@article{d91730d6560545a7b1c4af955702c54a,
title = "Outcomes of Patients With Syncope and Suspected Dementia",
abstract = "Objectives: Syncope and near-syncope are common in patients with dementia and a leading cause of emergency department (ED) evaluation and subsequent hospitalization. The objective of this study was to describe the clinical trajectory and short-term outcomes of patients who presented to the ED with syncope or near-syncope and were assessed by their ED provider to have dementia. Methods: This multisite prospective cohort study included patients 60 years of age or older who presented to the ED with syncope or near-syncope between 2013 and 2016. We analyzed a subcohort of 279 patients who were identified by the treating ED provider to have baseline dementia. We collected comprehensive patient-level, utilization, and outcomes data through interviews, provider surveys, and chart abstraction. Outcome measures included serious conditions related to syncope and death. Results: Overall, 221 patients (79%) were hospitalized with a median length of stay of 2.1 days. A total of 46 patients (16%) were diagnosed with a serious condition in the ED. Of the 179 hospitalized patients who did not have a serious condition identified in the ED, 14 (7.8%) were subsequently diagnosed with a serious condition during the hospitalization, and an additional 12 patients (6.7%) were diagnosed postdischarge within 30 days of the index ED visit. There were seven deaths (2.5%) overall, none of which were cardiac-related. No patients who were discharged from the ED died or had a serious condition in the subsequent 30 days. Conclusions: Patients with perceived dementia who presented to the ED with syncope or near-syncope were frequently hospitalized. The diagnosis of a serious condition was uncommon if not identified during the initial ED assessment. Given the known iatrogenic risks of hospitalization for patients with dementia, future investigation of the impact of goals of care discussions on reducing potentially preventable, futile, or unwanted hospitalizations while improving goal-concordant care is warranted.",
author = "Holden, {Timothy R.} and Shah, {Manish N.} and Gibson, {Tommy A.} and Weiss, {Robert E.} and Yagapen, {Annick N.} and Malveau, {Susan E.} and Adler, {David H.} and Aveh Bastani and Baugh, {Christopher W.} and Caterino, {Jeffrey M.} and Clark, {Carol L.} and Diercks, {Deborah B.} and Hollander, {Judd E.} and Nicks, {Bret A.} and Nishijima, {Daniel K.} and Stiffler, {Kirk A.} and Storrow, {Alan B.} and Wilber, {Scott T.} and Sun, {Benjamin C.}",
note = "Funding Information: From the Department of Medicine, Geriatrics Division (TRH), and the Department of Emergency Medicine (MNS), University of Wisconsin School of Medicine and Public Health, Madison, WI; the Department of Neurology, Washington University School of Medicine (TRH), St. Louis, MO; the Department of Biostatistics, Fielding School of Public Health, University of California at Los Angeles (TAG, REW), Los Angeles, CA; the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University (ANY, SEM, BCS), Portland, OR; the Department of Emergency Medicine, University of Rochester (DHA), Rochester, NY; the Department of Emergency Medicine, William Beaumont Hospital-Troy (AB), Troy, MI; the Department of Emergency Medicine, Brigham & Women{\textquoteright}s Hospital (CWB), Boston, MA; the Department of Emergency Medicine, The Ohio State University Wexner Medical Center (JMC), Columbus, OH; the Department of Emergency Medicine, William Beaumont Hospital-Royal Oak (CLC), Royal Oak, MI; the Department of Emergency Medicine, University of Texas–Southwestern (DBD), Dallas, TX; the Department of Emergency Medicine, Thomas Jefferson University Hospital (JEH), Philadelphia, PA; the Department of Emergency Medicine, Wake Forest School of Medicine (BAN), Winston Salem, NC; the Department of Emergency Medicine, University of California Davis School of Medicine (DKN), Sacramento, CA; the Department of Emergency Medicine, Northeast Ohio Medical University (KAS, STW), Rootstown, OH; and the Department of Emergency Medicine, Vanderbilt University (ABS), Nashville, TN. Received November 22, 2017; revision received February 22, 2018; accepted March 9, 2018. Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award R01HL111033. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. AB has received research funding from Radiometer and Portola and has been a consultant for Portola. CWB has received advisory board and speaker{\textquoteright}s fees from Roche, research funding from Janssen and Boehringer Ingelheim, and consulting and advisory board fees from Janssen. JMC has received funding from Astra Zeneca. CLC has received research funding from Radiometer, Ortho Clinical Trials, Janssen, Pfizer, NIH, Portola, Biocryst, Glaxo Smith Klein, Hospital Quality Foundation, and Abbott. She is a consultant for Portola, Janssen, and Hospital Quality Foundation. DBD is a consultant for Janssen and Roche, has received institutional research support from Novartis, Ortho Scientific, and Roche, and is on the editorial board for Academic Emergency Medicine and Circulation. JEH has received research funding from Alere, Siemens, Roche, Portola, and Trinity. DKN has received honorarium from Pfizer. ABS is a consultant for Siemens and Quidel and is on the Data and Safety Monitoring Board for Trevena. BCS is a consultant for Medtronic. Author contributions: study concept and design—TRH, MNS, and BCS; acquisition of the data—ANY, SEM, and BCS; analysis and interpretation of the data—TRH, MNS, TAG, REW, and BCS; drafting of the manuscript—TRH, MNS, and BCS; critical revision of the manuscript for important intellectual content: MNS, TAG, REW, ANY, SEM, DHA, AB, CWB, JMC, CLC, DBD, JEH, BAN, DKN, KAS, ABS, STW, and BCS; statistical expertise—TAG and REW; and acquisition of funding—BCS. Supervising Editor: Ula Hwang, MD, MPH. Address for correspondence and reprints: Timothy R. Holden, MD, MS; e-mail: tholden@wustl.edu. ACADEMIC EMERGENCY MEDICINE 2018;25:880–890.",
year = "2018",
month = aug,
doi = "10.1111/acem.13414",
language = "English (US)",
volume = "25",
pages = "880--890",
journal = "Academic Emergency Medicine",
issn = "1069-6563",
publisher = "Wiley-Blackwell",
number = "8",
}