Two-year morbidity and mortality in elderly patients with syncope
Open accessAbstract
BACKGROUND: syncope is a common cause of hospitalisation in the elderly. However, morbidity and mortality in elderly patients with syncope is not well established. METHODS: two-hundred and forty-two patients older than 65 years consecutively referred to the participating centres for evaluation of transient loss of consciousness were enrolled in a multicentre 2-year longitudinal observational study. Mortality and syncope recurrences were recorded and multidimensionally evaluated at 6, 12, 18 and 24 months. FINDINGS: at 24 months, total mortality was 17.2% and syncope recurrence was 32.5%. Cardiac syncope was more frequent in deceased than in survivor patients (21.7 versus 12.3%; P = 0.03), whereas neuro-mediated (62.1 versus 66.2%; P = 0.357) and unexplained syncope (10.8 versus 11.8%; P = 0.397) did not differ between the two groups. Drug-induced and/or multifactorial syncope was less frequent in patients with syncope recurrence (5.7 versus 10.7%; P = 0.02). Kaplan-Meyer curves indicated that mortality and syncope recurrence increased significantly with age (P = 0.006 and P = 0.008, respectively). At multivariate analysis, mortality was significantly predicted by age and comorbidity (hazard ratios: 1.17 and 1.39, and 95% confidence interval 1.01-1.37 and 1.01-1.93, respectively), and syncope recurrence by age and disability (hazard ratio: 1.13 and 1.04, 95% confidence interval 1.01-1.25 and 1.04-2.25, respectively). Depression increased from baseline to the end of follow-up (from 28.3 to 41.4%; P = 0.001). CONCLUSIONS: in our patients, mortality was related to increasing age and comorbidity, whereas recurrence was related to increasing age and disability. Cardiac syncope was more frequent in deceased than in survivor patients, and syncope recurrence was high despite a low incidence of unexplained syncope.
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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 [682]
The Mortality and syncope recurrence section reports that age and comorbidity predicted mortality, while age and disability predicted recurrence in elderly patients with syncope. The Mortality in elderly patients with syncope section describes deceased patients as having characteristics typical of frailty. The paper does not establish that frailty independently compounds risk or that these factors increase older adults’ vulnerability to developing syncope in the first place; its findings concern outcomes after syncope. (LLM, conf=0.85)
Experimental — accuracy not yet measuredOrthostatic blood pressure measurements, carotid sinus massage, and tilt testing are well tolerated, even in the frail elderly with cognitive impairment.
“Orthostatic BP measurements, CSM, and tilt testing are well tolerated, even in the frail elderly with cognitive impairment. 96,396,397”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [397]
The Diagnostic protocol describes tilt testing, carotid sinus massage and orthostatic blood-pressure criteria, but does not report how well patients tolerated the tests. The Methods exclude patients with severe cognitive impairment and substantial disability. Searches for tolerability, adverse events and testing in frail patients with cognitive impairment found no passage establishing the claim. (LLM, conf=0.76)
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Costantini, M., Costantini, L., & Maffia, M. (2020) · Journal of Gerontology and Geriatrics · doi:10.36150/2499-6564-325
Puisieux, F. L. (2022) · EMC - Tratado de Medicina · doi:10.1016/s1636-5410(22)46836-x
Syncope du sujet âgé : quelles spécificités ?
Puisieux, F. L. (2022) · La Presse Médicale Formation · doi:10.1016/j.lpmfor.2022.10.012
Puisieux, F. L. (2022) · EMC - AKOS - Trattato di Medicina · doi:10.1016/s1634-7358(22)46918-x
An unusual case of neurocardiogenic syncope: A case report and systematic review
Tan, W. W., Adler, M., Rochow, S. B., & Myint, P. K. (2023) · The Journal of the Royal College of Physicians of Edinburgh · doi:10.1177/14782715221147969
Onset Mechanisms and Prognosis of Neurally Mediated Syncope
Komiyama, T., Ayabe, K., Hasegawa, M., Yoshikawa, M., Sakama, S., Lee, K. H., Yagishita, A., Amino, M., Nagata, E., Ikari, Y., et al. (2023) · Reports — Medical Cases Images and Videos · doi:10.3390/reports6040056
Abklärung und Behandlung der Synkope
Dovjak, P. (2014) · Zeitschrift für Gerontologie und Geriatrie · doi:10.1007/s00391-014-0824-5
- Authors
- Ungar, A., Galizia, G., Morrione, A., Mussi, C., Noro, G., Ghirelli, L., Masotti, G., Rengo, F., Marchionni, N., & Abete, P.
- Affiliations
- Azienda Ospedaliero-Universitaria Careggi (IT)
- Federico II University Hospital (IT)
- University of Modena and Reggio Emilia (IT)
- Ospedale Santa Chiara (IT)
- Santa Maria Nuova Hospital (IT)
- Corresponding author
- Ungar, A.
- Venue
- Age and Ageing
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-09-09
- Volume
- 40
- Issue
- 6
- Pages
- 696-702
- ISSN
- 0002-0729 (ISSN-L)
- 1468-2834
- OpenAlex
- W2114571530
- Cited by
- 56
- References
- 21
- Citations by year
- 2026: 1 · 2024: 2 · 2023: 4 · 2022: 6 · 2021: 4 · 2020: 8 · 2019: 5 · 2018: 6 · 2017: 4 · 2015: 1 · 2014: 6 · 2013: 7 · 2012: 2
- FWCI
- 4.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Age and Ageing (publishedVersion)
- PubMed (publishedVersion)
- Florence Research (University of Florence) (submittedVersion)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
- HighWire Press Open Archive (submittedVersion)
- INFM-OAR (INFN Catania) (submittedVersion, other-oa)
- 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 › Geriatrics and Gerontology › Frailty in Older Adults
- Keywords
- syncope, elderly patients, mortality, syncope recurrence, cardiac syncope, unexplained syncope, drug-induced syncope, comorbidities, disability, depression, age as risk factor
- MeSH terms
- Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Italy, Longitudinal Studies, Male, Morbidity, Prospective Studies, Recurrence, Retrospective Studies, Syncope, Survival Rate, Multivariate Analysis
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