Is syncope a risk factor for poor outcomes? comparison of patients with and without syncope**

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Objective

To determine whether syncope, independent of underlying comorbidities, is associated with increased mortality or other cardiovascular outcomes.

Patients and methods

A prospective Cohort study of patients with syncope and a group of patients without syncope matched with respect to age, gender, site of care (inpatient/ outpatient) and a cardiac disease index at an urban university medical center. Overall mortality, cardiac mortality, cardiovascular outcomes, and occurrence of syncope within 1 year of study enrollment were compared between the groups with Kaplan-Meier rates and Mantel-Cox statistics.

Results

The characteristics of 470 patients with syncope and the matched patients without syncope were similar except that the patients without syncope had more cardiac diseases than those with syncope (P = 0.002). Patients with and without syncope had similar rates of 1-year overall mortality (9% versus 11%, P = 0.29) and cardiac mortality (3% versus 6%, P = 0.08). In multivariate analyses, syncope was not a significant predictor of overall or cardiac mortality, but male gender, age >55 years, and congestive heart failure were. One-year rates for other cardiovascular outcomes (myocardial infarction, congestive heart failure, cardiac arrest with survival, and cerebrovascular events) in patients with syncope were similar to those in patients without syncope (P ≥ 0.2 for all comparisons). Patients with syncope had a 20.2% recurrence rate in 1 year as compared with a 2.1% rate for new syncope in patients without prior syncope (P <0.00001).

Conclusions

Syncope itself is not a risk factor for increased overall and cardiac mortality or cardiovascular events. Underlying heart diseases are risk factors for mortality regardless of whether the patient has syncope or not. The major focus of the evaluation of patients with syncope should be to identify and treat underlying heart diseases.

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    • 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

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      In many instances, a syncopal event in an older adult is multifactorial, with many predisposing factors present simultaneously. Older patients (>75 years of age) who present with syncope tend to have poor outcomes, both fatal and nonfatal.109,679,680 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

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    **

    This study was supported in part by a grant from the National Heart, Lung, and Blood Institute (R01 HL36735).

    1

    Dr. Kapoor is a recipient of a Research Career Development Award from the National Heart, Lung, and Blood Institute (K04L 01899).

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