Short-term prognosis and current management of syncopal patients at intermediate risk: results from the IRiS (Intermediate-Risk Syncope) study
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OBJECTIVES: Despite guidelines, admission rates and expenditures for syncope remain high. This may be caused by an imprecise definition of cardiovascular disease considered at risk and an overestimation of the role of comorbidities and advanced age. In a cohort of patients with undetermined syncope, we prospectively compared the short-term prognosis of patients at intermediate risk (i.e., with stable heart diseases or comorbidities, of any age) versus those at high risk for cardiogenic syncope and identified factors associated with serious events. Secondarily, we analyzed the current management of intermediate-risk patients. METHODS: In a cohort of patients with undetermined syncope, we analyzed personal data, the presence of stable heart diseases or comorbidities, destination, length of hospitalization, incidence of serious events at 30 days, and costs. RESULTS: In a 6-month period, 347 patients (185 male and 162 female, age 72.8 years) with undetermined syncope were enrolled, 250 at intermediate risk and 97 at high risk. Intermediate-risk patients were younger, with less frequent comorbidities and with a drastically lower incidence of serious events (0.8% vs. 27.8%, p < 0.001). Risk factors for cardiogenic syncope were the unique variable associated with serious events. Intermediate-risk patients were mostly admitted (62.8%) in an ordinary ward or into an emergency department observation unit; in the case of ordinary admission we observed a mean prolonged hospitalization (8.8 days), elevated costs ($270,183), and a high rate of unexplained syncope (51%). CONCLUSIONS: According to the results of this study, the authors believe that intermediate-risk patients could be safely discharged, with potentially significant costs saving. In prognostic stratification, priority is to seek risk factors for cardiogenic syncope while advanced age, stable heart diseases, or comorbidities likely lead to inappropriate hospitalization.
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It is the acute underlying disease that most frequently determines short-term adverse events rather than the syncope itself.
“It is the acute underlying disease that most frequently determines short-term adverse events rather than the syncope itself. 43”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [43]
The Discussion says high-risk features of cardiogenic syncope were associated with short-term adverse events, and it recounts earlier work finding that underlying heart disease, rather than syncope itself, predicted death. It does not establish that acute underlying disease most frequently determines short-term adverse events; actively decompensated diseases needing admission were excluded from the study (Table 2). (LLM, conf=0.85)
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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 · see citing works
Derivation of the San Francisco Syncope Rule to predict patients with short-term serious outcomes
Quinn, J. V., Stiell, I. G., McDermott, D. A., Sellers, K. L., Kohn, M. A., & Wells, G. A. (2004) · Annals of Emergency Medicine · doi:10.1016/s0196-0644(03)00823-0 · Cited by 432 · see citing works
Colivicchi, F. (2003) · European Heart Journal · doi:10.1016/s0195-668x(02)00827-8 · Cited by 359 · see citing works
Del Rosso, A., Ungar, A., Maggi, R., Giada, F., Petix, N. R., De Santo, T., Menozzi, C., & Brignole, M. (2008) · Heart · doi:10.1136/hrt.2008.143123 · Cited by 344 · see citing works
Brignole, M., Menozzi, C., Bartoletti, A., Giada, F., Lagi, A., Ungar, A., Ponassi, I., Mussi, C., Maggi, R., Re, G., et al. (2006) · European Heart Journal · doi:10.1093/eurheartj/ehi647 · Cited by 332 · see citing works
Shen, W. K., Decker, W. W., Smars, P. A., Goyal, D. G., Walker, A. E., Hodge, D. O., Trusty, J. M., Brekke, K. M., Jahangir, A., Brady, P. A., et al. (2004) · Circulation · doi:10.1161/01.cir.0000149236.92822.07 · Cited by 318 · see citing works
Syncope in advanced heart failure: high risk of sudden death regardless of origin of syncope
Middlekauff, H. R., Stevenson, W. G., Stevenson, L. W., & Saxon, L. A. (1993) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(93)90724-f · Cited by 311 · see citing works
The ROSE (Risk Stratification of Syncope in the Emergency Department) Study
Reed, M. J., Newby, D. E., Coull, A. J., Prescott, R. J., Jacques, K. G., & Gray, A. J. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2009.09.049 · Cited by 272 · see citing works
Short- and Long-Term Prognosis of Syncope, Risk Factors, and Role of Hospital Admission
Costantino, G., Perego, F., Dipaola, F., Borella, M., Galli, A., Cantoni, G., Dell’Orto, S., Dassi, S., Filardo, N., Duca, P. G., et al. (2008) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.08.059 · Cited by 246 · see citing works
Huff, J. S., Decker, W. W., Quinn, J. V., Perron, A. D., Napoli, A. M., Peeters, S., & Jagoda, A. S. (2007) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2007.02.001 · Cited by 157 · see citing works
Costantino, G., Sun, B. C., Barbic, F., Bossi, I., Casazza, G., Dipaola, F., McDermott, D., Quinn, J., Reed, M. J., Sheldon, R. S., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehv378 · Cited by 138 · see citing works
Sheldon, R. S., Morillo, C. A., Krahn, A. D., O'Neill, B., Thiruganasambandamoorthy, V., Parkash, R., Talajic, M., Tu, J. V., Seifer, C., Johnstone, D., et al. (2011) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2010.11.002 · Cited by 126 · see citing works
Sun, B. C., McCreath, H., Liang, L.-J., Bohan, S., Baugh, C., Ragsdale, L., Henderson, S. O., Clark, C., Bastani, A., Keeler, E., et al. (2014) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2013.10.029 · Cited by 114 · see citing works
Do Symptoms Predict Cardiac Arrhythmias and Mortality in Patients With Syncope?
