improving patient satisfaction. Comprehensive assessment also leads to reduced length of hospital stay. Increasingly, geriatricians are involved in the assessment of syncope in the older patient, especially given the overlap with falls. Therefore, awareness of causes of syncope, as well as state-of-the-art assessment and treatment, is of great importance.
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Affiliation(s)
- Sofie Jansen
- Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
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Zou R, Wang S, Liu P, Chen D, Yan J, Cai H, Wang Y, Wang C. The association between patent foramen ovale and unexplained syncope in pediatric patients. Ital J Pediatr 2024; 50:2. [PMID: 38185629 PMCID: PMC10773133 DOI: 10.1186/s13052-023-01572-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/26/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Patent foramen ovale (PFO) is associated with transient ischemia attack (TIA) or stroke, paradoxical embolism, and migraines. PFO closure decreases the recurrent incidence of cerebral ischemic events and reduces the incidence of syncope in adults. However, whether PFO is associated with syncope in pediatric patients has not been investigated. METHODS 1001 pediatric patients (aged 4 to 17 years, mean age 10.31 ± 2.61 years, 519 males) who complained of unexplained syncope, palpitation, headache, dizziness and chest pain and were hospitalized in the Syncope Ward, The Second Xiangya Hospital, Central South University between January 2013 and April 2022 were recruited. Children with definite etiology of syncope, neurological, cardiogenic, psychological and other system diseases were excluded. PFO was measured by transthoracic echocardiography and right-heart contrast echocardiography was performed to identify the presence of right-to-left shunting. The demographic data and medical records were retrospectively reviewed and analyzed. RESULTS 276 cases were included in the simple syncope group, 379 cases in the headache/dizziness group, 265 cases in the chest pain group, and 81 cases in the palpitation group. The incidence of PFO between the four groups was insignificant (4.71%, 4.74%, 4.15%, 6.17%, respectively, P = 0.903). Multivariate Logistic regression demonstrated that PFO is not associated with the increased risk of syncope (P = 0.081). CONCLUSION PFO may not increase the risk of syncope in pediatric patients. Further study may include a large and multicenter sample to investigate the association between PFO and unexplained syncope.
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Affiliation(s)
- Runmei Zou
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, Hunan, 410011, China
| | - Shuo Wang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Ping Liu
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, Hunan, 410011, China
| | - Donghai Chen
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, Hunan, 410011, China
| | - Jun Yan
- Department of Pediatrics, The First Affiliated Hospital, Hunan University of Medicine, Huaihua, Hunan, 418000, China
| | - Hong Cai
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, Hunan, 410011, China
| | - Yuwen Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, Hunan, 410011, China
| | - Cheng Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, Hunan, 410011, China.
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Orenshtein S, Sheiner E, Sergienko R, Wainstock T. Syncope in pregnancy, immediate pregnancy outcomes, and offspring long-term neurologic health. Am J Obstet Gynecol MFM 2023; 5:101190. [PMID: 37838012 DOI: 10.1016/j.ajogmf.2023.101190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/26/2023] [Accepted: 10/09/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND There are limited data regarding the perinatal consequences of maternal syncope during pregnancy, and even less is known about the potential long-term effect on offspring health. OBJECTIVE This study aimed to examine perinatal outcomes as well as long-term offspring neurologic morbidity associated with prenatal maternal syncope, and the possible differential effect by trimester of first syncope episode. STUDY DESIGN A retrospective cohort study was conducted, including all singleton deliveries occurring between 1991 and 2021 at a large tertiary medical center. Multivariable analyses were applied to study the associations between prenatal maternal syncope and various perinatal outcomes as well as offspring neurologic morbidity up to the age of 18 years, while adjusting for clinically relevant factors. Analyses were further conducted by trimester of first syncope episode. RESULTS The study population included 232,475 pregnancies, 774 (0.3%) were affected by maternal syncope, which most frequently first occurred during the second trimester (44.5%), followed by the first trimester (31.8%) and finally the third trimester (27.7%). Maternal syncope was independently associated with increased risk for intrauterine growth restriction (adjusted odds ratio, 1.52; 95% confidence interval, 1.01-2.29), which appeared to be mainly driven by first trimester syncope occurrence; as well as with increased risk for cesarean delivery (adjusted odds ratio, 1.33; 95% confidence interval, 1.10-1.61), and for long-term offspring neurologic morbidity (adjusted hazard ratio, 1.79; 95% confidence interval, 1.65-2.08), regardless of the trimester of syncope occurrence. CONCLUSION Prenatal maternal syncope is an independent risk factor for intrauterine growth restriction, cesarean delivery, and for long-term offspring neurologic morbidity.
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Affiliation(s)
- Shani Orenshtein
- Faculty of Health Sciences, Department of Epidemiology, Biostatistics and Community Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Ms Orenshtein, Mr Sergienko, and Dr Wainstock).
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Prof Sheiner)
| | - Ruslan Sergienko
- Faculty of Health Sciences, Department of Epidemiology, Biostatistics and Community Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Ms Orenshtein, Mr Sergienko, and Dr Wainstock)
| | - Tamar Wainstock
- Faculty of Health Sciences, Department of Epidemiology, Biostatistics and Community Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Ms Orenshtein, Mr Sergienko, and Dr Wainstock)
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Ahuja M, Siddhpuria S, Karimi A, Lewis K, Wong E, Lee J, Reppas-Rindlisbacher C, Sood E, Gabor C, Patterson C. Cholinesterase inhibitors and falls, syncope and injuries in patients with cognitive impairment: a systematic review and meta-analysis. Age Ageing 2023; 52:afad205. [PMID: 37993407 DOI: 10.1093/ageing/afad205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Cholinesterase inhibitors are commonly used to treat patients with neurocognitive disorders, who often have an elevated risk of falling. Effective use of these medications requires a thoughtful assessment of risks and benefits. OBJECTIVE To provide an update on previous reviews and determine the association between cholinesterase inhibitors and falls, syncope, fracture and accidental injuries in patients with neurocognitive disorders. METHODS Embase, MEDLINE, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature and AgeLine were systematically searched through March 2023 to identify all randomised controlled trials of cholinesterase inhibitors (donepezil, galantamine, rivastigmine) in patients with cognitive impairment. Corresponding authors were contacted for additional data necessary for meta-analysis. Inclusion criteria consisted of adults ≥19 years, with a diagnosis of dementia, Parkinson's disease, mild cognitive impairment or traumatic brain injury. Data were extracted in duplicate for the aforementioned primary outcomes and all outcomes were analysed using random-effects meta-analysis. RESULTS Fifty three studies (30 donepezil, 14 galantamine, 9 rivastigmine) were included providing data on 25, 399 patients. Cholinesterase inhibitors, compared to placebo, were associated with reduced risk of falls (risk ratio [RR] 0.84 [95% confidence interval [CI] = 0.73-0.96, P = 0.009]) and increased risk of syncope (RR 1.50 [95% CI = 1.02-2.21, P = 0.04]). There was no association with accidental injuries or fractures. CONCLUSION In patients with neurocognitive disorders, cholinesterase inhibitors were associated with decreased risk of falls, increased risk of syncope and no association with accidental trauma or fractures. These findings will help clinicians better evaluate risks and benefits of cholinesterase inhibitors.
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Affiliation(s)
- Manan Ahuja
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shailee Siddhpuria
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Arian Karimi
- Department of Medicine, University of Illinois College of Medicine, Chicago, IL, USA
| | - Kaitlin Lewis
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Eric Wong
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Justin Lee
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Canada
| | | | - Emma Sood
- Faculty of Science, Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | | | - Christopher Patterson
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Canada
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Kondo JK, Earle WB, Turkson-Ocran RAN, Ngo LH, Cluett JL, Lipsitz LA, Daya NR, Selvin E, Lutsey PL, Coresh J, Windham BG, Kendrick KN, Juraschek SP. Standing Blood Pressure and Risk of Falls, Syncope, Coronary Heart Disease, and Mortality. Am J Hypertens 2023; 36:593-601. [PMID: 37458702 PMCID: PMC11003466 DOI: 10.1093/ajh/hpad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 07/05/2023] [Accepted: 07/13/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND ACC/AHA guidelines caution against the use of antihypertensive therapy in the setting of low standing systolic BP (SBP) < 110 mm Hg due to unclear benefits. METHODS The Atherosclerosis Risk in Communities (ARIC) Study measured supine and standing SBP in adults aged 45-64 years between 1987 and 1989. We used Cox regression to evaluate the associations of low standing SBP (<110 mm Hg) with risk of falls, syncope, coronary heart disease (CHD), and mortality through December 31, 2019. Falls and syncope were ascertained by hospitalization and outpatient claims; CHD events were adjudicated. Associations were examined overall and in strata of hypertension stage, 10-year atherosclerotic cardiovascular disease (ASCVD) risk, age, and sex. RESULTS Among 12,467 adults followed a median of 24 years (mean age at enrollment 54.1 ± 5.8 years, 55% women, 26% Black adults), 3,000 (24%) had a standing SBP < 110 mm Hg. A standing SBP < 110 mm Hg compared to standing SBP ≥ 110 mm Hg was not significantly associated with falls or syncope, and was associated with a lower risk of CHD events and mortality with HRs of 1.02 (95% CI 0.94, 1.11), 1.02 (0.93, 1.11), 0.88 (0.80, 0.97), and 0.91 (0.86, 0.97), respectively. There were no clinically meaningful differences when stratified by hypertension stage, 10-year ASCVD risk, age, and sex. CONCLUSIONS In this community-based population, low standing SBP was common and not significantly associated with falls or syncope, but was associated with a lower risk of CHD and mortality. These findings do not support screening for low standing BP as a risk factor for adverse events.
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Affiliation(s)
| | - William B Earle
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ruth-Alma N Turkson-Ocran
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Long H Ngo
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jennifer L Cluett
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Lewis A Lipsitz
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts, USA
| | - Natalie R Daya
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Beverly Gwen Windham
- Department of Medicine, Division of Geriatric Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Karla N Kendrick
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Winchester Hospital, Beth Israel Lahey Health, Woburn, MA, USA
| | - Stephen P Juraschek
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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11
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Gier C, Shapero K, Lynch M, Spatz ES, Young L, Arlis-Mayor S, Lampert R. Exertional Syncope in College Varsity Athletes. JACC Clin Electrophysiol 2023; 9:1596-1597. [PMID: 37227356 DOI: 10.1016/j.jacep.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/30/2023] [Accepted: 04/10/2023] [Indexed: 05/26/2023]
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Younis A, Bos JM, Zareba W, Aktas MK, Wilde AAM, Tabaja C, Bodurian C, Tobert KE, McNitt S, Polonsky B, Shimizu W, Ackerman MJ, Goldenberg I. Association Between Syncope Trigger Type and Risk of Subsequent Life-Threatening Events in Patients With Long QT Syndrome. JAMA Cardiol 2023; 8:775-783. [PMID: 37436769 PMCID: PMC10339217 DOI: 10.1001/jamacardio.2023.1951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/13/2023] [Indexed: 07/13/2023]
Abstract
IMPORTANCE Syncope is the most powerful predictor for subsequent life-threatening events (LTEs) in patients with congenital long QT syndrome (LQTS). Whether distinct syncope triggers are associated with differential subsequent risk of LTEs is unknown. OBJECTIVE To evaluate the association between adrenergic (AD)- and nonadrenergic (non-AD)-triggered syncopal events and the risk of subsequent LTEs in patients with LQT types 1 to 3 (LQT1-3). DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included data from 5 international LQTS registries (Rochester, New York; the Mayo Clinic, Rochester, Minnesota; Israel, the Netherlands, and Japan). The study population comprised 2938 patients with genetically confirmed LQT1, LQT2, or LQT3 stemming from a single LQTS-causative variant. Patients were enrolled from July 1979 to July 2021. EXPOSURES Syncope by AD and non-AD triggers. MAIN OUTCOMES AND MEASURES The primary end point was the first occurrence of an LTE. Multivariate Cox regression was used to determine the association of AD- or non-AD-triggered syncope on the risk of subsequent LTE by genotype. Separate analysis was performed in patients with β-blockers. RESULTS A total of 2938 patients were included (mean [SD] age at enrollment, 29 [7] years; 1645 [56%] female). In 1331 patients with LQT1, a first syncope occurred in 365 (27%) and was induced mostly with AD triggers (243 [67%]). Syncope preceded 43 subsequent LTEs (68%). Syncopal episodes associated with AD triggers were associated with the highest risk of subsequent LTE (hazard ratio [HR], 7.61; 95% CI, 4.18-14.20; P < .001), whereas the risk associated with syncopal events due to non-AD triggers was statistically nonsignificant (HR, 1.50; 95% CI, 0.21-4.77; P = .97). In 1106 patients with LQT2, a first syncope occurred in 283 (26%) and was associated with AD and non-AD triggers in 106 (37%) and 177 (63%), respectively. Syncope preceded 55 LTEs (56%). Both AD- and non-AD-triggered syncope were associated with a greater than 3-fold increased risk of subsequent LTE (HR, 3.07; 95% CI, 1.66-5.67; P ≤ .001 and HR, 3.45, 95% CI, 1.96-6.06; P ≤ .001, respectively). In contrast, in 501 patients with LQT3, LTE was preceded by a syncopal episode in 7 (12%). In patients with LQT1 and LQT2, treatment with β-blockers following a syncopal event was associated with a significant reduction in the risk of subsequent LTEs. The rate of breakthrough events during treatment with β-blockers was significantly higher among those treated with selective agents vs nonselective agents. CONCLUSION AND RELEVANCE In this study, trigger-specific syncope in LQTS patients was associated with differential risk of subsequent LTE and response to β-blocker therapy.
