Background:
In the US, 2 million people are evaluated for syncope annually. Published literature shows that of all ethnicities, African Americans (AA) are more likely to have comorbidities like hypertension, diabetes & lifestyle risk factors that translate to poorer outcome. Having published short-term outcomes showing worse outcome for AA with syncope, we followed up these patients over 5 years to evaluate long-term outcomes.
Methods:
3044 patients were prospectively followed after presenting with syncope. Patients were separated into five ethnic groups: Caucasians(30%), AA(30%), Hispanics(20%), Asians(3%) and others(17%). Patients or relatives were interviewed at least yearly during the follow-up period of 5 years. The primary endpoint was a composite of readmission for syncope, myocardial infarction, stroke or death.
Results:
AA were older with mean age of 68±20 years, had hypertension (72% vs. 60%, p<0.001), higher creatinine levels (1.5mg/dl vs. 1.2mg/dl, p< 0.001), diabetes (28% vs. 23%, p<0.001), heart failure (12% vs. 9%, p=0.04), and smoking (26% vs. 10%; p=0.003). Compared to all other races, AA had significantly worse outcome as seen by the KM curve in the primary endpoint (33% vs. 25%; HR 1.5; 95% CI: 1.25-1.75; p<0.0001).
Conclusions:
AA who are admitted with unexplained syncope are identified according to the SELF pathway as high risk group that can likely be attributed to the presence of comorbidities and warrants hospitalization for further work-up and optimizing medical management.
Background:
According to the design of published and validated SELF pathway, patients with syncope are stratified according to the SELF-1 criteria (Short period, Early-rapid onset, Loss of consciousness, Full recovery) and SELF-2 Criteria (Structural heart disease, abnormal electrocardiogram, and arrhythmia/AFib/AFl).
Methods:
3044 patients were prospectively followed after presenting to our emergency department for the evaluation of syncope. Patients were divided into four groups: Group A (SELF +/+) who met both SELF-1 and 2 criteria, Group B (SELF +/-) who met SELF-1 criteria but not SELF-2, Group C (SELF -/+) who met SELF-2 criteria but not SELF-1 and Group D (SELF -/-) who met neither SELF criteria. The primary endpoint was a composite of readmission for syncope, myocardial infarction (MI), stroke or death. Follow-up was 5 years.
Results:
Group A included 1001 patients (33%), Group B included 359 patients (12%), Group C had 880 patients (29%) and Group D had 804 patients (26%). Patients who met SELF-2 criteria, i.e., patients in Groups A and C, had significantly worse outcome (Group A: HR 1.85; 95% CI: 1.47-2.36; p<0.0001; Group C: HR 2.0; 95% CI: 1.54-2.52; p<0.0001). Presence of Diabetes (HR: 1.3; 95% CI: 1.1-1.5; p=0.003), Coronary Artery Disease (HR: 1.44; 95%CI: 1.2-1.7; p=0.0001) and Congestive Heart Failure (HR 2.0; 95% CI: 1.6-2.4; p<0.0001) were also important predictors of poor outcome.
Conclusions:
Using the SELF-pathway for patients presenting with syncope effectively identifies high risk patients who merit hospitalization and close follow-up post-discharge. These include patients with structural heart disease, abnormal EKG and abnormal telemetry, as well as patients with diabetes, CAD and CHF. This has important implications for the evaluation of a common disease that poses a significant economic burden on healthcare systems.
Background:
The ACAP program consists of strategies for implementing ACC/AHA guidelines for various cardiac disorders, one of which is the SELF pathway, which covers the spectrum of care from presentation to discharge in patients with syncope. Patients are stratified according to SELF-1 (Short period, Early onset, Loss of consciousness, Full recovery) and SELF-2 criteria (Structural heart disease, abnormal ECG, arrhythmia).
Methods:
3044 patients were prospectively followed for syncope. They were divided into 4 groups: Group A (SELF +/+) who met both SELF 1 and 2 criteria, Group B (SELF +/-) who met SELF-1 criteria but not SELF-2, Group C (SELF -/+) who met SELF-2 criteria alone and Group D (SELF -/-) who met neither criteria. These groups were further separated into males and females. The primary endpoint was composite of readmission for syncope, myocardial infarction, stroke or death. Follow-up was 5 years.
Results:
Females were older than males (69+/-21 years), had more hypertension (65% vs. 63%) and syncopal episodes (18% vs. 16%). Males were more likely to be diabetic (25% vs. 24%), have coronary artery disease (21% vs. 16%; p=0.001), heart failure (11% vs. 9%) and smoking (65% vs. 42%; p<0.001). Regardless of sex, Group A patients had worse outcomes (p=0.25) while Group D patients had better outcome with far fewer events (p=0.06). In Group B patients, males were noted to have worse outcome while in Group C, females were noted to have significantly worse long-term outcome.
Conclusions:
The SELF-pathway for patients with syncope helps identify at-risk subgroups in our patient population. Females with SELF-2 criteria (Structural heart disease, abnormal ECG, arrhythmia) had significantly worse long-term outcome compared to males regardless of manner of syncopal presentation.
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