Arrhythmias and Conduction DisturbancesComparison of Incidence, Predictors, and the Impact of Co-Morbidity and Polypharmacy on the Risk of Recurrent Syncope in Patients <85 Versus ≥85 Years of Age
Section snippets
Methods
All Danish residents are given a personal 10-digit civil registration number14, 15 at birth or when moving to the country, which enables linkage of nationwide administrative registers on the individual level. Information on all dispensed prescriptions from Danish pharmacies since 1995 is registered according to the Anatomical Therapeutic Chemical (ATC) system in The Register of Medicinal Product Statistics.16 Information on hospitalization and co-morbidities were obtained from the Danish
Results
During a mean follow-up of 3.4 years (SD 2.5), 6,267 patients (22%) had at least 1 recurrent syncope with a mean time to first recurrent syncope of 2.0 years (SD 2.0), and 50% of these had the recurrence within 1.2 years. Proportionately, recurrent syncope occurred evenly in the 4 age groups; 18%, 22%, 24%, and 23% for ages <65, 65 to 74, 75 to 84, and ≥85 years, respectively. Male gender was less common among the very elderly patients but more frequent in age groups 50 to 64 and 65 to 74 years
Discussion
In this nationwide study of patients with first-time syncope, we analyzed prognostic factors associated with recurrent syncope and the impact of co-morbidities and polypharmacy according to age. Important novel findings were related to 4 major topics: recurrence, co-morbidities, clinical predictors, and polypharmacy.
Compared with other older and smaller studies,25, 26, 27 the incidence of hospitalization for recurrent syncope around 22% after first-time syncope within a mean follow-up period of
Acknowledgment
None of these institutions had any influence on the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Dr. Ruwald had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed
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Cited by (41)
Syncope and the aging patient: Navigating the challenges
2022, Autonomic Neuroscience: Basic and ClinicalCitation Excerpt :Nitrate use, combined use of angiotensin-converting enzyme inhibitors (ACEi), and combined use of ACEi and diuretics were independently associated with OH-related syncope (Testa et al., 2018). The number of orthostatic medications taken by elderly patients is a strong predictor of recurrent syncope (Ruwald et al., 2013). Therefore, advancing age, the presence of orthostatic hypotension and certain medication classes and their combination seem to be more related to risk of falls and syncope than tight blood pressure control.
Variation in diagnostic testing for older patients with syncope in the emergency department
2019, American Journal of Emergency MedicineCitation Excerpt :We did not include an analysis of orthostatic vital signs in our analysis, which have previously been touted as a test with low cost and high diagnostic yield [3]. Orthostatic vital signs have proven to be a controversial topic in the role of syncope evaluation, as there is a high-degree of subjectivity in interpreting results and assigning as a causative mechanism for the presenting episode, especially since patient-reported symptoms are typically included as a “positive” result [30-34]. While the cost to perform this test is comprised only of the staff time to perform and interpret them, we chose not to include them in our analysis due to the lack of objectivity in their interpretation.
Role of Geriatric Syndromes in the Management of Atrial Fibrillation in Older Adults: A Narrative Review
2019, Journal of the American Medical Directors AssociationAutonomic dysfunction: Diagnosis and management
2019, Handbook of Clinical NeurologyCitation Excerpt :Given the overlap between falls and syncope in the elderly, interest has emerged in analyzing the presence of asymptomatic arrhythmias in these patients. Atrial fibrillation, the most common cardiac arrhythmia in adults, has been linked to recurrent syncope and falls (Ruwald et al., 2013). Indeed, AF has been found to be an independent predictor of nonaccidental falls in older adults (Sanders et al., 2012).
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
2017, Journal of the American College of CardiologyCitation Excerpt :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). Furthermore, recurrent syncope can lead to nursing home admission and a devastating loss of independence (683).
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
2017, Heart RhythmCitation Excerpt :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 Furthermore, recurrent syncope can lead to nursing home admission and a devastating loss of independence.683
Dr. Ruwald was supported by unrestricted grants 12-04-R90-A3806-22701 from The Danish Heart Association, R108-A104415 from The Lundbeck Foundation, 2012B018 from Helsefonden, and grants from Arvid Nilssons Fond, Snedkermester Sophus Jacobsens Fond, and Else og Mogens Wedell-Wedellsborgs Fond. Dr. Gislason is supported by an independent research scholarship from the Novo Nordisk Foundation.
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