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Affiliation(s)
- Arwa Younis
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
| | - J. Martijn Bos
- Divisions of Heart Rhythm Services and Pediatric Cardiology, Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Genetic Heart Rhythm Clinic and Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Wojciech Zareba
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
| | - Mehmet K. Aktas
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
| | - Arthur A. M. Wilde
- Heart Center, Amsterdam Cardiovascular Sciences, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam, the Netherlands
| | - Chadi Tabaja
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Christopher Bodurian
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
| | - Kathryn E. Tobert
- Divisions of Heart Rhythm Services and Pediatric Cardiology, Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Genetic Heart Rhythm Clinic and Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Scott McNitt
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
| | - Bronislava Polonsky
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Michael J. Ackerman
- Divisions of Heart Rhythm Services and Pediatric Cardiology, Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Genetic Heart Rhythm Clinic and Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
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Quartieri F, Harish M, Calò L, Ebrahim I, Fusco A, Mester S, Cauti F, Park SJ, Francia P, Giovagnoni M, Adragao P, Vezi B, Lin W, Hutson CS, Grammatico A. New insertable cardiac monitors show high diagnostic yield and good safety profile in real-world clinical practice: results from the international prospective observational SMART Registry. Europace 2023; 25:euad068. [PMID: 36935638 PMCID: PMC10227665 DOI: 10.1093/europace/euad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/05/2023] [Indexed: 03/21/2023] Open
Abstract
AIMS Insertable cardiac monitors (ICMs) are indicated for long-term monitoring of unexplained syncope or palpitations, and for detection of bradycardia, ventricular tachycardia, and/or atrial fibrillation (AF). The aim of our study was to evaluate the safety and clinical value associated with a new generation ICM (Confirm Rx™, Abbott, Illinois, USA), featuring a new remote monitoring system based on smartphone patient applications. METHODS AND RESULTS The SMART Registry is an international prospective observational study. The main endpoints were ICM safety (incidence of serious adverse device and procedure-related events (SADEs) at 1 month), ICM clinical value (incidence of device-detected true arrhythmias and of clinical diagnoses and interventions), and patient-reported experience measurements (PREMs). A total of 1400 subjects were enrolled. ICM indications included syncope (49.1%), AF (18.8%), unexplained palpitations (13.6%), risk of ventricular arrhythmia (6.6%), and cryptogenic stroke (6.0%). Freedom from SADEs at 1 month was 99.4% (95% Confidence Interval: 98.8-99.7%). In the 6-month monitoring period, the ICM detected true cardiac arrhythmias in 45.7% of patients and led to clinical interventions in a relevant proportion of patients; in particular, a pacemaker implant was performed after bradycardia detection in 8.9% of subjects who received an ICM for syncope and oral anticoagulation therapy was indicated after AF detection in 15.7% of subjects with cryptogenic stroke. PREMs showed that 78.2% of subjects were satisfied with the remote monitoring patient app. CONCLUSION The evaluated ICM is associated with an excellent safety profile and high diagnostic yield. Patients reported positive experiences associated with the use of their smartphone for the device remote monitoring.
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Affiliation(s)
- Fabio Quartieri
- Arcispedale Santa Maria Nuova, Viale Risorgimento, 80, 42123 Reggio Emilia, Italy
| | - Manyam Harish
- Erlanger Medical Center, 975 E 3rd St, Chattanooga, TN 37403, USA
| | - Leonardo Calò
- Policlinico Casilino, Via Casilina, 1049, 00169 Roma, Italy
| | - Iftikhar Ebrahim
- Netcare Unitas Hospital, 866 Clifton Ave, Die Hoewes, Centurion, 0163, South Africa
| | - Antonio Fusco
- Casa di Cura Pederzoli, Via Monte Baldo 24, 37019 Peschiera del Garda, VeronaItaly
| | - Stephen Mester
- Bay Area Cardiology Associates, 635 Eichenfeld Dr, Brandon, FL 33511, USA
| | - Filippo Cauti
- Ospedale S. Giovanni Calibita Fatebenefratelli, Via di Ponte Quattro Capi 39, 00186 Rome, Italy
| | - Seung-Jung Park
- Samsung Medical Center, 81 Ilwon-ro, Gangnam-gu, 06351 Seoul, South Korea
| | - Pietro Francia
- Ospedale S. Andrea, Via di Grottarossa, 1035, 00189 Rome, Italy
| | - Marco Giovagnoni
- Casa Di Cura Citta di Aprilia, Via delle Palme, 25, 04011 Aprilia, Italy
| | - Pedro Adragao
- Hospital de Santa Cruz, Av. Prof. Dr. Reinaldo dos Santos, 2790, 134 Carnaxide, Lisbon, Portugal
| | - Brian Vezi
- Busamed Gateway Private Hospital, 36-38 Aurora Dr, Umhlanga Rocks, Umhlanga 4319, South Africa
| | - Wenjiao Lin
- Abbott, 15900 Valley View Ct, Sylmar, CA 91342, USA
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Khan P, Selvarajah K, Gohel S, Sidhu BS, Cannatà A, Bromage DI, McDonagh T, Murgatroyd F, Scott PA. Syncope in ICD recipients: a single centre experience. Europace 2023; 25:940-947. [PMID: 36638366 PMCID: PMC10062314 DOI: 10.1093/europace/euac281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023] Open
Abstract
AIMS There is little evidence of the impact of syncope in implantable cardioverter-defibrillator (ICD) patients in routine community hospital care. This single-centre retrospective study sought to evaluate the incidence and prognostic significance of syncope in consecutive ICD patients. METHODS AND RESULTS Data were collected on consecutive patients undergoing first ICD implantation between January 2009 and December 2019. The primary endpoints were the first occurrence of all-cause syncope, all-cause mortality, and all-cause hospitalization. Multivariate Cox proportional hazard models were used to identify risk factors associated with syncope and to analyse the subsequent risk of mortality and hospitalization. 1003 patients (58% primary prevention) were included in the final analysis. During a mean follow-up of 1519 ± 1055 days, 106 (10.6%) experienced syncope, 304 died (30.3%), and 477 (47.5%) were hospitalized for any cause. In an analysis adjusted for baseline variables, the first occurrence of syncope was associated with a significantly increased risk of mortality (HR 2.82, P < 0.001) and the first occurrence of hospitalization (HR 2.46, P = 0.002). CONCLUSION Syncope in ICD recipients is common and associated with a poor prognosis irrespective of baseline variables and ICD programming. The occurrence of syncope is associated with a significant increase in the risk of mortality and hospitalization.
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Affiliation(s)
- Parisha Khan
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Karshana Selvarajah
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Sheena Gohel
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Baldeep S Sidhu
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Antonio Cannatà
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
- School of Cardiovascular Medicine and Sciences, King’s College London, James Black Centre, London SE5 9NU, UK
| | - Daniel I Bromage
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
- School of Cardiovascular Medicine and Sciences, King’s College London, James Black Centre, London SE5 9NU, UK
| | - Theresa McDonagh
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
- School of Cardiovascular Medicine and Sciences, King’s College London, James Black Centre, London SE5 9NU, UK
| | - Francis Murgatroyd
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Paul A Scott
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
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Staples JA, Erdelyi S, Merchant K, Yip C, Khan M, Redelmeier DA, Chan H, Brubacher JR. Syncope and subsequent traffic crash: A responsibility analysis. PLoS One 2023; 18:e0279710. [PMID: 36656813 PMCID: PMC9851499 DOI: 10.1371/journal.pone.0279710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/12/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Physicians are often asked to counsel patients about driving safety after syncope, yet little empirical data guides such advice. METHODS We identified a population-based retrospective cohort of 9,507 individuals with a driver license who were discharged from any of six urban emergency departments (EDs) with a diagnosis of 'syncope and collapse'. We examined all police-reported crashes that involved a cohort member as a driver and occurred between 1 January 2010 and 31 December 2016. We categorized crash-involved drivers as 'responsible' or 'non-responsible' for their crash using detailed police-reported crash data and a validated responsibility scoring tool. We then used logistic regression to test the hypothesis that recent syncope was associated with driver responsibility for crash. RESULTS Over the 7-year study interval, cohort members were involved in 475 police-reported crashes: 210 drivers were deemed responsible and 133 drivers were deemed non-responsible for their crash; the 132 drivers deemed to have indeterminate responsibility were excluded from further analysis. An ED visit for syncope occurred in the three months leading up to crash in 11 crash-responsible drivers and in 5 crash-non-responsible drivers, suggesting that recent syncope was not associated with driver responsibility for crash (adjusted odds ratio, 1.31; 95%CI, 0.40-4.74; p = 0.67). However, all drivers with cardiac syncope were deemed responsible, precluding calculation of an odds ratio for this important subgroup. CONCLUSIONS Recent syncope was not significantly associated with driver responsibility for traffic crash. Clinicians and policymakers should consider these results when making fitness-to-drive recommendations after syncope.
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Affiliation(s)
- John A. Staples
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology & Evaluation, Vancouver, Canada
- * E-mail:
| | - Shannon Erdelyi
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Ketki Merchant
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Candace Yip
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Mayesha Khan
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Donald A. Redelmeier
- Sunnybrook Research Institute, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Herbert Chan
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Jeffrey R. Brubacher
- Centre for Clinical Epidemiology & Evaluation, Vancouver, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
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Matsumoto K, Kodama Y, Ito S, Nakamura Y, Fujiwara R, Kajio K, Kasamatsu K, Murata E, Nakamura Y, Kawase Y. Clinical predictors of cardiac syncope in patients with unexplained syncope after the implantation of an insertable cardiac monitor. Heart Vessels 2022; 38:731-739. [PMID: 36443457 DOI: 10.1007/s00380-022-02212-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
Syncope prognosis is related to both its etiology and comorbidities, with cardiac syncope (CS) having higher risks for mortality and cardiovascular events than syncope of non-cardiac causes. Although a novel insertable cardiac monitor (ICM) is an effective diagnostic tool for unexplained syncope, decision regarding ICM implantation with a high pre-test likelihood of CS should contribute to economic cost reduction and avoidance of unnecessary complications. This study aimed to investigate clinical factors associated with CS after ICM implantation in patients with unexplained syncope. This retrospective observational study included 31 consecutive patients with ICM implantation for syncope between September 2016 and August 2021. The initial examinations for syncope included a detailed history, physical examination, blood tests, 12-lead electrocardiograms, and transthoracic echocardiography. Of the 31 patients, 13 (41.9%) experienced recurrent CS during follow-up (676 ± 469 days). Among several clinical factors, syncope-related minor injuries (p = 0.017) and higher brain natriuretic peptide (BNP; p = 0.043) levels were significantly associated with CS. Moreover, multivariable analysis showed that both syncope-related minor injuries (odds ratio, 11.2; 95% confidence interval, 1.4-88.4; p = 0.022) and BNP higher than 64.0 pg/mL (odds ratio, 7.0; 95% confidence interval, 1.1-44.2; p = 0.038) were independent predictors of CS after ICM implantation. In conclusion, a history of minor injury secondary to syncope and higher BNP levels were independent CS predictors in patients receiving ICM for syncope. These results emphasized the utility of ICM implantation early in the diagnostic journey of patients presenting with CS predictors requiring specific treatments.
