A Prospective Evaluation and Follow-up of Patients with Syncope
Abstract
We prospectively evaluated and followed 204 patients with syncope to determine how often a cause of syncope could be established and to define the prognosis of such patients. A cardiovascular cause was established in 53 patients and a noncardiovascular cause in 54. The cause remained unknown in 97 patients. At 12 months, the overall mortality was 14 +/- 2.5 per cent. The mortality rate (30 +/- 6.7 per cent) in patients with a cardiovascular cause of syncope was significantly higher than the rate (12 +/- 4.4 per cent) in patients with a noncardiovascular cause (P = 0.02) and the rate (6.4 +/- 2.8 per cent) in patients with syncope of unknown origin (P less than 0.0001). The incidence of sudden death was 24 +/- 6.6 per cent in patients with a cardiovascular cause, as compared with 4 +/- 2.7 per cent in patients with a noncardiovascular cause (P = 0.005) and 3 +/- 1.8 per cent in patients with syncope of unknown origin (P = 0.0002). Patients with syncope can be separated into diagnostic categories that have prognostic importance. Patients with a cardiovascular cause have a strikingly higher incidence of sudden death than patients with a noncardiovascular or unknown cause.
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The evidence suggests that routine neurological testing is of very limited value in the context of syncope evaluation and management; the diagnostic yield is low, with very high cost per diagnosis.
“The evidence suggests that routine neurological testing is of very limited value in the context of syncope evaluation and management; the diagnostic yield is low, with very high cost per diagnosis (36,77,78,251–260).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [36]
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- Authors
- Kapoor, W. N., Karpf, M., Wieand, S., Peterson, J. R., & Levey, G. S.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1983-07-28
- Volume
- 309
- Issue
- 4
- Pages
- 197-204
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2338589661
- Cited by
- 779
- References
- 0
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 2 · 2023: 7 · 2022: 4 · 2021: 6 · 2020: 10 · 2019: 6 · 2018: 13 · 2017: 20 · 2016: 14 · 2015: 14 · 2014: 22 · 2013: 19 · 2012: 18
- FWCI
- 26.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- 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 › Heart Rate Variability and Autonomic Control
- Keywords
- syncope, cardiovascular syncope, syncope of unknown origin, sudden death, mortality, prognosis, follow-up
- MeSH terms
- Adolescent, Adult, Aged, Cardiovascular Diseases, Death, Sudden, Electrocardiography, Electroencephalography, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Syncope
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