Original Article
Prevalence and Clinical Outcomes of Patients With Multiple Potential Causes of Syncope

https://doi.org/10.4065/78.4.414Get rights and content

Objective

To determine the prevalence, predictors, and prognosis of patients with multiple potential causes of syncope.

Patients and Methods

This is a retrospective cohort study with prospective follow-up of consecutive patients with syncope of uncertain cause who were referred to the electrophysiology service for syncope evaluation from January 1, 1996, through December 31, 1998. The main outcome measures were prevalence of multiple potential causes of syncope, survival of patients with multiple potential causes of syncope compared with survival of patients with a single cause, and clinical predictors of multiple potential causes of syncope.

Results

A total of 987 patients were studied (mean ± SD age, 58.0±21.4 years; male, 550 [55.7%]). Multiple potential causes were present in 182 patients (18.4%). Patients with multiple potential causes of syncope had a lower survival rate at 4 years, 73.1% (95% confidence interval, 64.6%-82.8%), vs those with a single cause, 89.3% (95% confidence interval, 86.4%-92.2%) (P<.001). Multivariate predictors of multiple potential causes were older age, atrial fibrillation, use of cardiac medications, and New York Heart Association classification II, III, and IV.

Conclusion

Of the patients evaluated for syncope, 18.4% had multiple potential causes. The presence of multiple potential causes was an independent predictor of increased mortality among patients with syncope.

Section snippets

Patient Accrual

All patients who were referred to the electrophysiology service for the evaluation of syncope at the Mayo Clinic in Rochester, Minn, from January 1, 1996, through December 31, 1998, were retrospectively identified and included in the study. These patients were referred from Mayo Clinic outpatient clinics, inpatient services, and hospital emergency departments and from other institutions. They were referred because, after an initial evaluation that included a history, physical examination,

Patient Characteristics

From January 1, 1996, through December 31, 1998, 3942 patients were evaluated at the Mayo Clinic for syncope. Of these, 1043 consecutive patients were referred to the electrophysiology service; 987 patients met study criteria, consented to having their charts reviewed, and were included in the analysis. The mean ± SD age was 58.0±21.4 years; 550 patients (55.7%) were male (Table 1).

Syncope Evaluation

Of the total 987 patients, 228 (23.1%) had electrophysiologic testing, 493 (49.9%) had table tilt testing, and 266

Major Findings

In this retrospective cohort study of 987 patients, the major findings were as follows: (1) multiple potential causes of syncope occurred in 18.4% of the patients; (2) multiple potential causes correlated with increased mortality; (3) patients with multiple potential causes had a greater recurrence rate, although this was not statistically significant; (4) older age, atrial fibrillation, use of cardiac medications, and New York Heart Association classification II, III, and IV were independent

CONCLUSION

This study emphasizes that syncope from multiple potential causes is a common phenomenon, especially in the elderly population. These patients also tend to have a greater mortality risk. Future research on therapeutic interventions and clinical outcomes is warranted with the aim of reducing recurrent symptoms and improving survival in patients who have multiple potential causes of syncope.

REFERENCES (33)

  • LA Lipsitz et al.

    Syncope in an elderly, institutionalised population: prevalence, incidence, and associated risk

    Q J Med

    (1985)
  • WN Kapoor

    Evaluation and outcome of patients with syncope

    Medicine (Baltimore)

    (1990)
  • WN Kapoor

    Evaluation and management of the patient with syncope

    JAMA

    (1992)
  • W-K Shen et al.

    Fainting: approach to management

  • KA Eagle et al.

    The impact of diagnostic tests in evaluating patients with syncope

    Yale J Biol Med

    (1983)
  • M Linzer et al.

    Diagnosing syncope, part 1: value of history, physical examination, and electrocardiography: Clinical Efficacy Assessment Project of the American College of Physicians

    Ann Intern Med

    (1997)
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