Clinical Decisionmaking

Outcomes of patients hospitalized for syncope usually are determined by age and coexisting illness

From 1 to 6 percent of people hospitalized are admitted to the hospital for syncope (brief loss of consciousness). Studies during the 1980s concluded that syncope due to cardiovascular causes led to more deaths than noncardiovascular or unexplained syncope. The findings from a recent study appear to contradict this earlier conclusion. The study, which was supported in part by the Agency for Healthcare Research and Quality National Research Service Award training grant T32 HS00069), demonstrates that patient survival is not related to the cause of syncope.

In fact, doctors cannot be sure that hospitalized elderly patients with noncardiovascular and unexplained syncope will have excellent outcomes, conclude William S. Getchell, M.D., M.P.H., and colleagues at the Oregon Health Sciences University and Portland Veterans Affairs Medical Center. They used databases of three diverse health care systems in Oregon to identify 1,516 elderly patients diagnosed with syncope and to determine factors that influenced their survival after discharge. The treating clinicians identified cardiovascular causes (most commonly arrhythmias) of syncope in 19 percent of patients and noncardiovascular causes such as anemia, seizures, dehydration, or drug-induced syncope, in 40 percent. The remaining 42 percent of patients were discharged with unexplained syncope.

Death from all causes was 1 percent during hospitalization, 13 percent 1 year later, and 41 percent 4 years later. However, the relative risk of dying for individuals with cardiovascular syncope (relative risk, RR 1.18) did not differ from that for unexplained syncope (RR 1.0) and noncardiovascular syncope (RR 0.94). On the other hand, age and coexisting illness had a profound impact on survival. Individuals under age 55 had generally excellent outcomes compared with those aged 85 and older (91 percent vs. 31 percent survival 4 years after hospitalization). Similarly, individuals with no other illness had better survival than those with several coexisting illnesses (81 percent vs. 23 percent at 4 years).

More details are in "Epidemiology of syncope in hospitalized patients," by Dr. Getchell, Greg C. Larsen, M.D., Cynthia D. Morris, Ph.D., M.P.H., and John H. McAnulty, M.D., in the Journal of General Internal Medicine 14, pp. 677-687, 1999.

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