Epidemiology of syncope in hospitalized patients

William S. Getchell, Greg C. Larsen, Cynthia Morris, John H. McAnulty

Research output: Contribution to journalArticle

79 Citations (Scopus)

Abstract

OBJECTIVE: To describe the etiologies of syncope in hospitalized patients and determine the factors that influence survival after discharge. DESIGN: Observational retrospective cohort. SETTING: Department of Veterans Affairs hospital, group-model HMO, and Medicare population in Oregon. PATIENTS: Hospitalized individuals (n = 1,516; mean age ± SD, 73.0 ± 13.4 years) with an admission or discharge diagnosis of syncope (ICD-9-CM 780.2) during 1992, 1993, or 1994. MEASUREMENTS AND MAIN RESULTS: During a median hospital stay of 3 days, most individuals received an electrocardiogram (97%) and prolonged electrocardiographic monitoring (90%), but few underwent electrophysiology testing (2%) or tilt-table testing (0.7%). The treating clinicians identified cardiovascular causes of syncope in 19% of individuals and noncardiovascular causes in 40%. The remaining 42% of individuals were discharged with unexplained syncope. Complete heart block (2.4%) and ventricular tachycardia (2.3%) were rarely identified as the cause of syncope. Pacemakers were implanted in 28% of the patients with cardiovascular syncope and 0.4% of the others. No patient received an implantable defibrillator. All-cause mortality ± SE was 1.1% ± 0.3% during the admission, 13% ± 1% at 1 year, and 41% ± 2% at 4 years. The adjusted relative risk (RR) of dying for individuals with cardiovascular syncope (RR 1.18; 95% confidence interval [CI] 0.92, 1.50) did not differ from that for unexplained syncope (RR 1.0) and noncardiovascular syncope (RR 0.94; 95% CI 0.77, 1.16). CONCLUSIONS: Among these elderly patients hospitalized with syncope, noncardiovascular causes were twice as common as cardiovascular causes. Because survival was not related to the cause of syncope, clinicians cannot be reassured that hospitalized elderly patients with noncardiovascular and unexplained syncope will have excellent outcomes.

Original languageEnglish (US)
Pages (from-to)677-687
Number of pages11
JournalJournal of General Internal Medicine
Volume14
Issue number11
DOIs
StatePublished - 1999

Fingerprint

Syncope
Epidemiology
Confidence Intervals
Veterans Hospitals
Heart Block
Survival
Health Maintenance Organizations
Implantable Defibrillators
Electrophysiology
International Classification of Diseases
Ventricular Tachycardia
Medicare
Length of Stay
Electrocardiography

Keywords

  • Mortality
  • Prognosis
  • Syncope

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Epidemiology of syncope in hospitalized patients. / Getchell, William S.; Larsen, Greg C.; Morris, Cynthia; McAnulty, John H.

In: Journal of General Internal Medicine, Vol. 14, No. 11, 1999, p. 677-687.

Research output: Contribution to journalArticle

Getchell, William S. ; Larsen, Greg C. ; Morris, Cynthia ; McAnulty, John H. / Epidemiology of syncope in hospitalized patients. In: Journal of General Internal Medicine. 1999 ; Vol. 14, No. 11. pp. 677-687.
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N2 - OBJECTIVE: To describe the etiologies of syncope in hospitalized patients and determine the factors that influence survival after discharge. DESIGN: Observational retrospective cohort. SETTING: Department of Veterans Affairs hospital, group-model HMO, and Medicare population in Oregon. PATIENTS: Hospitalized individuals (n = 1,516; mean age ± SD, 73.0 ± 13.4 years) with an admission or discharge diagnosis of syncope (ICD-9-CM 780.2) during 1992, 1993, or 1994. MEASUREMENTS AND MAIN RESULTS: During a median hospital stay of 3 days, most individuals received an electrocardiogram (97%) and prolonged electrocardiographic monitoring (90%), but few underwent electrophysiology testing (2%) or tilt-table testing (0.7%). The treating clinicians identified cardiovascular causes of syncope in 19% of individuals and noncardiovascular causes in 40%. The remaining 42% of individuals were discharged with unexplained syncope. Complete heart block (2.4%) and ventricular tachycardia (2.3%) were rarely identified as the cause of syncope. Pacemakers were implanted in 28% of the patients with cardiovascular syncope and 0.4% of the others. No patient received an implantable defibrillator. All-cause mortality ± SE was 1.1% ± 0.3% during the admission, 13% ± 1% at 1 year, and 41% ± 2% at 4 years. The adjusted relative risk (RR) of dying for individuals with cardiovascular syncope (RR 1.18; 95% confidence interval [CI] 0.92, 1.50) did not differ from that for unexplained syncope (RR 1.0) and noncardiovascular syncope (RR 0.94; 95% CI 0.77, 1.16). CONCLUSIONS: Among these elderly patients hospitalized with syncope, noncardiovascular causes were twice as common as cardiovascular causes. Because survival was not related to the cause of syncope, clinicians cannot be reassured that hospitalized elderly patients with noncardiovascular and unexplained syncope will have excellent outcomes.

AB - OBJECTIVE: To describe the etiologies of syncope in hospitalized patients and determine the factors that influence survival after discharge. DESIGN: Observational retrospective cohort. SETTING: Department of Veterans Affairs hospital, group-model HMO, and Medicare population in Oregon. PATIENTS: Hospitalized individuals (n = 1,516; mean age ± SD, 73.0 ± 13.4 years) with an admission or discharge diagnosis of syncope (ICD-9-CM 780.2) during 1992, 1993, or 1994. MEASUREMENTS AND MAIN RESULTS: During a median hospital stay of 3 days, most individuals received an electrocardiogram (97%) and prolonged electrocardiographic monitoring (90%), but few underwent electrophysiology testing (2%) or tilt-table testing (0.7%). The treating clinicians identified cardiovascular causes of syncope in 19% of individuals and noncardiovascular causes in 40%. The remaining 42% of individuals were discharged with unexplained syncope. Complete heart block (2.4%) and ventricular tachycardia (2.3%) were rarely identified as the cause of syncope. Pacemakers were implanted in 28% of the patients with cardiovascular syncope and 0.4% of the others. No patient received an implantable defibrillator. All-cause mortality ± SE was 1.1% ± 0.3% during the admission, 13% ± 1% at 1 year, and 41% ± 2% at 4 years. The adjusted relative risk (RR) of dying for individuals with cardiovascular syncope (RR 1.18; 95% confidence interval [CI] 0.92, 1.50) did not differ from that for unexplained syncope (RR 1.0) and noncardiovascular syncope (RR 0.94; 95% CI 0.77, 1.16). CONCLUSIONS: Among these elderly patients hospitalized with syncope, noncardiovascular causes were twice as common as cardiovascular causes. Because survival was not related to the cause of syncope, clinicians cannot be reassured that hospitalized elderly patients with noncardiovascular and unexplained syncope will have excellent outcomes.

KW - Mortality

KW - Prognosis

KW - Syncope

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