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Affiliation(s)
- Kenji Matsumoto
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan.
| | - Yuka Kodama
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Shinji Ito
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Yuka Nakamura
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Ryosuke Fujiwara
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Keiko Kajio
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Keiko Kasamatsu
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Eriko Murata
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Yasuhiro Nakamura
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Yoshio Kawase
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
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17
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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. Rev Esp Cardiol (Engl 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Moussa BS, Ali MA, Ali AAEN, Abou Zeid AELSM. Assessment of Canadian Syncope Risk Score in the prediction of outcomes of patients with syncope at the Emergency Department of Suez Canal University: STROBE compliant. Medicine (Baltimore) 2022; 101:e29287. [PMID: 35758358 PMCID: PMC9276233 DOI: 10.1097/md.0000000000029287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/25/2022] [Indexed: 12/04/2022] Open
Abstract
Syncope is a temporary loss of consciousness usually related to insufficient blood flow to the brain. It's also called fainting or "passing out." Syncope is responsible for 3% to 5% of emergency department visits, with a hospitalization rate in about 40% of cases, with an average stay of 5.5 days. The Canadian Syncope Risk Score showed good discrimination and calibration for 30-day risk of serious adverse events after disposition from the emergency department.The aim was to assess Canadian Syncope Risk Score in predicting outcomes and mortality at the emergency department of Suez Canal University Hospitals.A prospective observational cohort study was carried out in emergency department in Suez Canal University Hospital. After approval by the Ethical and Research Committee of Faculty of Medicine, Suez Canal University, 60 patients with syncope attending to emergency department were included to this study. All included participants were assessed by history taking and they also assessed by the Canadian Syncope Risk Score.The Canadian Syncope Risk Score's mean of the study group was 4.9 and the range of the scores was from -2 to 11. The mean of the percentage of risk of serious events at 30 days in the study group was 29.17% and it ranged from 0.7% to 83.6%.There was a statistically significant difference between means Canadian Syncope Risk Score's score regarding complication occurrence. Cases which showed complications had a mean score of 7.33 compared to a mean score of 1.25 in case of no complication occurrence P-value <.001. At a cut-off point of more than 3 for the Canadian Syncope Risk Score's, sensitivity of that score in complication's occurrence prediction was 100% and the specificity was 87.5% P-value <.001.The Canadian Syncope Risk Score's is strong predictor for risk of serious adverse events and a good indicator for admission, with 100% sensitivity and 87.5% specificity at cut off point more than 3.
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Affiliation(s)
- Bassant Sayed Moussa
- Emergency Medicine, Department Faculty of Medicine, Suez Canal University, Egypt
| | - Mohamed Amin Ali
- Lecturer of Emergency Medicine Department Faculty of Medicine, Suez Canal University
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Fitzpatrick N, Romero-Ortuno R. The Syncope-Falls Index: a tool for predicting risk of syncope and complex falls in the older adult based on cumulative health deficits. QJM 2022; 115:367-373. [PMID: 34014303 PMCID: PMC9172838 DOI: 10.1093/qjmed/hcab141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/04/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Syncope is aetiologically diverse and associated with adverse outcomes; in older people, there is clinical overlap with complex falls presentations (i.e. recurrent, unexplained and/or injurious). AIM To formulate an index to predict future risk of syncope and falls in the Irish longitudinal study on ageing (TILDA). DESIGN/METHODS Using the frailty index methodology, we selected, from TILDA Wave 1 (2010), 40 deficits that might increase risk of syncope and falls. This syncope-falls index (SYFI) was applied to TILDA Wave 1 participants aged 65 and over, who were divided into three risk groups (low, intermediate and high) based on SYFI tertiles. Multivariate logistic regression models were used to investigate, controlling for age and sex, how SYFI groups predicted incident syncope, complex falls and simple falls occurring up to Wave 4 of the study (2016). RESULTS At Wave 1, there were 3499 participants (mean age 73, 53% women). By Wave 4, of the remaining 2907 participants, 185 (6.4%) had reported new syncope, 1077 (37.0%) complex falls and 218 (7.5%) simple falls. The risk of both syncope and complex falls increased along the SYFI groups (high risk group: odds ratio 1.88 [1.26-2.80], P = 0.002 for syncope; 2.22 [1.82-2.72], P < 0.001 for complex falls). No significant relationship was identified between SYFI and simple falls. CONCLUSION The 6-year incidences of falls and syncope were high in this cohort. SYFI could help identify older adults at risk of syncope and complex falls, and thus facilitate early referral to specialist clinics to improve outcomes.
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Affiliation(s)
- N Fitzpatrick
- Address correspondence to Dr N. Fitzpatrick, MedEL Directorate, St. James’s Hospital, James St, Dublin 8, Ireland.
| | - R Romero-Ortuno
- From the MedEL Directorate, St. James’s Hospital, James St, Dublin 8, D08 NHY1, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, College Green, Dublin 2, D02 PN40, Ireland
- Global Brain Health Institute, Trinity College Dublin, College Green, Dublin, D02 PN40, Ireland
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Probst MA, Janke AT, Haimovich AD, Venkatesh AK, Lin MP, Kocher KE, Nemnom MJ, Thiruganasambandamoorthy V. Development of a Novel Emergency Department Quality Measure to Reduce Very Low-Risk Syncope Hospitalizations. Ann Emerg Med 2022; 79:509-517. [PMID: 35487840 PMCID: PMC9117517 DOI: 10.1016/j.annemergmed.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE Emergency department (ED) evaluations for syncope are common, representing 1.3 million annual US visits and $2 billion in related hospitalizations. Despite evidence supporting risk stratification and outpatient management, variation in syncope hospitalization rates persist. We sought to develop a new quality measure for very low-risk adult ED patients with syncope that could be applied to administrative data. METHODS We developed this quality measure in 2 phases. First, we used an existing prospective, observational ED patient data set to identify a very low-risk cohort with unexplained syncope using 2 variables: age less than 50 years and no history of heart disease. We then applied this to the 2019 Nationwide Emergency Department Sample (NEDS) to assess its potential effect, assessing for hospital-level factors associated with hospitalization variation. RESULTS Of the 8,647 adult patients in the prospective cohort, 3,292 (38%) patients fulfilled these 2 criteria: age less than 50 years and no history of heart disease. Of these, 15 (0.46%) suffered serious adverse events within 30 days. In the NEDS, there were an estimated 566,031 patients meeting these 2 criteria, of whom 15,507 (2.7%; 95% confidence interval [CI] 2.48% to 3.00%) were hospitalized. We found substantial variation in the hospitalization rates for this very low-risk cohort, with a median rate of 1.7% (range 0% to 100%; interquartile range 0% to 3.9%). Factors associated with increased hospitalization rates included a yearly ED volume of more than 80,000 (odds ratio [OR] 3.14; 95% CI 2.02 to 4.89) and metropolitan teaching status (OR 1.5; 95% CI 1.24 to 1.81). CONCLUSION In summary, our novel syncope quality measure can assess variation in low-value hospitalizations for unexplained syncope. The application of this measure could improve the value of syncope care.
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Affiliation(s)
- Marc A Probst
- Department of Emergency Medicine, Columbia University Medical Center, New York, NY.
| | - Alexander T Janke
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Adrian D Haimovich
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Michelle P Lin
- Department of Emergency Medicine and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Keith E Kocher
- Department of Emergency Medicine and Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Marie-Joe Nemnom
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Wu REY, Khan FM, Hockin BCD, Lobban TCA, Sanatani S, Claydon VE. Faintly tired: a systematic review of fatigue in patients with orthostatic syncope. Clin Auton Res 2022; 32:185-203. [PMID: 35689118 PMCID: PMC9186485 DOI: 10.1007/s10286-022-00868-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/11/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Orthostatic syncope (transient loss of conscious when standing-fainting) is common and negatively impacts quality of life. Many patients with syncope report experiencing fatigue, sometimes with "brain fog", which may further impact their quality of life, but the incidence and severity of fatigue in patients with syncope remain unclear. In this systematic review, we report evidence on the associations between fatigue and conditions of orthostatic syncope. METHODS We performed a comprehensive literature search of four academic databases to identify articles that evaluated the association between orthostatic syncope [postural orthostatic tachycardia syndrome (POTS), vasovagal syncope (VVS), orthostatic hypotension (OH)] and fatigue. Studies were independently screened using a multi-stage approach by two researchers to maintain consistency and limit bias. RESULTS Our initial search identified 2797 articles, of which 13 met our inclusion criteria (POTS n = 10; VVS n = 1; OH n = 1; VVS and POTS n = 1). Fatigue scores were significantly higher in patients with orthostatic syncope than healthy controls, and were particularly severe in those with POTS. Fatigue associated with orthostatic syncope disorders spanned multiple domains, with each dimension contributing equally to increased fatigue. "Brain fog" was an important symptom of POTS, negatively affecting productivity and cognition. Finally, fatigue was negatively associated with mental health in patients with POTS. CONCLUSION In conditions of orthostatic syncope, fatigue is prevalent and debilitating, especially in patients with POTS. The consideration of fatigue in patients with orthostatic disorders is essential to improve diagnosis and management of symptoms, thus improving quality of life for affected individuals.
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Affiliation(s)
- Ryan E Y Wu
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Farhaan M Khan
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Brooke C D Hockin
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Trudie C A Lobban
- Syncope Trust and Reflex Anoxic Seizures Group (STARS) and Arrhythmia Alliance, Stratford-upon-Avon, Warwickshire, UK
| | - Shubhayan Sanatani
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Victoria E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
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22
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Numeroso F, Mossini G, Grieco I, Bergamin M, Maggio M, Lippi G, Cervellin G. Incidence and predictive factors of acute diseases in patients with syncope: the ESCAPE study. Intern Emerg Med 2022; 17:215-221. [PMID: 33735415 PMCID: PMC7971406 DOI: 10.1007/s11739-021-02678-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/15/2021] [Indexed: 11/01/2022]
Abstract
According to the 2018 ESC guidelines, emergency physicians shall primarily aim to identify syncopal episodes associated with an underlying acute principal disease. Therefore, in this study, we aimed to assess the incidence of syncope associated with acute principal diseases (APDs) and to identify predictive factors reflecting the presence of these underlying conditions. We retrospectively evaluated all patients presenting with syncope during a 6-month period to the local emergency department, collecting incidence of syncopal cases associated with APDs, personal information, clinical features, and laboratory abnormalities, which were compared between syncopal patients with or without APDs. A syncope-associated APD could be diagnosed in 346/1279 patients (27.1%). In the majority of cases, the cause was a non-cardiovascular acute condition (67%), mostly non-life-threatening such as infectious diseases (34.4%) and acute diseases with pain, fluid loss or hypotension (23.7%). Severe acute cardiovascular conditions were less frequent (4.2%). Cardiogenic syncope, no previous history of syncopal episodes, not full agreement with typical clinical features of syncope, alterations of vital parameters, and laboratory abnormalities were also found to be independently associated with syncope-associated APDs. Syncope may be frequently associated with APDs of varying severity, though mostly non-clinically threatening, thus confirming that this condition shall be considered a symptom and not a disease. Emergency physicians should hence be first engaged in troubleshooting an underlying pathology when facing patients with syncope, for timely identifying patients at higher risk of short-term adverse events and reducing inappropriate admissions and diagnostic investigations, especially in the presence of hypotensive syncope elicited by non-severe concurrent conditions.
