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Reflex syncope in the UK Armed Forces
  1. Iain Parsons1,2,
  2. J Ellwood3,
  3. M J Stacey1,
  4. N Gall4,
  5. M Grundy-Bowers3,
  6. P Chowienczyk2 and
  7. D Woods1
  1. 1Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  2. 2School of Cardiovascular Medicine and Sciences, King's College London, London, UK
  3. 3Department of Nursing, City University of London, London, UK
  4. 4Department of Cardiology, King's College Hospital, London, UK
  1. Correspondence to Maj Iain Parsons, Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham B15 2TH, UK; iainparsons{at}doctors.org.uk

Abstract

Introduction Reflex syncope is the most common subtype of syncope and, despite not being associated with increased mortality, often results in significant morbidity and costly diagnostics. Reflex syncope can be of concern for certain occupational groups and may be exacerbated by some occupations. Reflex syncope in the military is anecdotally common but the extent in the UK Armed Forces (UKAF) is unknown. The aim of this study was to assess the incidence and prevalence of reflex syncope in the UKAF.

Methods A retrospective search of the Defence Medical Information Capability Programme using prespecified read-codes was performed at defence primary healthcare centres over the period of 1 January 2019 to 1 January 2020. Data were obtained on 76 103 service personnel (SP) (53% of the UKAF).

Results The overall syncope case rate for the UKAF was 10.5 per 1000 person-years (p-yrs). In comparing services there was a significantly increased risk of syncope in the British Army (10.7 per 1000 p-yrs) compared with the Royal Air Force (8.6 per 1000 p-yrs) (p=0.0365), SP who served overseas (16.7 per 1000 p-yrs) in comparison with UK medical centres (10.3 per 1000 p-yrs) (p<0.0001), and British Army units that regularly took part in State Ceremonial and Public Duties (15.8 per 1000 p-yrs vs 10.2 per 1000 p-yrs) (p=0.0035). Army training units conferred a significantly reduced risk of syncope (p<0.0001).

Conclusions These data are the first to define the incidence and prevalence of syncope in the UKAF. Orthostasis and heat are probable triggers, although recruits are potentially protected. These data offer opportunities to improve the health and well-being of SP, with economic, logistical and reputational benefits for the UKAF. Further research to identify personnel at risk of future syncopal events may allow for targeted use of countermeasures.

  • cardiac epidemiology
  • pacing & electrophysiology
  • cardiology

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Contributors IP conceived the study, performed the analysis and drafted the manuscript. JE performed data collection, performed the analysis, and drafted and reviewed the manuscript. MJS critically edited the manuscript and contributed to the content. NG and PC critically edited the manuscript and reviewed the content. MG-B critically edited the manuscript and reviewed the manuscript. DW edited the manuscript, provided insight to data analysis and was responsible for the overarching review of the content. All authors reviewed the manuscript.

  • Funding This study was supported by the Ministry of Defence.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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