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Diagnosis and Characteristics of Syncope in Older Patients Referred to Geriatric Departments
Open accessAbstract
OBJECTIVES: To test the applicability and safety of a standardized diagnostic algorithm in geriatric departments and to define the prevalence of different causes of syncope in older patients. DESIGN: Multicenter cross-sectional observational study. SETTING: In-hospital geriatric acute care departments and outpatient clinics. PARTICIPANTS: Two hundred forty-two patients (aged>or=65, mean+/-standard deviation=79+/-7, range 65-98) consecutively referred for evaluation of transient loss of consciousness to any of six clinical centers participating in the study. Of these, 11 had a syncope-like condition (5 transient ischemic attack; 6 seizures), and 231 had syncope (aged 65-74, n=71; aged>or=75, n=160). MEASUREMENTS: Protocol designed to define etiology and clinical characteristics of syncope derived from European Society of Cardiology Guidelines on syncope. RESULTS: No major complication occurred with use of the protocol. Neurally mediated was the more prevalent form of syncope in this population (66.6%). Cardiac causes accounted for 14.7% of all cases. The neuroreflex form of syncope (vasovagal, situational, and carotid sinus syndrome) was more common in younger than in older patients (62.3% vs 36.2%; P=.001), whereas orthostatic syncope was more frequent in the older than in the younger group (30.5% vs 4.2%; P<.001). In only 10.4% of cases, syncope remained of unexplained origin. After initial evaluation, a definite diagnosis was possible in 40.1% of the cases, and a suspected diagnosis was obtained in 57.9%. Syncope of suspected cardiac origin after initial evaluation was confirmed in 43.7% of cases, and neuromediated causes were confirmed in 83.5% of the cases. CONCLUSION: The protocol is applicable even beyond the age of 90 in geriatric departments. The standardized protocol is associated with a reduction in the frequency of unexplained syncope to about 10%.
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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
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Metadata
- Authors
- Ungar, A., Mussi, C., Del Rosso, A., Noro, G., Abete, P., Ghirelli, L., Cellai, T., Landi, A., Salvioli, G., Rengo, F., Marchionni, N., Masotti, G., & for the Italian Group for the Study of Syncope in the Elderly
- Affiliations
- University of Modena and Reggio Emilia (IT)
- Corresponding author
- Ungar, Andrea
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2006-09-15
- Volume
- 54
- Issue
- 10
- Pages
- 1531-1536
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- OpenAlex
- W2152101062
- Cited by
- 127
- References
- 24
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 2 · 2023: 4 · 2022: 10 · 2021: 4 · 2019: 2 · 2018: 11 · 2017: 10 · 2016: 6 · 2015: 4 · 2014: 15 · 2013: 14 · 2012: 7
- FWCI
- 7.05
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Florence Research (University of Florence) (submittedVersion)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Keywords
- syncope, older adults, geriatric departments, diagnostic algorithm, syncope etiology, neurally mediated syncope, vasovagal syncope, carotid sinus syndrome, orthostatic syncope, cardiac syncope, transient ischemic attack, seizures, unexplained syncope
- MeSH terms
- Age Factors, Aged, Aged, 80 and over, Algorithms, Cross-Sectional Studies, Decision Trees, Female, Health Services for the Aged, Hospital Departments, Humans, Male, Middle Aged, Referral and Consultation, Syncope, Geriatric Assessment
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