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Affiliation(s)
- Filippo Numeroso
- Emergency Department, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy.
| | - Gianluigi Mossini
- Emergency Department, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Ilaria Grieco
- Postgraduate School of Gerontology, University of Parma, Via Università 12, 43121, Parma, Italy
| | - Marina Bergamin
- Postgraduate School of Gerontology, University of Parma, Via Università 12, 43121, Parma, Italy
| | - Marcello Maggio
- Emergency Department, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Gianfranco Cervellin
- Academy of Emergency Medicine and Care (AcEMC), Via Maugeri 10, 27100, Pavia, Italy
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Abstract
Aims Methods and results Conclusion
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Affiliation(s)
| | | | - Viktor Hamrefors
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Andrea Ungar
- Syncope Unit, Division of Geriatrics and Intensive Care Unit, University of Florence and Careggi Hospital, Florence, Italy
| | - 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 & Fall Programme, 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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24
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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. Int J Environ Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Russo V, Boggian G, Bolognesi MG, Carretta DM, Cencetti S, De Laura D, Hrovatin E, Pastori P, Tomaselli C, Parente E, Rafanelli M, Ungar A. The Impact of COVID-19 Outbreak on Syncope Units Activities in Italy: A Report from the Italian Multidisciplinary Working Group on Syncope (GIMSI). Int J Environ Res Public Health 2021; 18:9194. [PMID: 34501793 PMCID: PMC8431220 DOI: 10.3390/ijerph18179194] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 12/23/2022]
Abstract
The aim of our study was to evaluate the impact of the COVID-19 outbreak on Syncope Units (SUs) Activities in Italy. Methods: Data about types of SU activities and admissions were obtained from 10 SUs throughout Italy, certified by the Italian Multidisciplinary Working Group on Syncope (GIMSI), from 10 March 2020 to 31 December 2020 and compared with the same time frame in 2019. Results: A remarkable reduction in overall non-invasive diagnostic tests (-67%; p < 0.001) and cardiac invasive procedure. Elective cardiac pacing procedures disclosed a significant decrease (-62.7%; p < 0.001); conversely, the decrease of urgent procedures was not significant (-50%; p = 0.08). There was a significantly increased rate of patients who underwent both telemedicine follow-up visits (+225%, p < 0.001) and cardiac implantable electronic devices (CIEDs) remote monitoring follow-up visits (+100%; p < 0.001). Conclusion: The COVID-19 outbreak was associated with a remarkable decrease in all clinical activities of Syncope Units in Italy, including both non-invasive tests and cardiac invasive procedures; conversely, a significant increase in telehealth activities was shown.
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Affiliation(s)
- Vincenzo Russo
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, 80131 Naples, Italy;
| | - Giulio Boggian
- Internal Medicine and Syncope Unit, Bentivoglio Hospital, Health Authority Bologna, 40053 Bologna, Italy;
| | | | | | - Simone Cencetti
- Internal Medicine and Syncope Unit, Piero Palagi Hospital, Health Authority Toscana Centro, 50122 Firenze, Italy;
| | | | - Enzo Hrovatin
- Cardiology and Syncope Unit, Monfalcone Hospital, Health Authority Giuliano Isontina (GO), 34074 Monfalcone, Italy;
| | - Paolo Pastori
- Cardiology and Syncope Unit, Fidenza Hospital, Health Authority Parma, 43036 Fidenza, Italy;
| | | | - Erika Parente
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, 80131 Naples, Italy;
| | - Martina Rafanelli
- Geriatrics and Intensive Care Unit, Hypertension Centre—Syncope Unit University of Florence and Careggi Hospital, 50134 Florence, Italy; (M.R.); (A.U.)
| | - Andrea Ungar
- Geriatrics and Intensive Care Unit, Hypertension Centre—Syncope Unit University of Florence and Careggi Hospital, 50134 Florence, Italy; (M.R.); (A.U.)
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MacFarlane A, Phillips C, Oki O, Harvey A, Nabavi N. Swooning, stereotypes, and observing a birth-the Sharp Scratch roundup. BMJ 2021; 374:n1612. [PMID: 34353816 DOI: 10.1136/bmj.n1612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Muhtaseb O, Alpert EA, Grossman SA. A Tale of Two Cities: Applying the Boston Syncope Criteria to Jerusalem. Isr Med Assoc J 2021; 23:420-425. [PMID: 34251124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Syncope is a common reason for emergency department (ED) visits; however, the decision to admit or discharge patients after a syncopal episode remains challenging for emergency physicians. Decision rules such as the Boston Syncope Criteria have been developed in an attempt to aid clinicians in identifying high-risk patients as well as those who can be safely discharged, but applying these rules to different populations remains unclear. OBJECTIVES To determine whether the Boston Syncope Criteria are valid for emergency department patients in Israel. METHODS This retrospective cohort convenience sample included patients who visited a tertiary care hospital in Jerusalem from August 2018 to July 2019 with a primary diagnosis of syncope. Thirty-day follow-up was performed using a national health system database. The Boston Syncope Criteria were retrospectively applied to each patient to determine whether they were at high risk for an adverse outcome or critical intervention, versus low risk and could be discharged. RESULTS A total of 198 patients fulfilled the inclusion criteria and completed follow-up. Of these, 21 patients had either an adverse outcome or critical intervention. The rule detected 20/21 with a sensitivity of 95%, a specificity of 66%, and a negative predictive value of 99. CONCLUSIONS The Boston Syncope Criteria may be useful for physicians in other locations throughout the world to discharge low-risk syncope patients as well as identify those at risk of complications.
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Affiliation(s)
- Osama Muhtaseb
- Department of Emergency Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Evan Avraham Alpert
- Department of Emergency Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Shamai A Grossman
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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de Queiros VS, Dantas M, Neto GR, da Silva LF, Assis MG, Almeida-Neto PF, Dantas PMS, Cabral BGDAT. Application and side effects of blood flow restriction technique: A cross-sectional questionnaire survey of professionals. Medicine (Baltimore) 2021; 100:e25794. [PMID: 33950976 PMCID: PMC8104249 DOI: 10.1097/md.0000000000025794] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 04/15/2021] [Indexed: 01/04/2023] Open
Abstract
The physiological benefits of applying blood flow restriction (BFR) in isolation or in the presence of physical exercise have been widely documented in the scientific literature. Most investigations carried out under controlled laboratory conditions have found the technique to be safe. However, few studies have analyzed the use of the technique in clinical settings.To analyze how the BFR technique has been applied by professionals working in the clinical area and the prevalence of side effects (SEs) resulting from the use of this technique.This is a cross-sectional study. A total of 136 Brazilian professionals who perform some function related to physical rehabilitation, sports science, or physical conditioning participated in this study. Participants answered a self-administered online questionnaire consisting of 21 questions related to the professional profile and methodological aspects and SEs of the BFR technique.Professionals reported applying the BFR technique on individuals from different age groups from youth (≤18 years; 3.5%) to older adults (60-80 years; 30.7%), but mainly on people within the age group of 20 to 29 years (74.6%). A total of 99.1% of the professionals coupled the BFR technique with resistance exercise. Their main goals were muscle hypertrophy and physical rehabilitation. The majority (60.9%) of interviewees reported using BFR in durations of less than 5 minutes and the pressure used was mainly determined through the values of brachial blood pressure and arterial occlusion. Moreover, 92% of professionals declared observing at least 1 SE resulting from the BFR technique. Most professionals observed tingling (71.2%) and delayed onset of muscle soreness (55.8%). Rhabdomyolysis, fainting, and subcutaneous hemorrhaging were reported less frequently (1.9%, 3.8%, and 4.8%, respectively).Our findings indicate that the prescription of blood flow restriction technique results in minimal serious side effects when it is done in a proper clinical environment and follows the proposed recommendations found in relevant scientific literature.
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Affiliation(s)
- Victor Sabino de Queiros
- Master of Science in Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte
| | - Matheus Dantas
- Master of Science in Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte
| | - Gabriel Rodrigues Neto
- Professional Master's in Family Health/Physical Education Coordination/Physiotherapy Coordination, Faculties of Nursing and Medicine Nova Esperança (FACENE/FAMENE), João Pessoa
| | - Luiz Felipe da Silva
- Master of Science in Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte
| | - Marina Gonçalves Assis
- Bachelor of Science in Physical Education, Unifacisa University Center (UNIFACISA), Campina Grande, Paraíba, Brazil
| | - Paulo Francisco Almeida-Neto
- Master of Science in Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte
| | - Paulo Moreira Silva Dantas
- Master of Science in Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte
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Krishna MR. Increased Screen Time — A Pandemic Era Trigger for Neuro-Cardiogenic Syncope. Indian Pediatr 2021. [PMID: 33883318 PMCID: PMC8079849 DOI: 10.1007/s13312-021-2205-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Mani Ram Krishna
- Dr RK Hospital for Women and Children, Thanjavur, Tamil Nadu, India.
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Abstract
IMPORTANCE Reflex syncope is the major cause of transient loss of consciousness, which affects one-third of the population, but effective treatment for individuals with severe syncope is lacking. Better understanding of reflex syncope predisposition may offer new therapeutic solutions. OBJECTIVES To determine the familial risk of syncope in first-, second-, and third-degree relatives of affected individuals and to explore the role of genes and family environment in reflex syncope. DESIGN, SETTING, AND PARTICIPANTS In this national population-based family cohort study, the Swedish multigeneration register was linked to 3 Swedish nationwide registers: hospital discharge, outpatient care, and primary care registers for the period from 1997 to 2015. Sibling pairs born to Swedish parents between 1948 and 2005 were included. Linkage was also made to half-siblings and cousins. Data analysis was performed from June to October 2020. EXPOSURES Register-based syncope diagnosis among relatives: pairs of twins, siblings, half-siblings, and cousins. MAIN OUTCOMES AND MEASURES Odds ratios for syncope were calculated for relatives (twins, siblings, half-siblings, and cousins) of individuals who had syncope compared with relatives of individuals without syncope for reference. Sensitivity analysis excluding families with definite nonreflex syncope diagnosis was performed. RESULTS Among the study population of 2 694 442 participants, 1 381 453 (51.3%) were male, and the median (interquartile range) age was 32 (22-43) years. The study population consisted of 24 020 twins, 1 546 108 siblings, 264 244 half-siblings, and 1 044 546 cousins. In total, 61 861 (2.30%) unique individuals were diagnosed with syncope. Sixty-two percent (38 226) of the syncope-positive individuals were female. The odds ratio (OR) for syncope was 2.39 (95% CI, 1.61-3.53) for twins, 1.81 (95% CI, 1.71-1.91) for siblings, 1.28 (95% CI, 1.20-1.37) for half-siblings, and 1.13 (95% CI, 1.10-1.17) for cousins of individuals with syncope. The OR was highest among male twins at 5.03 (95% CI, 2.57-9.85). The proportion of syncope-positive individuals was consistently higher in women vs men, regardless of degree of relationship (twins: 346 [2.88%] vs 193 [1.61%]; siblings: 22 111 [2.92%] vs 13 419 [1.70%], half-siblings: 4148 [3.44%] vs 2425 [1.93%], cousins: 14 498 [2.87%] vs 9246 [1.72%]). Exclusion of nonreflex syncope diagnoses did not change syncope risk in affected families. CONCLUSIONS AND RELEVANCE In this Swedish national population-based study, the risk of syncope among relatives of affected individuals was associated with the relationship degree and was strongest in twins and siblings, which suggests that there are genetic components of reflex syncope. Women were more likely to experience syncope independently of family relationship. A better understanding of genetic predisposition to reflex syncope may offer new therapeutic options in severely affected individuals.
