Syncope in the Older Person
Abstract
Syncope in the older person carries a high morbidity, mortality, and health economic burden. While neurally mediated disorders and orthostatic hypotension account for the majority of syncopal episodes in this age group, around a third of causes are cardiac, predominantly arrhythmic. Clinicians need to be aware of the management of potential comorbid issues such as osteoporosis and cognitive impairment and if not in a position to act on them, ensure that appropriate specialist help is sought. Further work is needed to understand the pathophysiology and hence the management of syncope in the older patient, with ongoing studies helping to tease out some of the treatment controversies.
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The diagnosis of syncope in older adults is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy.
“The management of syncope in older adults is particularly challenging: The incidence is high; the differential diagnosis is broad; the diagnosis is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy; and secondary morbidity is high because of comorbidities, physical injury, and frailty (35,45,666–675).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [671]
The differential diagnosis of syncope in older adults is broad.
“The management of syncope in older adults is particularly challenging: The incidence is high; the differential diagnosis is broad; the diagnosis is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy; and secondary morbidity is high because of comorbidities, physical injury, and frailty (35,45,666–675).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [671]
The incidence of syncope in older adults is high.
“The management of syncope in older adults is particularly challenging: The incidence is high; the differential diagnosis is broad; the diagnosis is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy; and secondary morbidity is high because of comorbidities, physical injury, and frailty (35,45,666–675).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [671]
Age-associated cardiovascular and autonomic changes increase vulnerability of older adults to syncope.
“The vulnerability of older adults to syncope increases because of age-associated cardiovascular and autonomic changes, decreased fluid conservation (45,671,676–678), and an increased probability of developing multiple concurrent morbidities (with their associated pharmacological treatments) that can overwhelm homeostasis.”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [671]
Secondary morbidity from syncope in older adults is high because of comorbidities, physical injury, and frailty.
“The management of syncope in older adults is particularly challenging: The incidence is high; the differential diagnosis is broad; the diagnosis is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy; and secondary morbidity is high because of comorbidities, physical injury, and frailty (35,45,666–675).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [671]
Decreased fluid conservation increases vulnerability of older adults to syncope.
“The vulnerability of older adults to syncope increases because of age-associated cardiovascular and autonomic changes, decreased fluid conservation (45,671,676–678), and an increased probability of developing multiple concurrent morbidities (with their associated pharmacological treatments) that can overwhelm homeostasis.”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [671]
An increased probability of developing multiple concurrent morbidities (with their associated pharmacological treatments) that can overwhelm homeostasis increases vulnerability of older adults to syncope.
“The vulnerability of older adults to syncope increases because of age-associated cardiovascular and autonomic changes, decreased fluid conservation (45,671,676–678), and an increased probability of developing multiple concurrent morbidities (with their associated pharmacological treatments) that can overwhelm homeostasis.”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [671]
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 [671]
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“A multicenter randomized controlled study of metoprolol showed no benefit overall, but suggested benefit in patients older than 42 years.(57,58) This theory will be the subject of a further randomized trial of metoprolol in this age group (POST 5 [Prevention of Syncope Trial 5], RS Sheldon, personal communication,”
BackgroundDrop attacks in older adults: systematic assessment has a high diagnostic yield
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2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.03.004 · Cited by 484 · see citing works
2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
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Syncope and bifascicular block in the absence of structural heart disease
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Jordán-Martínez, L., Rivera-López, R., Bermúdez-Jiménez, F., Jiménez-Jaimez, J., Alzueta, J., Barrera-Cordero, A., Rivera-Fernández, R., Jiménez-Navarro, M., Álvarez, M., & Tercedor, L. (2020) · Revista Española de Cardiología · doi:10.1016/j.recesp.2019.09.006 · Cited by 5 · see citing works
- Authors
- Matthews, I. G., Tresham, I. A. E., & Parry, S. W.
- Affiliations
- Newcastle University (GB)
- Royal Victoria Infirmary (GB)
- Corresponding author
- Parry, Steve W.
- ORCID
- Parry, Steve W.
- Venue
- Cardiology Clinics
- Publisher
- Elsevier BV
- Published
- 2015-08
- Volume
- 33
- Issue
- 3
- Pages
- 411-421
- ISSN
- 0733-8651 (ISSN-L)
- OpenAlex
- W2177675865
- Cited by
- 16
- References
- 13
- Citations by year
- 2026: 1 · 2020: 4 · 2019: 3 · 2018: 2 · 2017: 5 · 2014: 1
- FWCI
- 0.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Cardiology Clinics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- syncope, older adults, neurally mediated syncope, orthostatic hypotension, cardiac syncope, cardiac arrhythmias, osteoporosis, cognitive impairment, syncope management, health economic burden
- MeSH terms
- Cardiac Pacing, Artificial, Humans, Hypotension, Orthostatic, Risk Factors, Syncope, Global Health, Incidence, Tilt-Table Test
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