Recurrent syncope is not an independent risk predictor for future syncopal events or adverse outcomes

Anna Marie Chang, Judd E. Hollander, Erica Su, Robert E. Weiss, Annick N. Yagapen, Susan E. Malveau, David H. Adler, Aveh Bastani, Christopher W. Baugh, Jeffrey M. Caterino, Carol L. Clark, Deborah Diercks, Bret A. Nicks, Daniel K. Nishijima, Manish N. Shah, Kirk A. Stiffler, Alan B. Storrow, Scott T. Wilber, Benjamin C. Sun

Research output: Contribution to journalArticle

Abstract

Almost 20% of patients with syncope will experience another event. It is unknown whether recurrent syncope is a marker for a higher or lower risk etiology of syncope. The goal of this study is to determine whether older adults with recurrent syncope have a higher likelihood of 30-day serious clinical events than patients experiencing their first episode. Methods: This study is a pre-specified secondary analysis of a multicenter prospective, observational study conducted at 11 emergency departments in the US. Adults 60 years or older who presented with syncope or near syncope were enrolled. The primary outcome was occurrence of 30-day serious outcome. The secondary outcome was 30-day serious cardiac arrhythmia. In multivariate analysis, we assessed whether prior syncope was an independent predictor of 30-day serious events. Results: The study cohort included 3580 patients: 1281 (35.8%) had prior syncope and 2299 (64.2%) were presenting with first episode of syncope. 498 (13.9%) patients had 1 prior episode while 771 (21.5%) had >1 prior episode. Those with recurrent syncope were more likely to have congestive heart failure, coronary artery disease, previous diagnosis of arrhythmia, and an abnormal ECG. Overall, 657 (18.4%) of the cohort had a serious outcome by 30 days after index ED visit. In multivariate analysis, we found no significant difference in risk of events (adjusted odds ratio 1.09; 95% confidence interval 0.90–1.31; p = 0.387). Conclusion: In older adults with syncope, a prior history of syncope within the year does not increase the risk for serious 30-day events.

Original languageEnglish (US)
JournalAmerican Journal of Emergency Medicine
DOIs
StateAccepted/In press - Jan 1 2018

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Syncope
Cardiac Arrhythmias
Multivariate Analysis
Observational Studies
Hospital Emergency Service
Coronary Artery Disease
Electrocardiography
Cohort Studies
Heart Failure
Odds Ratio
Prospective Studies
Confidence Intervals

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Chang, A. M., Hollander, J. E., Su, E., Weiss, R. E., Yagapen, A. N., Malveau, S. E., ... Sun, B. C. (Accepted/In press). Recurrent syncope is not an independent risk predictor for future syncopal events or adverse outcomes. American Journal of Emergency Medicine. https://doi.org/10.1016/j.ajem.2018.08.004

Recurrent syncope is not an independent risk predictor for future syncopal events or adverse outcomes. / Chang, Anna Marie; Hollander, Judd E.; Su, Erica; Weiss, Robert E.; Yagapen, Annick N.; Malveau, Susan E.; Adler, David H.; Bastani, Aveh; Baugh, Christopher W.; Caterino, Jeffrey M.; Clark, Carol L.; Diercks, Deborah; Nicks, Bret A.; Nishijima, Daniel K.; Shah, Manish N.; Stiffler, Kirk A.; Storrow, Alan B.; Wilber, Scott T.; Sun, Benjamin C.

In: American Journal of Emergency Medicine, 01.01.2018.