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Affiliation(s)
- Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Mirnabi Pirouzifard
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California
| | - Richard Sutton
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
- National Heart and Lung Institute, Imperial College, Department of Cardiology, London, United Kingdom
| | - Bengt Zöller
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
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Francisco-Pascual J, Rivas-Gándara N, Santos-Ortega A, Pérez-Rodón J, Benito B, Belahnech Y, Ferreira-González I. [Cardiac biometric variables and arrhythmic events during COVID-19 pandemic lockdown in patients with an implantable cardiac monitor for syncope work-up]. Med Clin (Barc) 2021; 156:496-499. [PMID: 33642036 DOI: 10.1016/j.medcli.2020.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 12/25/2022]
Abstract
AIM To assess the changes induced by the COVID-19 lockdown on cardiac biometric variables recorded using an implantable cardiac monitor (ICM) in a patient population monitored for syncope work-up, as well to assess whether there has been an effect on arrhythmic events among the patients. METHODS Longitudinal cohort study. We included 245 adult patients monitored with an ICM indicated for the investigation of syncope. The records from days 1 to 12 March 2020 (prior to the institution of lockdown by the state government) with days 16 to 28 March 2020 were compared. RESULTS Daily physical exercise reduced markedly after the imposition of lockdown (132 [55-233] minutes vs. 78 [21-154] minutes). The mean daytime HR prior to lockdown was 77 [69-85] bpm, whereas during lockdown it was 74 [66-81] bpm. During the lockdown period, a drop in the variability in heart rate (114 [94-136] ms vs. 111 [92-133] ms) was observed. Although the incidence of AF was similar over both periods, the daily AF burden was significantly higher post-lockdown (405 [391-425] minutes vs. 423 [423-537] minutes). No differences in the number of other arrhythmias were found. CONCLUSIONS The establishment of mandatory lockdown has led to a marked drop in daily physical activity in this population which probably explains changes observed in other cardiac biometric variables. Although, in the short term, we have not documented an increased risk of arrhythmia, we cannot rule out an effect in the medium to long term or in other populations of at-risk patients.
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Affiliation(s)
- Jaume Francisco-Pascual
- Unitat d'Arritmies. Servei de Cardiologia. Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, CIBER-CV, Spain.
| | - Núria Rivas-Gándara
- Unitat d'Arritmies. Servei de Cardiologia. Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, CIBER-CV, Spain.
| | - Alba Santos-Ortega
- Unitat d'Arritmies. Servei de Cardiologia. Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, CIBER-CV, Spain
| | - Jordi Pérez-Rodón
- Unitat d'Arritmies. Servei de Cardiologia. Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, CIBER-CV, Spain
| | - Begoña Benito
- Unitat d'Arritmies. Servei de Cardiologia. Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, CIBER-CV, Spain
| | - Yassin Belahnech
- Unitat d'Arritmies. Servei de Cardiologia. Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, CIBER-CV, Spain
| | - Ignacio Ferreira-González
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron. Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, CIBER-ESP, Spain
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Mohanty S, Kumar CPR, Kaku SM. Clinico-Etiological Profile of Pediatric Syncope: A Single Center Experience. Indian Pediatr 2021; 58:134-137. [PMID: 33632942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To describe the clinical profile of children with syncope. METHODS Hospital records were reviewed for clinical and laboratory details of children presenting with real or apparent syncope. Five diagnostic categories were identified: neurocardiogenic syncope (NCS), psychogenic pseudosyncope (PPS), cardiac, neurological and indeterminate. RESULTS 30 children (aged 4 to 17 years)were included. The commonest cause of syncope was NCS (63.3%), followed by PPS (13.3%), cardiac (10%), neurological (10%) and indeterminate (3.3%). Exercise, loud noise or emotional triggers and family history were associated with cardiac etiology, and electrocardiogram (ECG) was diagnostic in the majority. Children with PPS and cardiacsyncope had frequent episodes when compared with other groups. Indiscriminate antiepileptic use was found in 5 children, including two cardiac cases. CONCLUSIONS Frequent recurrences of syncope may suggest PPS or cardiac cause. Cardiac etiology may be readily identified on history and ECG alone.
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Affiliation(s)
- Sweta Mohanty
- Department of Pediatric Cardiology, Aster CMI Hospital, Bengaluru, Karnataka, India. Correspondence to: Dr Sweta Mohanty, Valmark Apas, Bangalore 560 076, Karnataka, India.
| | - C P Ravi Kumar
- Department of Neurology, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - Sowmyashree Mayur Kaku
- Department of Clinical Neurosciences and Child and Adolescent Psychiatry, Aster CMI Hospital, Bengaluru, Karnataka, India
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Kadri AN, Zawit M, Al-Adham R, Hader I, Nusairat L, Almahmoud MF, Senussi M, Altibi A, Barakat A, Hernandez AV, Masri A. Prevalence of venous thromboembolism in admissions and readmissions with and without syncope: a nationwide cohort study. Eur Heart J Qual Care Clin Outcomes 2021; 7:52-58. [PMID: 31562526 PMCID: PMC8785949 DOI: 10.1093/ehjqcco/qcz051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/28/2019] [Accepted: 09/12/2019] [Indexed: 06/10/2023]
Abstract
AIMS The Pulmonary Embolism in Syncope Italian Trial reported 17.3% prevalence of pulmonary embolism (PE) in patients admitted with syncope. We investigated the prevalence of venous thromboembolism [VTE, including PE and deep vein thrombosis (DVT)] in syncope vs. non-syncope admissions and readmissions, and if syncope is an independent predictor of VTE. METHODS AND RESULTS We conducted an observational study of index admissions of the 2013-14 Nationwide Readmission Database. We excluded patients <18 years, December discharges, died during hospitalization, hospital transfers, and missing length of stay. Encounters were stratified by the presence or absence of DVT/PE and syncope diagnoses. Multivariable logistic regression analysis was used to evaluate the association between syncope and VTE. There were 38 655 570 admissions, of whom 285 511 had syncope. In the overall cohort, syncope occurred in 1.6% of VTE and 1.8% in non-VTE admissions. In a multivariable model, syncope was associated with a lower prevalence of VTE [odds ratio (OR) 0.76, 95% confidence interval (CI) 0.75-0.78; P < 0.001]. In index syncope vs. non-syncope admissions, the prevalence of DVT, PE, and VTE were 0.4 ± 0.06% vs. 1.3 ± 0.12%, 0.2 ± 0.04% vs. 1.2 ± 0.11%, and 0.5 ± 0.07% vs. 2.1 ± 0.14% (all P < 0.001), respectively. At 30 days, the prevalence of DVT, PE, and VTE in syncope vs. non-syncope were 2.2 ± 0.14% vs. 2.1 ± 0.14% (P = 0.38), 1.4 ± 0.12% vs. 1.2 ± 0.11% (P = 0.01), and 2.6 ± 0.17% vs. 3.0 ± 0.17% (P = 0.99), respectively. CONCLUSION Syncope admissions were associated with a lower prevalence of VTE as compared to non-syncope admissions. Syncope should not trigger an automatic PE workup, rather, should be put into context of patient presentation.
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Affiliation(s)
- Amer N Kadri
- Department of Cardiology, Beaumont Health System, Troy, MI, USA
| | - Misam Zawit
- Department of Medicine, Ohio Heritage College of Osteopathic Medicine, Portsmouth, OH, USA
| | - Raed Al-Adham
- Department of Medicine, University of Arizona, Phoenix, AZ, USA
| | - Ismail Hader
- Department of Medicine, Beaumont Health System, Troy, MI, USA
| | - Leen Nusairat
- Department of Medicine, Beaumont Health System, Troy, MI, USA
| | - Mohamed F Almahmoud
- Department of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Mourad Senussi
- Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ahmed Altibi
- Department of Medicine, Henry Ford Health System, Jackson, MI, USA
| | - Amr Barakat
- Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adrian V Hernandez
- University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford, CT, USA
- School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru
| | - Ahmad Masri
- Corresponding author. Tel: +1 503 494 8582, Fax: +1 503 346 8463,
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Javalkar V, Amireh A, Kelley RE. Neurological complications of syncope and sudden cardiac arrest. Handb Clin Neurol 2021; 177:189-192. [PMID: 33632438 DOI: 10.1016/b978-0-12-819814-8.00025-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Syncope is very common and usually comes with enough warning for the person to assume a safer position rather than fall in a potentially dangerous way. Syncope may be associated with pregnancy, for example, but we rarely encounter significant injury related to the potential for an associated fall. In the elderly, however, there are often comorbid factors such as delayed reaction time and other aspects of cognitive impairment, along with gait instability, that can affect the defensive reflexes to the point that brain injury, including subdural or epidural hematoma, is not uncommonly encountered. Sudden syncope without warning can also have both neurological and general physical implications in terms of driving safety, safety operating potentially dangerous equipment or exposure to heights as well as the potential impact for drowning or near-drowning while swimming or taking a bath. Sudden death, from whatever the mechanism, implies cerebral hypoperfusion with the potential consequences of hypoxic-ischemic brain injury.
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Affiliation(s)
- Vijayakumar Javalkar
- Department of Neurology, Ochsner/Louisiana State University Health Sciences Center, Shreveport, LA, United States
| | - Abdallah Amireh
- Department of Neurology, Ochsner/Louisiana State University Health Sciences Center, Shreveport, LA, United States
| | - Roger E Kelley
- Department of Neurology, Ochsner/Louisiana State University Health Sciences Center, Shreveport, LA, United States.
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Abstract
IMPORTANCE Conflicting evidence exists on the association between azithromycin use and cardiac events. OBJECTIVE To compare the odds of cardiac events among new users of azithromycin relative to new users of amoxicillin using real-world data. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from Truven Health Analytics MarketScan database from January 1, 2009, to June 30, 2015. Patients receiving either amoxicillin or azithromycin and enrolled in a health care plan 365 days before (baseline period) the dispensing date (index date) were included in the study. Patients were matched 1:1 on high-dimensional propensity scores. Data were analyzed from October 1, 2018, to December 31, 2019. EXPOSURES New use of azithromycin compared with new use of amoxicillin. MAIN OUTCOMES AND MEASURES The primary outcome consisted of cardiac events, including syncope, palpitations, ventricular arrhythmias, cardiac arrest, or death as a primary diagnosis for hospitalization at 5, 10, and 30 days from the index date. Logistic regression models were used to estimate odds ratios (ORs) with 95% CIs. RESULTS After matching, the final cohort included 2 141 285 episodes of each index therapy (N = 4 282 570) (mean [SD] age of patients, 35.7 [22.3] years; 52.6% female). Within 5 days after therapy initiation, 1474 cardiac events (0.03%) occurred (708 in the amoxicillin cohort and 766 in the azithromycin cohort). The 2 most frequent events were syncope (1032 [70.0%]) and palpitations (331 [22.5%]). The odds of cardiac events with azithromycin compared with amoxicillin were not significantly higher at 5 days (OR, 1.08; 95% CI, 0.98-1.20), 10 days (OR, 1.05; 95% CI, 0.97-1.15), and 30 days (OR, 0.98; 95% CI, 0.92-1.04). Among patients receiving any concurrent QT-prolonging drug, the odds of cardiac events with azithromycin were 1.40 (95% CI, 1.04-1.87) greater compared with amoxicillin. Among patients 65 years or older and those with a history of cardiovascular disease and other risk factors, no increased risk of cardiac events with azithromycin was noted. CONCLUSIONS AND RELEVANCE This study found no association of cardiac events with azithromycin compared with amoxicillin except among patients using other QT-prolonging drugs concurrently. Although azithromycin is a safe therapy, clinicians should carefully consider its use among patients concurrently using other QT-prolonging drugs.
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Affiliation(s)
- Haridarshan Patel
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago
| | - Gregory S. Calip
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago
- Flatiron Health, Inc, New York, New York
| | - Robert J. DiDomenico
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago
| | - Glen T. Schumock
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago
| | - Katie J. Suda
- Center for Health Equity Research and Promotions, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Medicine, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Todd A. Lee
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago
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Ro R, Khera S, Tang GHL, Krishnamoorthy P, Sharma SK, Kini A, Lerakis S. Characteristics and Outcomes of Patients Deferred for Transcatheter Aortic Valve Replacement Because of COVID-19. JAMA Netw Open 2020; 3:e2019801. [PMID: 32997121 PMCID: PMC7527872 DOI: 10.1001/jamanetworkopen.2020.19801] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cohort study examines the characteristics and outcomes of patients for whom transcatheter aortic valve replacement (TAVR) was deferred because of the coronavirus disease 2019 (COVID-19) pandemic.