Oh, J. H., Hanusa, B. H., & Kapoor, W. N. (1999) · Archives of Internal Medicine · doi:10.1001/archinte.159.4.375 · Cited by 102 · see citing works
New Concepts in the Assessment of Syncope
Brignole, M., & Hamdan, M. H. (2012) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.11.056 · Cited by 75 · see citing works
Determining Sample Sizes Needed to Detect a Difference between Two Proportions
Fleiss, J. L., Levin, B., & Paik, M. C. (2003) · Wiley series in probability and statistics · doi:10.1002/0471445428.ch4 · Cited by 53 · see citing works
The older patient with syncope: Practicalities and controversies
Marrison, V. K., Fletcher, A., & Parry, S. W. (2010) · International Journal of Cardiology · doi:10.1016/j.ijcard.2010.10.055 · Cited by 37 · see citing works
Grossman, S. A., Chiu, D. T. W., Lipsitz, L. A., Mottley, J. L., & Shapiro, N. I. (2013) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2013.07.010 · Cited by 22 · see citing works
Numeroso, F., Mossini, G., Lippi, G., & Cervellin, G. (2017) · Clinical and Experimental Emergency Medicine · doi:10.15441/ceem.17.231 · Cited by 15 · see citing works
Self-citationEvaluation of the current prognostic role of cardiogenic syncope
Numeroso, F., Mossini, G., Lippi, G., & Cervellin, G. (2012) · Internal and Emergency Medicine · doi:10.1007/s11739-012-0889-3 · Cited by 8 · see citing works
Self-citationSyncope Risk Stratification in the Emergency Department: Another Step Forward
Nicks, B. A., & Hiestand, B. C. (2016) · Academic Emergency Medicine · doi:10.1111/acem.13036 · Cited by 3 · see citing works
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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 · see citing works
2018 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 474 · see citing works
Predictors of Short-Term Outcomes after Syncope: A Systematic Review and Meta-Analysis
Gibson, T. A., Weiss, R., & Sun, B. (2018) · Western Journal of Emergency Medicine · doi:10.5811/westjem.2018.2.37100 · Cited by 24 · see citing works
Outcomes in syncope research: a systematic review and critical appraisal
Solbiati, M., Bozzano, V., Barbic, F., Casazza, G., Dipaola, F., Quinn, J., Reed, M. J., Sheldon, R. S., Shen, W.-K., Sun, B., et al. (2018) · Internal and Emergency Medicine · doi:10.1007/s11739-018-1788-z · Cited by 17 · see citing works
Numeroso, F., Mossini, G., Lippi, G., & Cervellin, G. (2017) · Clinical and Experimental Emergency Medicine · doi:10.15441/ceem.17.231 · Cited by 15 · see citing works
Self-citationSyncope in the Emergency Department: A Guide for Clinicians
Hussein, M. T. E., & Cuncannon, A. (2020) · Journal of Emergency Nursing · doi:10.1016/j.jen.2020.11.002 · Cited by 11 · see citing works
Chang, A. M., Hollander, J. E., Su, E., Weiss, R. E., Yagapen, A. N., Malveau, S. E., Adler, D. H., Bastani, A., Baugh, C. W., Caterino, J. M., et al. (2018) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2018.08.004 · Cited by 10 · see citing works
Numeroso, F., Mossini, G., Lippi, G., & Cervellin, G. (2019) · International Journal of Cardiology · doi:10.1016/j.ijcard.2019.02.021 · Cited by 5 · see citing works
Self-citationFurlan, L., Trombetta, L., Casazza, G., Dipaola, F., Furlan, R., Marta, C., Numeroso, F., Pérez‐Rodon, J., Quinn, J., Reed, M. J., et al. (2021) · Medicina · doi:10.3390/medicina57111235 · Cited by 5 · see citing works
Self-citationİnce, Ç., Gülen, M., Acehan, S., Sevdimbaş, S., Balcik, M., Yuksek, A., & Satar, S. (2023) · Irish Journal of Medical Science (1971 -) · doi:10.1007/s11845-023-03395-6 · Cited by 5 · see citing works
Ort, B. B. A., Broek-Creemers, L. G. U. H., de Bruin, H., Akkermans, R., Goosselink, B., Vermeulen, H., Ebben, R. H. A., Vloet, L. C. M., & Berben, S. A. A. (2023) · BMC Emergency Medicine · doi:10.1186/s12873-023-00890-y · Cited by 4 · see citing works
