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Short- and Long-Term Prognosis of Syncope, Risk Factors, and Role of Hospital Admission
Open accessAbstract
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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“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]
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“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]
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“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]
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In the citing paper
“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”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [56]
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“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”
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]
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“The Short-Term Prognosis in Syncope (STePS) Study identified risk factors for death and therapeutic interventions within 10 days. 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]
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“Three of the studies 13,14,26 included re admission to hospital without identification of serious underlying conditions as an outcome.”
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]
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Citations
Cites
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Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), societies, E. B. T. F., European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp298 · Cited by 2,040
2018 ESC Guidelines for the diagnosis and management of syncope
Brignole, M., Moya, A., de Lange, F. J., Deharo, J.-C., Elliott, P. M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R. A., Martín, A., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy037 · Cited by 1,951
“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)”
Self-citationEuropean Resuscitation Council Guidelines 2021: Adult advanced life support
Soar, J., Böttiger, B. W., Carli, P. A., Couper, K., Deakin, C. D., Djärv, T., Lott, C., Olasveengen, T. M., Paal, P., Pellis, T., et al. (2021) · Resuscitation · doi:10.1016/j.resuscitation.2021.02.010 · Cited by 1,255
2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
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“No prodrome (68) Absence of nausea/vomiting preceding syncopal event (93)”
BackgroundInfluential2018 ESC Guidelines for the diagnosis and management of syncope
Brignole, M., Moya‐Mitjans, À., de Lange, F. J., Deharo, J., Elliot, P. M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R. A., Martiın, A., et al. (2018) · Kardiologia Polska · doi:10.5603/kp.2018.0161 · Cited by 475
Self-citation
Metadata
- 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
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Regione Lombardia
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › 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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