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Affiliation(s)
- Richard Ro
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
| | - Sahil Khera
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
| | - Gilbert H. L. Tang
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
| | - Parasuram Krishnamoorthy
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
| | - Samin K. Sharma
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
| | - Annapoorna Kini
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
| | - Stamatios Lerakis
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
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Gungabissoon U, Perera G, Galwey NW, Stewart R. The association between dementia severity and hospitalisation profile in a newly assessed clinical cohort: the South London and Maudsley case register. BMJ Open 2020; 10:e035779. [PMID: 32284392 PMCID: PMC7200045 DOI: 10.1136/bmjopen-2019-035779] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/07/2020] [Accepted: 03/20/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate the risk and common causes of hospitalisation in patients with newly diagnosed dementia and variation by severity of cognitive impairment. SETTING We used data from a large London mental healthcare case register linked to a national hospitalisation database. PARTICIPANTS Individuals aged ≥65 years with newly diagnosed dementia with recorded cognitive function and the catchment population within the same geography. OUTCOME MEASURES We evaluated the risk and duration of hospitalisation in the year following a dementia diagnosis. In addition we identified the most common causes of hospitalisation and calculated age-standardised and gender-standardised admission ratios by dementia severity (mild/moderate/severe) relative to the catchment population. RESULTS Of the 5218 patients with dementia, 2596 (49.8%) were hospitalised in the year following diagnosis. The proportion of individuals with mild, moderate and severe dementia who had a hospital admission was 47.9%, 50.8% and 51.7%, respectively (p= 0.097). Duration of hospital stay increased with dementia severity (median 2 days in mild to 4 days in severe dementia, p 0.0001). After excluding readmissions for the same cause, the most common primary hospitalisation discharge diagnoses among patients with dementia were urinary system disorders, pneumonia and fracture of femur, accounting for 15%, 10% and 6% of admissions, respectively. Overall, patients with dementia were hospitalised 30% more than the catchment population, and this trend was observed for most of the discharge diagnoses evaluated. Standardised admission ratios for urinary and respiratory disorders were higher in those with more severe dementia at diagnosis. CONCLUSIONS Individuals with a dementia diagnosis were more likely to be hospitalised than individuals in the catchment population. The length of hospital stay increased with dementia severity. Most of the common causes of hospitalisation were more common than expected relative to the catchment population, but standardised admission ratios only varied by dementia stage for certain groups of conditions.
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Affiliation(s)
- Usha Gungabissoon
- Epidemiology (Value Evidence and Outcomes), GSK, Brentford, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Gayan Perera
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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Abstract
BACKGROUND: The aim of this study was to evaluate the use of ground-based medical services (GBMS) by the cabin crew of a major South Korean airline for in-flight medical incidents involving passengers.METHODS: We conducted a survey of cabin crew to identify the anticipated use of GBMS in 2017. We compared the anticipated use to actual use as reported in cabin crew records submitted to the GBMS team and cabin crew logs from May 2013 to April 2016.RESULTS: Among 766 team leaders and assistant leaders, 211 individuals answered the questionnaire. A total of 915 instances of GBMS use were reported during the study period. There were no significant differences between anticipated and actual use in terms of the reasons for needing GBMS, with medication prescription being the most common reason. However, there were significant differences in the specific symptoms that triggered contact with GBMS. Pediatric and digestive symptoms were under-predicted, while neuropsychiatric and cardiac symptoms were over-predicted.DISCUSSION: Cabin crew tended to require GBMS to assist with pediatric and digestive conditions more often than anticipated. Furthermore, digestive and pediatric symptoms often require prescription medications.Kim JH, Choi-Kwon S. Ground-based medical services for in-flight emergencies. Aerosp Med Hum Perform. 2020; 91(4):348-351.
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Angelini P. In Syncope or Sudden Death from Coronary Artery Anomalies, Hypotension and Bradycardia are More Frequent than Ventricular Fibrillation. Tex Heart Inst J 2020; 47:168-169. [PMID: 32603462 PMCID: PMC7328092 DOI: 10.14503/thij-19-7105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Paolo Angelini
- Department of Cardiology, Texas Heart Institute, Houston, Texas 77030
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Hernandez-Ojeda J, Arbelo E, Jorda P, Borras R, Campuzano O, Sarquella-Brugada G, Iglesias A, Mont L, Brugada R, Brugada J. The role of clinical assessment and electrophysiology study in Brugada syndrome patients with syncope. Am Heart J 2020; 220:213-223. [PMID: 31864099 DOI: 10.1016/j.ahj.2019.10.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/12/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cardiogenic syncope in Brugada syndrome (BrS) increases the risk of major events. Nevertheless, clinical differentiation between cardiogenic and vasovagal syncope can be challenging. We characterized the long-term incidence of major events in a large cohort of BrS patients who presented with syncope. METHODS From a total of 474 patients, syncope was the initial manifestation in 135 (28.5%) individuals (43.9 ± 13.9 years, 71.1% male). The syncope was classified prospectively as cardiogenic, vasovagal, or undefined if unclear characteristics were present. Clinical, electrocardiographic, genetic, and electrophysiologic features were analyzed. Cardiogenic syncope, sustained ventricular arrhythmias, and sudden death were considered major events in follow-up. RESULTS In 66 patients (48.9%), the syncope was cardiogenic; in 51 (37.8%), vasovagal and in 18 (13.3%); undefined. The electrophysiology study (EPS) inducibility was more frequent in patients with cardiogenic syncope and absent in all patients with undefined syncope (28 [53.8%] vs 5 [12.2%] vs 0 [0%]; P < .01). During follow-up (7.7 ± 5.6 years), only patients with cardiogenic syncope presented major events (16 [11.9%]). Among patients with inducible EPS, 7 (21.2%) presented major events (P = .04). The negative predictive value of the EPS for major events was 92.4%. The incidence rate of major events was 2.6% person-year. Parameters associated with major events included cardiogenic syncope (hazard ratio [HR] 6.3; 95% CI 1.1-10.4; P = .05), spontaneous type 1 electrocardiogram (HR 3.7; 95% CI 1.3-10.5; P = .01), and inducible EPS (HR 2.8; 95% CI 1.1-8.8; P = .05). CONCLUSIONS An accurate syncope classification is crucial in BrS patients for risk stratification. In patients with syncope of unclear characteristics, the EPS may be helpful to prevent unnecessary implantable cardioverter defibrillators.
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Affiliation(s)
- Jaime Hernandez-Ojeda
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona. Barcelona, Spain; IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona. Barcelona, Spain; IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Paloma Jorda
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona. Barcelona, Spain; IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Roger Borras
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona. Barcelona, Spain; IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Oscar Campuzano
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain; Medical Science Department, School of Medicine, University of Girona, Girona, Spain
| | - Georgia Sarquella-Brugada
- Medical Science Department, School of Medicine, University of Girona, Girona, Spain; Arrhythmia Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Anna Iglesias
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain; Medical Science Department, School of Medicine, University of Girona, Girona, Spain
| | - Lluis Mont
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona. Barcelona, Spain; IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ramon Brugada
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain; Medical Science Department, School of Medicine, University of Girona, Girona, Spain; Cardiology Service, Hospital Josep Trueta, Girona, Spain
| | - Josep Brugada
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona. Barcelona, Spain; IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Arrhythmia Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
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Ohyama K, Hori Y, Sugiura M. Evaluation of syncope association with α 1-adrenoceptor blockers in males using the FAERS database: impact of concomitant hypertension. Pharmazie 2019; 74:755-759. [PMID: 31907118 DOI: 10.1691/ph.2019.9706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Previous studies have revealed an association between the administration of α1-adrenoceptor blockers (α1Bs) and episodes of syncope in patients with benign prostatic hyperplasia (BPH). The objective of the present study was to evaluate the association between α1Bs and syncope in BPH patients with hypertension using two different pharmacoepidemiological indices. Using the US Food and Drug Administration Adverse Event Reporting System, we analyzed the whole dataset and subsets for specific indications, including hypertension, diabetes, and dyslipidemia, for males older than 40 years. The drugs of interest were alfuzosin, doxazosin, and terazosin as non-selective α1Bs and silodosin and tamsulosin as selective α1Bs. The reporting odds ratio (ROR) and information component (IC) were used for signal detection. The association between the non-selective α1Bs and syncope was observed for all the items examined. The results obtained using the whole dataset, as well as the diabetes and dyslipidemia subsets, were same for the selective and non-selective α1Bs in terms of the association with syncope, while no association with syncope was observed for both silodosin [ROR: 1.09, 95% confidence interval (CI): 0.61-1.93; IC: 0.10, 95% CI: -0.72-0.92] and tamsulosin (ROR: 1.08, 95% CI: 0.90-1.30; IC: 0.10, 95% CI: -0.17-0.37) in patients with hypertension. The data suggested that α1Bs, even those with receptor subtype selectivity, were associated with syncope. Thus, careful attention should be paid when prescribing α1Bs, especially to patients who do not take medications for hypertension.
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Juraschek SP, Simpson LM, Davis BR, Beach JL, Ishak A, Mukamal KJ. Effects of Antihypertensive Class on Falls, Syncope, and Orthostatic Hypotension in Older Adults: The ALLHAT Trial. Hypertension 2019; 74:1033-1040. [PMID: 31476905 PMCID: PMC6739183 DOI: 10.1161/hypertensionaha.119.13445] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypertension treatment has been implicated in falls, syncope, and orthostatic hypotension (OH), common events among older adults. Whether the choice of antihypertensive agent influences the risk of falls, syncope, and OH in older adults is unknown. ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) was a randomized clinical trial that compared the effects of hypertension first-step therapy on fatal coronary heart disease or nonfatal myocardial infarction (1994-2002). In a subpopulation of ALLHAT participants, age 65 years and older, we determined the relative risk of falls, syncope, OH, or a composite based on Centers for Medicare and Medicaid Services and Veterans Affairs claims, using Cox regression. We also determined the adjusted association of self-reported atenolol use (ascertained at the 1-month visit for indications other than hypertension) on outcomes in Cox models adjusted for age, sex, and race. Among 23 964 participants (mean age 69.8±6.8 years, 45% women, 31% non-Hispanic black) followed for a mean of 4.9 years, we identified 267 falls, 755 syncopes, 249 OH, and 1157 composite claims. There were no significant differences in the cumulative incidences of events across randomized drug assignments. However, amlodipine increased risk of falls during the first year of follow-up compared with chlorthalidone (hazard ratio [95% CI]: 2.24 [1.06-4.74]; P=0.03) or lisinopril (hazard ratio [95% CI]: 2.61 [1.03-6.72]; P=0.04). Atenolol use (N=928) was not associated with any of the 3 individual or composite claims. In older adults, the choice of antihypertensive agent had no effect on risk of fall, syncope, or OH long-term. However, amlodipine increased risk of falls within 1 year of initiation. These short-term findings require confirmation. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000542.
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Affiliation(s)
- Stephen P Juraschek
- Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, MA
| | - Lara M Simpson
- University of Texas, Health Science Center at Houston, Department of Biostatistics, Houston, TX
| | - Barry R Davis
- University of Texas, Health Science Center at Houston, Department of Biostatistics, Houston, TX
| | - Jennifer L Beach
- Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, MA
| | - Anthony Ishak
- Healthcare Associates, Beth Israel Deaconess Medical Center
| | - Kenneth J Mukamal
- Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, MA
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Abstract
Cardiac arrhythmia is a common cause of syncope. The prompt identification of arrhythmic syncope has diagnostic and prognostic implications. In this article, an approach to identifying and managing arrhythmic syncope is discussed, including key findings from the history, physical examination, electrocardiogram, role of risk stratification, use of supplemental investigations, and treatment.