Current best practices in emergency evaluation and management of syncope
Geer, B. (2021) · The Nurse Practitioner · doi:10.1097/01.npr.0000757080.85601.1e · Cited by 4 · see citing works
Brignole, M. (2018) · Emergency Care Journal · doi:10.4081/ecj.2018.7509 · Cited by 3 · see citing works
Goldsmith, A. J., Duggan, N. M., Keschner, Y. G., Baymon, D. E., Luo, A. D., Nagdev, A. D., Kapur, T., Caplan, S., Meguerdichian, D. A., & Baugh, C. W. (2025) · Journal of the American College of Emergency Physicians Open · doi:10.1016/j.acepjo.2025.100139 · Cited by 3 · see citing works
Cardiovascular Conditions in the Observation Unit
Gaddy, J., Davenport, K., & Hiestand, B. C. (2017) · Emergency Medicine Clinics of North America · doi:10.1016/j.emc.2017.03.004 · Cited by 3 · see citing works
Syncope Risk Stratification in the Emergency Department: Another Step Forward
Nicks, B. A., & Hiestand, B. C. (2016) · Academic Emergency Medicine · doi:10.1111/acem.13036 · Cited by 3 · see citing works
Orthostatic hypotension: clinical review and case study
Bailey, R., & Mortimore, G. (2020) · British Journal of Nursing · doi:10.12968/bjon.2020.29.9.506 · Cited by 2 · see citing works
Christ, M., & Bruno, R. R. (2019) · Notfall + Rettungsmedizin · doi:10.1007/s10049-019-0583-3 · Cited by 2 · see citing works
2018 KHRS guideline for the evaluation and management of syncope-Part 1
Park, J., Cha, M.-J., Kim, D. H., Kim, Y. R., Mun, H. S., Bae, E. J., Seo, D. W., Song, M. K., Ahn, J., Yoon, H. D., et al. (2018) · International Journal of Arrhythmia · doi:10.18501/arrhythmia.2018.009 · Cited by 1 · see citing works
2018 KHRS guideline for the evaluation and management of syncope-Part 2
Kim, Y. R., Chun, K. J., Kim, J. S., Mun, H. S., Park, J., Seo, D. W., Song, M. K., Ahn, J. H., Yoon, H. J., Lee, D. I., et al. (2018) · International Journal of Arrhythmia · doi:10.18501/arrhythmia.2018.010 · Cited by 1 · see citing works
Ort, B. B. A., Broek-Creemers, L. G. U. H., de Bruin, H., Akkermans, R. P., Goosselink, B., Vermeulen, H., Ebben, R. H. A., Vloet, L. C. M., & Berben, S. A. A. (2024) · Figshare · doi:10.6084/m9.figshare.24257636
Ort, B. B. A., Broek-Creemers, L. G. U. H., de Bruin, H., Akkermans, R. P., Goosselink, B., Vermeulen, H., Ebben, R. H. A., Vloet, L. C. M., & Berben, S. A. A. (2023) · Figshare · doi:10.6084/m9.figshare.24257448
Carbonel–Tabuenca, A., López‐Sobrino, T., Vilurbina–Pérez, P., Andujar‐Lara, I., Cararach‐Salami, D., Borges, B. A., Szlendak, L., Golvano, L. C. C., & Paz, L. G. (2026) · BMC Emergency Medicine · doi:10.1186/s12873-026-01533-8
Burlon, F., Poggiali, E., Bolognesi, M. G., Aschieri, D., & Vercelli, A. (2026) · Emergency Care Journal · doi:10.4081/ecj.2026.15166
- Authors
- Numeroso, F., Mossini, G., Giovanelli, M., Lippi, G., & Cervellin, G.
- Affiliations
- Ospedale di Parma (IT)
- University of Parma (IT)
- Corresponding author
- Numeroso, Filippo
- Venue
- Academic Emergency Medicine
- Publisher
- Wiley
- Published
- 2016-08
- Volume
- 23
- Issue
- 8
- Pages
- 941-948
- ISSN
- 1069-6563 (ISSN-L)
- 1553-2712
- OpenAlex
- W2374389791
- Cited by
- 24
- References
- 21
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 3 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 8 · 2017: 2 · 2016: 1
- FWCI
- 4.80
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Academic Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Keywords
- syncope, cardiac syncope, short-term prognosis, risk stratification, hospitalization, length of hospital stay, health care costs, unexplained syncope, risk factors, emergency department observation unit, discharge
- MeSH terms
- Aged, Aged, 80 and over, Cardiovascular Diseases, Emergency Medicine, Female, Hospitalization, Humans, Length of Stay, Male, Middle Aged, Prognosis, Risk Factors, Syncope, Cohort Studies, Comorbidity, Incidence
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