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ARTICLE CONTRIBUTORS

Journal of the American College of Cardiology

Clinical Articles, Lead Article

Syncope associated with increased mortality

The first admission for syncope among healthy individuals significantly predicts the risk of all-cause mortality, stroke, cardiovascular hospitalisation, device implantation, and recurrent syncope, according to a study1 published recently in the Journal of the American College of Cardiology.

Researchers investigated patients without previous comorbidity admitted for syncope in Denmark from 2001 to 2009, from nationwide administrative registries, and matched by sex and age with five control subjects from the Danish population. The risk of death or recurrent syncope, implantation of pacemaker or implantable cardioverter-defibrillator, and cardiovascular hospitalisation were analysed with multivariable Cox proportional hazard models.

They identified 37,017 patients with a first-time diagnosis of syncope and 185,085 control subjects; their median age was 47 years (interquartile range, 32 to 63 years) and 47% were male. A total of 3,023 (8.2%) and 14,251 (7.1%) [p = 0.0033] deaths occurred in the syncope and the control population, respectively, yielding an event rate of 14.3 per 1,000 person-years (PY) in the syncope population.

Multivariable Cox regression analysis demonstrated a significantly increased risk of all-cause mortality, cardiovascular hospitalisation event rate of 26.5 per 1,000 PY, recurrent syncope event rate of 45.1 per 1,000, stroke event rate of 6.8 per 1,000 PY, and pacemaker or implantable cardioverter-defibrillator event rate of 4.2 per 1,000 PY.

In an accompanying editorial, Dr Robert Sheldon (Libin Cardiovascular Institute of Calgary, Canada) says that the study “provides solid grounding of our understanding of the numbers and long-term outcome of apparently well syncope patients in an entire nation, and this alone is a unique contribution… It shows that even low-risk patients with apparently no comorbidities on presentation need to be reviewed carefully.”

References

1. Ruwald MH, Hansen ML, Lamberts M, et al. Prognosis among healthy individuals discharged with a primary diagnosis of syncope. J Am Coll Cardiol 2013. http://dx.doi.org/10.1016/j.jacc.2012.08.1024

2. Sheldon R. Syncope outcomes in a National Health database: low risk is not no risk. J Am Coll Cardiol 2013. http://dx.doi.org/10.1016/j.jacc.2012.10.019

Published on: December 20, 2012

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  • Atrial Fibrillation Association
 

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