Incidence, etiology and predictors of adverse outcomes in 43,315 patients presenting to the Emergency Department with syncope: An international meta-analysis

Fabrizio D'Ascenzo, Giuseppe Biondi-Zoccai, Matthew J. Reed, Gelareh Z. Gabayan, Masaru Suzuki, Giorgio Costantino, Raffaello Furlan, Andrea Del Rosso, Francois P. Sarasin, Benjamin Sun, Maria Grazia Modena, Fiorenzo Gaita

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background: Syncope remains challenging for Emergency Department (ED) physicians due to difficulties in assessing the risk of future adverse outcomes. The aim of this meta-analysis is to establish the incidence and etiology of adverse outcomes as well as the predictors, in patients presenting with syncope to the ED. Methods: A systematic electronic literature review was performed looking for eligible studies published between 1990 and 2010. Studies reporting multivariate predictors of adverse outcomes in patients presenting with syncope to the ED were included and pooled, when appropriate, using a random-effect method. Adverse events were defined as 'incidence of death, or of hospitalization and interventional procedures because of arrhythmias, ischemic heart disease or valvular heart disease'. Results: 11 studies were included. Pooled analysis showed 42% (CI 95%; 32-52) of patients were admitted to hospital. Risk of death was 4.4% (CI 95%; 3.1-5.1) and 1.1% (CI 95%; 0.7-1.5) had a cardiovascular etiology. One third of patients were discharged without a diagnosis, while the most frequent diagnosis was 'situational, orthostatic or vasavagal syncope' in 29% (CI 95%; 12-47). 10.4% (CI 95%; 7.8-16) was diagnosed with heart disease, the most frequent type being bradyarrhythmia, 4.8% (CI 95%; 2.2-6.4) and tachyarrhythmia 2.6% (CI 95%; 1.1-3.1). Palpitations preceding syncope, exertional syncope, a history consistent of heart failure or ischemic heart disease, and evidence of bleeding were the most powerful predictors of an adverse outcome. Conclusion: Syncope carries a high risk of death, mainly related to cardiovascular disease. This large study which has established the most powerful predictors of adverse outcomes, may enable care and resources to be better focused at high risk patients.

Original languageEnglish (US)
Pages (from-to)57-62
Number of pages6
JournalInternational Journal of Cardiology
Volume167
Issue number1
DOIs
StatePublished - Jul 15 2013
Externally publishedYes

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Syncope
Meta-Analysis
Hospital Emergency Service
Incidence
Myocardial Ischemia
Heart Valve Diseases
Bradycardia
Tachycardia
Cardiac Arrhythmias
Heart Diseases
Hospitalization
Cardiovascular Diseases
Heart Failure
History
Hemorrhage
Physicians

Keywords

  • Emergency Department
  • Meta-analysis
  • Multivariate predictors
  • Prognosis
  • Syncope

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Incidence, etiology and predictors of adverse outcomes in 43,315 patients presenting to the Emergency Department with syncope : An international meta-analysis. / D'Ascenzo, Fabrizio; Biondi-Zoccai, Giuseppe; Reed, Matthew J.; Gabayan, Gelareh Z.; Suzuki, Masaru; Costantino, Giorgio; Furlan, Raffaello; Del Rosso, Andrea; Sarasin, Francois P.; Sun, Benjamin; Modena, Maria Grazia; Gaita, Fiorenzo.

In: International Journal of Cardiology, Vol. 167, No. 1, 15.07.2013, p. 57-62.

Research output: Contribution to journalArticle

D'Ascenzo, F, Biondi-Zoccai, G, Reed, MJ, Gabayan, GZ, Suzuki, M, Costantino, G, Furlan, R, Del Rosso, A, Sarasin, FP, Sun, B, Modena, MG & Gaita, F 2013, 'Incidence, etiology and predictors of adverse outcomes in 43,315 patients presenting to the Emergency Department with syncope: An international meta-analysis', International Journal of Cardiology, vol. 167, no. 1, pp. 57-62. https://doi.org/10.1016/j.ijcard.2011.11.083
D'Ascenzo, Fabrizio ; Biondi-Zoccai, Giuseppe ; Reed, Matthew J. ; Gabayan, Gelareh Z. ; Suzuki, Masaru ; Costantino, Giorgio ; Furlan, Raffaello ; Del Rosso, Andrea ; Sarasin, Francois P. ; Sun, Benjamin ; Modena, Maria Grazia ; Gaita, Fiorenzo. / Incidence, etiology and predictors of adverse outcomes in 43,315 patients presenting to the Emergency Department with syncope : An international meta-analysis. In: International Journal of Cardiology. 2013 ; Vol. 167, No. 1. pp. 57-62.
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AU - Reed, Matthew J.

AU - Gabayan, Gelareh Z.

AU - Suzuki, Masaru

AU - Costantino, Giorgio

AU - Furlan, Raffaello

AU - Del Rosso, Andrea

AU - Sarasin, Francois P.

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