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Affiliation(s)
- Evan Martow
- Division of Cardiology, University of Alberta, University of Alberta Hospital, Walter Mackenzie Health Sciences Centre, 8440 112 Street, Edmonton, Alberta T6G 2B7, Canada
| | - Roopinder Sandhu
- Division of Cardiology, University of Alberta, Walter Mackenzie Health Sciences Centre, 8440 112 Street, Edmonton, Alberta T6G 2B7, Canada.
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Chen CYJ, Juang JMJ, Lin LY, Liu YB, Ho LT, Yu CC, Huang HC, Lin TT, Liao MC, Chen JJ, Hwang JJ, Chen WJ, Yeh SFS, Yang DH, Chiang FT, Lin JL, Lai LP, Horie M. Gender difference in clinical and genetic characteristics of Brugada syndrome: SADS-TW BrS registry. QJM 2019; 112:343-350. [PMID: 30690642 DOI: 10.1093/qjmed/hcz028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Brugada syndrome (BrS) is a heritable sudden cardiac death (SCD) disease with male predominance. Information on gender difference of BrS remains scarce. AIM To investigate the gender difference of BrS in Han Chinese. DESIGN We consecutively enrolled 169 BrS patients (153 males and 16 females) from Han Chinese in Taiwan from 1998 to 2017. METHODS Clinical characteristics, electrocardiographic parameters and SCN5A mutation status were compared between genders. RESULTS The percentage of family history of SCD in females was slightly higher (31.3% vs. 15%, P = 0.15). Females exhibited longer QTc (457.8 ± 33.0 vs. 429.5 ± 42.1 ms, P < 0.01). Regarding cumulative event occurrence by age, Mantel-Cox test showed females had earlier age of onset of first cardiac events (SCD or syncope) than males (P = 0.049), which was mainly attributed to syncope (P < 0.01). Males with SCD exhibited longer QRS duration (114.2 ± 26.8 vs. 104.8 ± 15.3 ms, P = 0.02) and QTc (442.5 ± 57.4 vs. 422.9 ± 28.8 ms, P = 0.02). Males with syncope exhibited longer PR interval (181.2 ± 33.7 vs. 165.7 ± 27.1 ms, P = 0.01), whereas females with SCD or syncope had a trend towards slower heart rates (69.1 ± 9.6 vs. 82.2 ± 16.3 bpm, P = 0.10) than female with no or mild symptoms. There was no difference in the percentage of SCN5A mutation between genders. CONCLUSION Gender difference is present in BrS. Females have longer QTc and suffer from syncope earlier than males. Risk of SCD in males is associated with boarder QRS complex and longer QTc, whereas risk of syncope is associated with longer PR interval in males and slower heart rate in females.
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Affiliation(s)
- C-Y J Chen
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - J-M J Juang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - L-Y Lin
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Y-B Liu
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - L-T Ho
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - C-C Yu
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - H-C Huang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - T-T Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan
| | - M-C Liao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan
| | - J-J Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - J-J Hwang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - W-J Chen
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - S-F S Yeh
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - D-H Yang
- Department of Radiology, Tainan Municipal Hospital, Tainan, Taiwan
| | - F-T Chiang
- Division of Cardiology, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - J-L Lin
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - L-P Lai
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - M Horie
- Department of Cardiovascular Medicine, Shiga University of Medical Sciences, Shiga, Japan
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Michowitz Y, Milman A, Andorin A, Sarquella-Brugada G, Gonzalez Corcia MC, Gourraud JB, Conte G, Sacher F, Juang JJM, Kim SH, Leshem E, Mabo P, Postema PG, Hochstadt A, Wijeyeratne YD, Denjoy I, Giustetto C, Mizusawa Y, Huang Z, Jespersen CH, Maeda S, Takahashi Y, Kamakura T, Aiba T, Arbelo E, Mazzanti A, Allocca G, Brugada R, Casado-Arroyo R, Champagne J, Priori SG, Veltmann C, Delise P, Corrado D, Brugada J, Kusano KF, Hirao K, Calo L, Takagi M, Tfelt-Hansen J, Yan GX, Gaita F, Leenhardt A, Behr ER, Wilde AAM, Nam GB, Brugada P, Probst V, Belhassen B. Characterization and Management of Arrhythmic Events in Young Patients With Brugada Syndrome. J Am Coll Cardiol 2019; 73:1756-1765. [PMID: 30975291 DOI: 10.1016/j.jacc.2019.01.048] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/29/2018] [Accepted: 01/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Information on young patients with Brugada syndrome (BrS) and arrhythmic events (AEs) is limited. OBJECTIVES The purpose of this study was to describe their characteristics and management as well as risk factors for AE recurrence. METHODS A total of 57 patients (age ≤20 years), all with BrS and AEs, were divided into pediatric (age ≤12 years; n = 26) and adolescents (age 13 to 20 years; n = 31). RESULTS Patients' median age at time of first AE was 14 years, with a majority of males (74%), Caucasians (70%), and probands (79%) who presented as aborted cardiac arrest (84%). A significant proportion of patients (28%) exhibited fever-related AE. Family history of sudden cardiac death (SCD), prior syncope, spontaneous type 1 Brugada electrocardiogram (ECG), inducible ventricular fibrillation at electrophysiological study, and SCN5A mutations were present in 26%, 49%, 65%, 28%, and 58% of patients, respectively. The pediatric group differed from the adolescents, with a greater proportion of females, Caucasians, fever-related AEs, and spontaneous type-1 ECG. During follow-up, 68% of pediatric and 64% of adolescents had recurrent AE, with median time of 9.9 and 27.0 months, respectively. Approximately one-third of recurrent AEs occurred on quinidine therapy, and among the pediatric group, 60% of recurrent AEs were fever-related. Risk factors for recurrent AE included sinus node dysfunction, atrial arrhythmias, intraventricular conduction delay, or large S-wave on ECG lead I in the pediatric group and the presence of SCN5A mutation among adolescents. CONCLUSIONS Young BrS patients with AE represent a very arrhythmogenic group. Current management after first arrhythmia episode is associated with high recurrence rate. Alternative therapies, besides defibrillator implantation, should be considered.
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Affiliation(s)
- Yoav Michowitz
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Milman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiology, Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Antoine Andorin
- L'institut du Thorax, Service de Cardiologie, CHU de Nantes, Nantes, France; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
| | - Georgia Sarquella-Brugada
- Pediatric Arrhythmias, Electrophysiology and Sudden Death Unit Cardiology, Department Hospital Sant Joan de Déu, Barcelona-Universitat de Barcelona, Barcelona, Spain
| | | | - Jean-Baptiste Gourraud
- L'institut du Thorax, Service de Cardiologie, CHU de Nantes, Nantes, France; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
| | - Giulio Conte
- Heart Rhythm Management Centre, UZ-VUB, Brussels, Belgium
| | - Frederic Sacher
- Hôpital Cardiologique du Haut-Lévêque & Université Bordeaux, LIRYC Institute, Bordeaux, France
| | - Jimmy J M Juang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Sung-Hwan Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eran Leshem
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Philippe Mabo
- Cardiology and Vascular Disease Division, Rennes University Health Centre, Rennes, France
| | - Pieter G Postema
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; Heart Centre AMC, Department of Clinical and Experimental Cardiology, AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Aviram Hochstadt
- Department of Internal Medicine J, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Yanushi D Wijeyeratne
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; Cardiovascular Sciences, St. George's University of London and Cardiology Clinical Academic Group St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Isabelle Denjoy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; Service de Cardiologie et CNMR Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris, and Université Paris Diderot, Sorbonne, Paris, France
| | - Carla Giustetto
- Division of Cardiology, University of Torino, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Torino, Italy
| | - Yuka Mizusawa
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; Heart Centre AMC, Department of Clinical and Experimental Cardiology, AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Zhengrong Huang
- Department of Cardiology, the First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Camilla H Jespersen
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Shingo Maeda
- Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Tsukasa Kamakura
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takeshi Aiba
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Elena Arbelo
- Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia, Spain
| | - Andrea Mazzanti
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; Molecular Cardiology, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Giuseppe Allocca
- Division of Cardiology, Hospital of Peschiera del Garda, Veneto, Italy
| | - Ramon Brugada
- Cardiovascular Genetics Center, Medical Science Department, University of Girona-IDIBGI (CIBERCV) Cardiology Service, Hospital Josep Trueta, Girona, Spain
| | - Ruben Casado-Arroyo
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean Champagne
- Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Silvia G Priori
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; Molecular Cardiology, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Christian Veltmann
- Rhythmology and Electrophysiology, Department of Cardiology, Hannover Medical School, Hannover, Germany
| | - Pietro Delise
- Division of Cardiology, Hospital of Peschiera del Garda, Veneto, Italy
| | - Domenico Corrado
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; Department of Cardiac, Thoracic and Vascular Sciences University of Padova, Padova, Italy
| | - Josep Brugada
- Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia, Spain
| | - Kengo F Kusano
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kenzo Hirao
- Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Leonardo Calo
- Division of Cardiology, Policlinico Casilino, Roma, Italy
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Jacob Tfelt-Hansen
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gan-Xin Yan
- Lankenau Medical Center, Wynnewood, Pennsylvania
| | - Fiorenzo Gaita
- Division of Cardiology, University of Torino, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Torino, Italy
| | - Antoine Leenhardt
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; Service de Cardiologie et CNMR Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris, and Université Paris Diderot, Sorbonne, Paris, France
| | - Elijah R Behr
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; Cardiovascular Sciences, St. George's University of London and Cardiology Clinical Academic Group St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Arthur A M Wilde
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; Heart Centre AMC, Department of Clinical and Experimental Cardiology, AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Gi-Byoung Nam
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Pedro Brugada
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; Heart Rhythm Management Centre, UZ-VUB, Brussels, Belgium
| | - Vincent Probst
- L'institut du Thorax, Service de Cardiologie, CHU de Nantes, Nantes, France; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
| | - Bernard Belhassen
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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White JL, Hollander JE, Chang AM, Nishijima DK, Lin AL, Su E, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Clark CL, Diercks DB, Nicks BA, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Sun BC. Orthostatic vital signs do not predict 30 day serious outcomes in older emergency department patients with syncope: A multicenter observational study. Am J Emerg Med 2019; 37:2215-2223. [PMID: 30928476 DOI: 10.1016/j.ajem.2019.03.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 03/20/2019] [Accepted: 03/24/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Syncope is a common chief complaint among older adults in the Emergency Department (ED), and orthostatic vital signs are often a part of their evaluation. We assessed whether abnormal orthostatic vital signs in the ED are associated with composite 30-day serious outcomes in older adults presenting with syncope. METHODS We performed a secondary analysis of a prospective, observational study at 11 EDs in adults ≥ 60 years who presented with syncope or near syncope. We excluded patients lost to follow up. We used the standard definition of abnormal orthostatic vital signs or subjective symptoms of lightheadedness upon standing to define orthostasis. We determined the rate of composite 30-day serious outcomes, including those during the index ED visit, such as cardiac arrhythmias, myocardial infarction, cardiac intervention, new diagnosis of structural heart disease, stroke, pulmonary embolism, aortic dissection, subarachnoid hemorrhage, cardiopulmonary resuscitation, hemorrhage/anemia requiring transfusion, with major traumatic injury from fall, recurrent syncope, and death) between the groups with normal and abnormal orthostatic vital signs. RESULTS The study cohort included 1974 patients, of whom 51.2% were male and 725 patients (37.7%) had abnormal orthostatic vital signs. Comparing those with abnormal to those with normal orthostatic vital signs, we did not find a difference in composite 30-serious outcomes (111/725 (15.3%) vs 184/1249 (14.7%); unadjusted odds ratio, 1.05 [95%CI, 0.81-1.35], p = 0.73). After adjustment for gender, coronary artery disease, congestive heart failure (CHF), history of arrhythmia, dyspnea, hypotension, any abnormal ECG, physician risk assessment, medication classes and disposition, there was no association with composite 30-serious outcomes (adjusted odds ratio, 0.82 [95%CI, 0.62-1.09], p = 0.18). CONCLUSIONS In a cohort of older adult patients presenting with syncope who were able to have orthostatic vital signs evaluated, abnormal orthostatic vital signs did not independently predict composite 30-day serious outcomes.
