Cited by 246Cardiovascular Syncope and Autonomic DisordersCardiac electrophysiology and arrhythmiasTakotsubo Cardiomyopathy and Associated Phenomena

Short- and Long-Term Prognosis of Syncope, Risk Factors, and Role of Hospital Admission

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Costantino, Giorgio, Perego, Francesca, Dipaola, Franca, Borella, Marta, Galli, Andrea, Cantoni, Giulia, Dell’Orto, Simonetta, Dassi, Simonetta +4 more·2008·Journal of the American College of Cardiology

Abstract

Objective We sought to assess short- and long-term prognosis of syncope and associated risk factors.Background Syncope is a common clinical event, but our knowledge of its short-term outcome is largely incomplete. Further, it is unknown whether hospital admission might positively affect a patient's syncope prognosis.Methods We screened 2,775 consecutive subjects who presented for syncope at 4 emergency departments between January and July 2004. Short- and long-term severe outcomes (i.e., death and major therapeutic procedures) and related risk factors were compared in all enrolled patients arrayed according to hospital admission or discharge.Results A total of 676 subjects were included in the study. Forty-one subjects (6.1%) experienced severe outcomes (5 deaths, 0.7%; 36 major therapeutic procedures, 5.4%) in the 10 days after presentation. An abnormal electrocardiogram, concomitant trauma, absence of symptoms of impending syncope, and male gender were associated with short-term unfavorable outcomes. Long-term severe outcomes were 9.3% (40 deaths, 6.0%; 22 major therapeutic procedures, 3.3%), and their occurrence was correlated with an age >65 years, history of neoplasms, cerebrovascular diseases, structural heart diseases, and ventricular arrhythmias. Short-term major therapeutic procedures were more common (p < 0.05) in subjects who had been admitted to hospital (13.3%) than in discharged (1.6%), whereas mortality was similar. One-year mortality was greater (p < 0.05) in admitted (14.7%) than in discharged (1.8%) patients.Conclusions Risk factors for short- and long-term adverse outcomes after syncope differed. Hospital admission favorably influenced syncope short term prognosis. Instead, 1-year mortality was unaffected by hospital admission and related to comorbidity.

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Crossref · 10.1016/j.jacc.2007.08.059

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  • A few prospective studies developed clinical decision tools to identify patients at risk of serious adverse events within 30 days.

    “A few prospective studies developed clinical decision tools to identify patients at risk of serious adverse events within 30 days. 8,9,13,14”

    From Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope (2016) · cites this paper as [14]

    The Abstract (page not provided) describes a prospective study of predictors of adverse events after syncope, and the Results identify short-term risk factors. But this paper assessed outcomes within 10 days, not 30, and does not report developing a clinical decision tool. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • The existing clinical decision tools for syncope have poor diagnostic test characteristics and several methodological flaws that preclude their widespread adoption by clinicians.

    “However, they have poor diagnostic test characteristics and several methodological flaws that preclude their widespread adoption by clinicians.”

    From Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope (2016) · cites this paper as [14]

    The Long-term mortality and severe outcomes section identifies a methodological concern: emergency-setting prognostic scores based on 6- or 12-month outcomes may be misleading for immediate risk assessment unless validated for the short term. It does not report that existing tools have poor diagnostic test characteristics or say that these limitations preclude their widespread adoption by clinicians. The Study limitations section discusses limitations of the authors’ own study, not of existing tools. (LLM, conf=0.83)

    Experimental — accuracy not yet measured
  • Five prospective syncope studies attempted to develop tools for identification of short-term risk of serious adverse events.

    “Five prospective syncope studies attempted to develop tools for identification of short-term risk of serious adverse events. 8,9,13,14,26”

    From Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope (2016) · cites this paper as [14]

    The Population and Results sections describe a prospective syncope study that analyzed predictors of severe outcomes within 10 days and identified independent risk factors. Our copy does not show that the authors developed a risk-identification tool or score; that part of the characterization is unsupported. This citation identifies one study, so it need not establish the total of five. (LLM, conf=0.84)

    Experimental — accuracy not yet measured
  • Clinical decision rules can predict poor outcomes, but most syncope deaths and many poor outcomes are associated with underlying illness rather than syncope per se, particularly in the long term.

    “Clinical decision rules can predict poor outcomes, but most syncope deaths and many poor outcomes are associated with underlying illness rather than syncope per se , 58 particularly in the long term. 56”
  • Several previous prospective studies have reported heart disease and abnormal ECG findings as independent risk factors for serious outcomes among patients with syncope.

    “Several previous prospective studies have reported heart disease and abnormal ECG findings as independent risk factors for serious outcomes among patients with syncope. 13,14,29”

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Authors
Costantino, G., Perego, F., Dipaola, F., Borella, M., Galli, A., Cantoni, G., Dell’Orto, S., Dassi, S., Filardo, N., Duca, P. G., Montano, N., & Furlan, R.
Affiliations
University of Milan (IT)
Corresponding author
Furlan, Raffaello
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2008-01
Volume
51
Issue
3
Pages
276-283
ISSN
0735-1097 (ISSN-L)
OpenAlex
W2169409503
Cited by
246
References
33
Citations by year
2026: 1 · 2025: 6 · 2024: 2 · 2023: 7 · 2022: 7 · 2021: 10 · 2020: 12 · 2019: 15 · 2018: 19 · 2017: 22 · 2016: 18 · 2015: 12 · 2014: 27 · 2013: 19 · 2012: 19
FWCI
17.56
Type
journal article
Language
en
Open access
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
Funders
Regione Lombardia
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Takotsubo Cardiomyopathy and Associated Phenomena
Keywords
syncope, prognosis, risk factors, hospitalization, mortality, electrocardiographic abnormalities, comorbidities, ventricular arrhythmias, structural heart disease, cerebrovascular disease, emergency department patients
MeSH terms
Adult, Age Factors, Aged, Analysis of Variance, Arrhythmias, Cardiac, Cardiovascular Diseases, Cause of Death, Female, Hospitalization, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Risk Factors, Syncope, Comorbidity

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