Research output: Contribution to journalArticle

Chang, AM, Hollander, JE, Su, E, Weiss, RE, Yagapen, AN, Malveau, SE, Adler, DH, Bastani, A, Baugh, CW, Caterino, JM, Clark, CL, Diercks, D, Nicks, BA, Nishijima, DK, Shah, MN, Stiffler, KA, Storrow, AB, Wilber, ST & Sun, BC 2018, 'Recurrent syncope is not an independent risk predictor for future syncopal events or adverse outcomes', American Journal of Emergency Medicine. https://doi.org/10.1016/j.ajem.2018.08.004
Chang, Anna Marie ; Hollander, Judd E. ; Su, Erica ; Weiss, Robert E. ; Yagapen, Annick N. ; Malveau, Susan E. ; Adler, David H. ; Bastani, Aveh ; Baugh, Christopher W. ; Caterino, Jeffrey M. ; Clark, Carol L. ; Diercks, Deborah ; Nicks, Bret A. ; Nishijima, Daniel K. ; Shah, Manish N. ; Stiffler, Kirk A. ; Storrow, Alan B. ; Wilber, Scott T. ; Sun, Benjamin C. / Recurrent syncope is not an independent risk predictor for future syncopal events or adverse outcomes. In: American Journal of Emergency Medicine. 2018.
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abstract = "Almost 20{\%} of patients with syncope will experience another event. It is unknown whether recurrent syncope is a marker for a higher or lower risk etiology of syncope. The goal of this study is to determine whether older adults with recurrent syncope have a higher likelihood of 30-day serious clinical events than patients experiencing their first episode. Methods: This study is a pre-specified secondary analysis of a multicenter prospective, observational study conducted at 11 emergency departments in the US. Adults 60 years or older who presented with syncope or near syncope were enrolled. The primary outcome was occurrence of 30-day serious outcome. The secondary outcome was 30-day serious cardiac arrhythmia. In multivariate analysis, we assessed whether prior syncope was an independent predictor of 30-day serious events. Results: The study cohort included 3580 patients: 1281 (35.8{\%}) had prior syncope and 2299 (64.2{\%}) were presenting with first episode of syncope. 498 (13.9{\%}) patients had 1 prior episode while 771 (21.5{\%}) had >1 prior episode. Those with recurrent syncope were more likely to have congestive heart failure, coronary artery disease, previous diagnosis of arrhythmia, and an abnormal ECG. Overall, 657 (18.4{\%}) of the cohort had a serious outcome by 30 days after index ED visit. In multivariate analysis, we found no significant difference in risk of events (adjusted odds ratio 1.09; 95{\%} confidence interval 0.90–1.31; p = 0.387). Conclusion: In older adults with syncope, a prior history of syncope within the year does not increase the risk for serious 30-day events.",
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AU - Chang, Anna Marie

AU - Hollander, Judd E.

AU - Su, Erica

AU - Weiss, Robert E.

AU - Yagapen, Annick N.

AU - Malveau, Susan E.

AU - Adler, David H.

AU - Bastani, Aveh

AU - Baugh, Christopher W.

AU - Caterino, Jeffrey M.

AU - Clark, Carol L.

AU - Diercks, Deborah

AU - Nicks, Bret A.

AU - Nishijima, Daniel K.

AU - Shah, Manish N.

AU - Stiffler, Kirk A.

AU - Storrow, Alan B.

AU - Wilber, Scott T.

AU - Sun, Benjamin C.

PY - 2018/1/1

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N2 - Almost 20% of patients with syncope will experience another event. It is unknown whether recurrent syncope is a marker for a higher or lower risk etiology of syncope. The goal of this study is to determine whether older adults with recurrent syncope have a higher likelihood of 30-day serious clinical events than patients experiencing their first episode. Methods: This study is a pre-specified secondary analysis of a multicenter prospective, observational study conducted at 11 emergency departments in the US. Adults 60 years or older who presented with syncope or near syncope were enrolled. The primary outcome was occurrence of 30-day serious outcome. The secondary outcome was 30-day serious cardiac arrhythmia. In multivariate analysis, we assessed whether prior syncope was an independent predictor of 30-day serious events. Results: The study cohort included 3580 patients: 1281 (35.8%) had prior syncope and 2299 (64.2%) were presenting with first episode of syncope. 498 (13.9%) patients had 1 prior episode while 771 (21.5%) had >1 prior episode. Those with recurrent syncope were more likely to have congestive heart failure, coronary artery disease, previous diagnosis of arrhythmia, and an abnormal ECG. Overall, 657 (18.4%) of the cohort had a serious outcome by 30 days after index ED visit. In multivariate analysis, we found no significant difference in risk of events (adjusted odds ratio 1.09; 95% confidence interval 0.90–1.31; p = 0.387). Conclusion: In older adults with syncope, a prior history of syncope within the year does not increase the risk for serious 30-day events.

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