Recurrent syncope is a major cause of hospitalizations and may be associated with
cardiovascular co-morbidities. Despite this, prognostic factors and the clinical characteristics
among patients are not well described. Therefore, we identified and analyzed data
on all patients >50 years of age discharged after a first-time episode of syncope
in the period 2001 to 2009 through nationwide administrative registries. We identified
the clinical characteristics of 5,141 patients ≥85 years of age and 23,454 patients
<85 years of age. Multivariate Cox models were used to assess prognostic factors associated
with the end point of recurrent syncope according to age. We found that those with
syncope and ≥85 years were more often women (65% vs 47%) and generally had a greater
prevalence of noncardiovascular co-morbidities, whereas the prevalence of cardiovascular
co-morbidities was more heterogeneously distributed across age groups. Overall, significant
baseline predictors of recurrent syncope were aortic valve stenosis (hazard ratio
[HR] 1.48, 95% confidence interval [CI] 1.31 to 1.68), impaired renal function (HR
1.34, 95% CI 1.15 to 1.58), atrioventricular or left bundle branch block (HR 1.32,
95% CI 1.16 to 1.51), male gender (HR 1.18, 95% CI 1.12 to 1.24), chronic obstructive
pulmonary disorder (HR 1.10, 95% CI 1.02 to 1.19), heart failure (HR 1.10, 95% CI
1.02 to 1.21), atrial fibrillation (HR = 1.09, 95% CI 1.01 to 1.19), age per 5-year
increment (HR 1.09, 95% CI 1.07 to 1.10), and orthostatic medications per increase
(HR 1.06, 95% CI 1.03 to 1.09). Atrial fibrillation and impaired renal function both
exhibited less prognostic importance for recurrent syncope in the elderly compared
with younger population (p for interactions <0.01). In conclusion, predictive factors
of recurrent syncope were closely associated with increased cardiovascular risk profile
age and gender. The use of multiple orthostatic medications additively increased the
risk of recurrences representing a need for strategies to reduce unnecessary polypharmacy.
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Article Info
Publication History
Published online: September 16, 2013
Accepted:
July 24,
2013
Received in revised form:
July 24,
2013
Received:
April 22,
2013
Footnotes
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 .
See page 1614 for disclosure information.
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