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Affiliation(s)
- Jennifer L White
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America; Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA, United States of America.
| | - Judd E Hollander
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Anna Marie Chang
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Daniel K Nishijima
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America
| | - Amber L Lin
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America
| | - Erica Su
- Department of Biostatistics, University of California, Los Angeles, CA, United States of America
| | - Robert E Weiss
- Department of Biostatistics, University of California, Los Angeles, CA, United States of America
| | - Annick N Yagapen
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America
| | - Susan E Malveau
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America
| | - David H Adler
- Department of Emergency Medicine, University of Rochester, NY, United States of America
| | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI, United States of America
| | - Christopher W Baugh
- Department of Emergency Medicine, Brigham & Women's Hospital, Boston, MA, United States of America
| | - Jeffrey M Caterino
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Carol L Clark
- Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI, United States of America
| | - Deborah B Diercks
- Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX, United States of America
| | - Bret A Nicks
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States of America
| | - Manish N Shah
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Kirk A Stiffler
- Department of Emergency Medicine, Summa Health System, Akron, OH, United States of America
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Scott T Wilber
- Department of Emergency Medicine, Summa Health System, Akron, OH, United States of America
| | - Benjamin C Sun
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America
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47
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Bonaldo G, Vaccheri A, D'Annibali O, Motola D. Safety profile of human papilloma virus vaccines: an analysis of the US Vaccine Adverse Event Reporting System from 2007 to 2017. Br J Clin Pharmacol 2019; 85:634-643. [PMID: 30569481 PMCID: PMC6379209 DOI: 10.1111/bcp.13841] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 11/27/2022] Open
Abstract
AIMS Human papilloma virus (HPV) is the cause of different types of carcinoma. Despite the remarkable effectiveness of the HPV vaccines, there have been many complaints about their risk-benefit profile due to adverse events following immunization (AEFI). The purpose of this study is to analyse the safety profile of the HPV vaccine basing on real-life data derived from reports of suspected AEFIs collected in the US Vaccine Adverse Events Reporting System (VAERS) and assess if the searches on Google overlap with spontaneous reporting. METHODS We collected all the reports in VAERS between January 2007 to December 2017 related to the HPV vaccines. A disproportionality analysis using reporting odds ratio (ROR) with 95% confidence interval was performed. RESULTS Over the 10-year period, 55 356 reports of AEFI related to HPV vaccines were retrieved in VAERS, corresponding to 224 863 vaccine-event pairs. The highest number of reports was related to Gardasil (n = 42 244). The two events more frequently reported and statistically significant for HPV vaccines were dizziness (n = 6259; ROR = 2.60; 95% confidence interval 2.53-2.66) and syncope (n = 6004; ROR = 6.28; 95% confidence interval 6.12-6.44). The trends of spontaneous reporting and Google searches overlap. CONCLUSION The AEFI analysis showed that the events most frequently reported were non-serious and listed in the corresponding summary of product characteristics. Potential safety signals arose regarding less frequent AEFIs that would deserve further investigation. It is extremely important to disseminate correct and evidence-based scientific information.
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Affiliation(s)
- Giulia Bonaldo
- Unit of Pharmacology, Department of Medical and Surgical SciencesUniversity of Bolognavia Irnerio 4840126BolognaItaly
| | - Alberto Vaccheri
- Unit of Pharmacology, Department of Medical and Surgical SciencesUniversity of Bolognavia Irnerio 4840126BolognaItaly
| | - Ottavio D'Annibali
- Unit of Pharmacology, Department of Medical and Surgical SciencesUniversity of Bolognavia Irnerio 4840126BolognaItaly
| | - Domenico Motola
- Unit of Pharmacology, Department of Medical and Surgical SciencesUniversity of Bolognavia Irnerio 4840126BolognaItaly
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Song C, Guo Y, Zheng X, Lu J, Fang X, Wang S, Huang X. Prognostic Significance and Risk of Atrial Fibrillation of Wolff-Parkinson-White Syndrome in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2018; 122:1546-1550. [PMID: 30201118 DOI: 10.1016/j.amjcard.2018.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/11/2018] [Accepted: 07/17/2018] [Indexed: 01/05/2023]
Abstract
To assess the mid-term mortality and risk of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HC) and Wolff-Parkinson-White (WPW) syndrome, 40 patients with HC and WPW were enrolled in our center between 2010 and 2017. An age- and gender-matched comparison cohort of patients with HC without WPW (n = 160) was generated from the same center. The clinical profile and outcomes were assessed. Of 40 patients with WPW, 28 underwent accessory pathway (AP) elimination. Two patients (7%) had failed in AP elimination. During mid-term follow-up, 1 patient had an implantable cardioverter-defibrillator intervention. Fourteen patients had AF. A previous history of AF (hazard ratio [HR]: 4.69; 95% confidence interval [CI] 1.51 to 14.63) and left atrial dimension (HR: 1.12; 95% CI 1.03 to 1.23) at baseline were risk factors for AF occurrence during follow-up. The AP elimination significantly reduced risk for the incidence of AF (HR: 0.22; 95% CI 0.06 to 0.83). Compared with the control group, the prevalence of syncope and AF were significantly higher in the WPW group. During follow-up, no difference was identified in outcome measures consisting of all-cause death, cardiac transplantation, and implantable cardioverter-defibrillator intervention. A previous history of AF (HR: 5.20; 95% CI 2.63 to 10.30, p <0.001) and persistent existing WPW (HR: 3.64; 95% CI 1.63 to 8.11, p = 0.002) were independent risk factors for AF occurrence during follow-up in the entire cohort. In conclusion, although WPW was uncommon and might not be correlated with mid-term mortality in HC patients, WPW might increase the risk of AF occurrence. Additionally, AP elimination may reduce the risk of AF occurrence.
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Affiliation(s)
- Changpeng Song
- Department of Special Medical Treatment Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Ying Guo
- Department of Special Medical Treatment Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Xinxin Zheng
- Department of Special Medical Treatment Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Jie Lu
- Department of Special Medical Treatment Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaonan Fang
- Department of Special Medical Treatment Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Shuiyun Wang
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China.
| | - Xiaohong Huang
- Department of Special Medical Treatment Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China.
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49
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Krishnaswami A, Kim DH, McCulloch CE, Forman DE, Maurer MS, Alexander KP, Rich MW. Individual and Joint Effects of Pulse Pressure and Blood Pressure Treatment Intensity on Serious Adverse Events in the SPRINT Trial. Am J Med 2018; 131:1220-1227.e1. [PMID: 29940151 DOI: 10.1016/j.amjmed.2018.05.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE The objective of this study was to determine individual and joint effects of pulse pressure and blood pressure treatment intensity on serious adverse events in the Systolic Blood Pressure Intervention Trial. METHODS Pulse pressure was calculated by subtracting diastolic blood pressure from systolic blood pressure. Blood pressure treatment intensity goal was ≤140mm Hg in the control arm and ≤120mm Hg in the intensive arm. The primary outcome was a 5-point composite of hypotension, syncope, electrolyte abnormalities, acute renal insufficiency, or injurious falls. RESULTS In 9361 trial participants, the incident rate for the primary outcome per 1000 person-years increased with higher pulse pressure category: ≤49 mmHg: 20.4 (17.2-24.1), 50-59 mmHg: 24.5 (21.3-28.2), 60-69 mmHg: 31.7 (27.7-36.2), ≥70 mmHg: 44.6 (39.8-49.9; Ptrend < .0001; hazard ratio [HR] of pulse pressure [every 10mm Hg] 1.23; 95% confidence interval [CI], 1.18-1.28). The intensive treatment arm had a higher incidence rate of serious adverse events than the control arm (34.2, 95% CI, 31.2-37.3, vs 26.0, 95% CI, 23.4-28.8, P = .0001; HR 1.32; 95% CI, 1.15-1.51). The combined effect was not significant in the relative risk scale (HR 0.97, Pinteraction = .48) but was significant in the risk difference scale (P = .027), contributing 2.5 additional serious adverse events per 1000 person-years for every 10mm Hg increase in pulse pressure in excess of the individual effects of pulse pressure and treatment intensity. CONCLUSIONS Wider pulse pressure and intensive blood pressure treatment were individually associated with the composite adverse event outcome. A modest effect modification of pulse pressure and treatment intensity led to additional adverse events when both were present. Clinicians should use caution when treating older patients with elevated pulse pressure to an intensive blood pressure treatment target.
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Affiliation(s)
- Ashok Krishnaswami
- Division of Cardiology, Kaiser Permanente San Jose Medical Center, CA; Department of Epidemiology and Biostatistics, Universityof California, San Francisco, CA.
| | - Dae Hyun Kim
- Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, Universityof California, San Francisco, CA
| | - Daniel E Forman
- Division of Geriatric Cardiology, University of Pittsburgh, PA; Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, PA
| | - Mathew S Maurer
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Karen P Alexander
- Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Michael W Rich
- Division of Cardiology, Washington University,St. Louis, MO
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50
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Maclagan LC, Bronskill SE, Guan J, Campitelli MA, Herrmann N, Lapane KL, Hogan DB, Amuah JE, Seitz DP, Gill SS, Maxwell CJ. Predictors of Cholinesterase Discontinuation during the First Year after Nursing Home Admission. J Am Med Dir Assoc 2018; 19:959-966.e4. [PMID: 30262440 DOI: 10.1016/j.jamda.2018.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/24/2018] [Accepted: 07/28/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES For persons with dementia, the appropriate duration of cholinesterase inhibitor (ChEI) use remains unclear. We examined patterns of ChEI use during nursing home (NH) transition and the factors associated with discontinuation following admission. DESIGN Population-based retrospective cohort study using linked health administrative and Resident Assessment Instrument Minimum Dataset, version 2.0 databases. SETTING AND PARTICIPANTS A total of 47,851 older adults (mean age = 84.8 years, standard deviation = 6.8) with dementia newly admitted to a NH in Ontario, Canada between 2011 and 2015. MEASUREMENTS ChEI use at admission and during the following year was identified from prescription claims. Resident sociodemographic and health characteristics at admission, including a 72-item frailty index, were derived from the Resident Assessment Instrument Minimum Dataset 2.0. Additional resident and prescriber characteristics were derived from administrative data. Discontinuation was defined as a 30+-day gap in ChEI supply. Multivariable subdistribution hazard models were used to estimate the independent effect of resident frailty and other factors on ChEI discontinuation. RESULTS Approximately one-third (17,560) of residents with dementia were on a ChEI at admission. Among this group, 17.7% (3110) discontinued use over follow-up. Incidence of discontinuation was significantly higher among residents with syncope [subdistribution hazard ratio, sHR = 2.21, 95% confidence interval, CI (1.52, 3.22)], more severe behavioral symptoms [sHR = 1.79, 95% CI (1.57, 2.05)], cognitive impairment [sHR = 1.26, 95% CI (1.07, 1.48)], higher frailty, [sHR = 1.19, 95% CI (1.04, 1.36)], and a primary prescriber active in the NH [sHR = 1.28, 95% CI (1.14, 1.45)]. A significantly lower incidence was observed for older and unmarried residents and those with a longer duration of use. CONCLUSIONS/IMPLICATIONS Less than one-fifth of residents on a ChEI at admission discontinued use during the following year. Although some of the predictors of discontinuation align with past research and current clinical recommendations, others were unexpected and point to novel drivers of ChEI use. Future investigations should explore the varied reasons underlying these associations and resident outcomes associated with ChEI discontinuation.
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Affiliation(s)
- Laura C Maclagan
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Susan E Bronskill
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Jun Guan
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Nathan Herrmann
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joseph E Amuah
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dallas P Seitz
- Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Ontario, Canada; Division of Geriatric Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Sudeep S Gill
- Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Ontario, Canada; Division of Geriatric Medicine, Queen's University, Kingston, Ontario, Canada; Providence Care Hospital, Kingston, Ontario, Canada
| | - Colleen J Maxwell
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada.
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