Comparison of Incidence, Predictors, and the Impact of Co-Morbidity and Polypharmacy on the Risk of Recurrent Syncope in Patients <85 Versus ≥85 Years of Age
Abstract
Recurrent syncope is a major cause of hospitalizations and may be associated with cardiovascular co-morbidities. Despite this, prognostic factors and the clinical characteristics among patients are not well described. Therefore, we identified and analyzed data on all patients >50 years of age discharged after a first-time episode of syncope in the period 2001 to 2009 through nationwide administrative registries. We identified the clinical characteristics of 5,141 patients ≥85 years of age and 23,454 patients <85 years of age. Multivariate Cox models were used to assess prognostic factors associated with the end point of recurrent syncope according to age. We found that those with syncope and ≥85 years were more often women (65% vs 47%) and generally had a greater prevalence of noncardiovascular co-morbidities, whereas the prevalence of cardiovascular co-morbidities was more heterogeneously distributed across age groups. Overall, significant baseline predictors of recurrent syncope were aortic valve stenosis (hazard ratio [HR] 1.48, 95% confidence interval [CI] 1.31 to 1.68), impaired renal function (HR 1.34, 95% CI 1.15 to 1.58), atrioventricular or left bundle branch block (HR 1.32, 95% CI 1.16 to 1.51), male gender (HR 1.18, 95% CI 1.12 to 1.24), chronic obstructive pulmonary disorder (HR 1.10, 95% CI 1.02 to 1.19), heart failure (HR 1.10, 95% CI 1.02 to 1.21), atrial fibrillation (HR = 1.09, 95% CI 1.01 to 1.19), age per 5-year increment (HR 1.09, 95% CI 1.07 to 1.10), and orthostatic medications per increase (HR 1.06, 95% CI 1.03 to 1.09). Atrial fibrillation and impaired renal function both exhibited less prognostic importance for recurrent syncope in the elderly compared with younger population (p for interactions <0.01). In conclusion, predictive factors of recurrent syncope were closely associated with increased cardiovascular risk profile age and gender. The use of multiple orthostatic medications additively increased the risk of recurrences representing a need for strategies to reduce unnecessary polypharmacy.
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The prescription of polypharmacy, cardiovascular medications, and psychotropic and dopaminergic drugs increases the risk of syncope and falls.
“The prescription of polypharmacy, cardiovascular medications, and psychotropic (neuroleptics and antidepressants) and dopaminergic drugs also increases the risk of syncope and falls. 381-385”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [382]
Among older adults, risks of syncope are usually compounded by multiple morbidities and frailty, which add to age-related vulnerability to syncope.
“Although some of the risk is attributable to the aspects of syncope described in this guideline, among older adults such risks are usually compounded by multiple morbidities and frailty, which add to age-related vulnerability to syncope (671,681,682), and by the physical injuries associated with falls, collisions, or trauma, which more commonly result from syncope in old age (670).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [681]
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Delara, M., Murray, L., Jafari, B., Bahji, A., Goodarzi, Z., Kirkham, J. G., Chowdhury, Z., & Seitz, D. P. (2022) · Figshare · doi:10.6084/m9.figshare.20342262
Delara, M., Murray, L., Jafari, B., Bahji, A., Goodarzi, Z., Kirkham, J. G., Chowdhury, Z., & Seitz, D. P. (2022) · Figshare · doi:10.6084/m9.figshare.20342250
Delara, M., Murray, L., Jafari, B., Bahji, A., Goodarzi, Z., Kirkham, J. G., Chowdhury, Z., & Seitz, D. P. (2022) · Figshare · doi:10.6084/m9.figshare.20342274
Metabolic syndrome identifies a high-risk polypharmacy phenotype in older adults with syncope
Longo, S., Rizza, S., Fernández‐Real, J. M., & Federici, M. (2026) · Pharmacological Research · doi:10.1016/j.phrs.2026.108426
- Authors
- Ruwald, M. H., Hansen, M. L., Lamberts, M., Hansen, C. M., Numé, A.-K., Vinther, M., Køber, L., Torp-Pedersen, C., Hansen, J., & Gislason, G. H.
- Affiliations
- Gentofte Hospital (DK)
- Rigshospitalet (DK)
- Corresponding author
- Ruwald, Martin Huth
- ORCID
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2013-11
- Volume
- 112
- Issue
- 10
- Pages
- 1610-1615
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W1967390646
- Cited by
- 59
- References
- 30
- Citations by year
- 2026: 1 · 2023: 2 · 2022: 14 · 2021: 2 · 2020: 4 · 2019: 6 · 2018: 8 · 2017: 5 · 2016: 5 · 2015: 4 · 2014: 7
- FWCI
- 5.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Funders
- Lundbeckfonden (2012B018)
- Helsefonden
- Hjerteforeningen (R108-A104415)
- Novo Nordisk Fonden
- Else og Mogens Wedell Wedellsborgs Fond
- Arvid Nilssons Fond
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Keywords
- recurrent syncope, syncope, oldest old, polypharmacy, comorbidities, aortic stenosis, renal dysfunction, atrial fibrillation, heart failure, bundle branch block, prognostic factors, cardiovascular comorbidity, age differences, hospitalization risk, older adults, chronic obstructive pulmonary disease, atrioventricular block
- MeSH terms
- Aged, Aged, 80 and over, Cardiovascular Agents, Denmark, Female, Humans, Male, Middle Aged, Registries, Risk Factors, Syncope, Comorbidity, Prevalence, Survival Rate, Proportional Hazards Models, Risk Assessment, Polypharmacy
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