Epidemiology of Syncope/Collapse in Younger and Older Western Patient Populations

Abstract

Syncope is a common problem which can be remarkably debilitating and associated with high health care costs; its true incidence is difficult to estimate due to variation in definition, differences in population prevalence and under reporting in the general population. The median peak of first syncope is around 15 years with a sharp increase after 70 years.Vasovagal syncope is the commonest cause of syncope for all age groups, but cardiac causes become more common with advancing age. The cumulative incidence of syncope ranges from 5% in females aged 20 to 29, up to 50% in females aged 80 and above. Onethird of medical students report at least one syncopal episode in their life-time. The life-time cumulative incidence of syncope in women is almost twice that of men. Syncope accounts for up to 1-3% of hospital admissions and Emergency Room (ER) visits and in these settings is associated with cardiovascular co-morbidity and cardiovascular pharmacotherapy. In older adults syncope is a major cause of morbidity and mortality with enormous personal and wider health economic costs. Prevalence and incidence figures for syncope in older adults are confounded by an overlap with presentations classified as falls. In addition to injury and increasing dependency, quality-of-life studies consistently show that functional impairment in persons with recurrent syncope is similar to other chronic diseases.

Entropy in Investigation of Vasovagal Syndrome in Passive Head Up Tilt Test

“…The unequal proportion in gender reflects the occurrence of syncope in the general population [47,48]. We are also aware that the hemodynamic parameters and their complexity are age-dependent [49,50].…”

Geriatric giants – contemporary occurrence in 12,210 in-patients

“…Falls represent a complex multifactorial phenomenon which could be caused by several risk factors (11,12,13). Lakhan (10) depicts minimally one fall that took place 90 days before admission to the hospital in 41.9 % of people at the age of 70 y. Billington (14) indicates risk factors for falls in hospitalized patients, namely gait instability, mental disorders, urge incontinence, past history of falling, use of psychopharmaceuticals, restraints, and environmental factors.…”

History of syncope predicts loss of consciousness after head trauma: Retrospective study

“…It is well known that injuries, both serious and minor, of other parts of the body than the head may provoke TLOC of reflex origin. Blood drawing, injection, piercing, and orthopedic arthroscopy have been reported to induce vasovagal syncope [4][5][6]. A tilt testing protocol involving subcutaneous insertion of a needle into the dorsum of hand after 10 min of passive tilt has been shown to have similar to conventional tilt protocols sensitivity and specificity [7].…”

“…A tilt testing protocol involving subcutaneous insertion of a needle into the dorsum of hand after 10 min of passive tilt has been shown to have similar to conventional tilt protocols sensitivity and specificity [7]. Further, factors, which often accompany head injury such as sudden and severe emotional distress, pain, sight of blood and wounding, have the potential to provoke reflex syncope [4].…”