Likelihood of injury due to vasovagal syncope: a systematic review and meta-analysis

Abstract

Aims Vasovagal syncope (VVS) is the most common type of syncope and is usually considered a benign disorder. The potential for injury is worrisome but the likelihood is unknown. We aimed to determine the proportion of patients injured due to VVS. Methods and results A systematic search of studies published until August 2020 was performed in multiple medical and nursing databases. Included studies had data on the proportion of patients with injury due to VVS prior to study enrolment. Random effects methods were used. Twenty-three studies having 3593 patients met inclusion criteria. Patients were diagnosed clinically with VVS, and 82% had >2 syncopal episodes before enrolment. Tilt test was positive in 60% and 14 studies reported comorbidities (32.6% hypertensive). The weighted mean injury rate was 33.5% [95% confidence interval (CI): 27.3–40.5%]. The likelihood of injury correlated with population age (r = 0.4, P = 0.05), but not with sex, positive tilt test, or hypertension. The injury rates were 25.7% (95% CI: 19.1–32.8%) in studies with younger patients (mean age ≤50 years, n = 1803) and 43.4% (95% CI: 34.9–52.3%) in studies with older patients (P = 0.002). Nine studies reported major injuries; with a weighted mean rate of major injuries of 13.9% (95% CI: 9.5–19.8%). Conclusion Injuries due to syncope are frequent, occurring in 33% of patients with VVS. The risk of major injuries is substantial. Older patients are at higher risk. Clinicians should be aware of the risk of injuries when providing care and advice to patients with VVS.

56-year-old man • increased heart rate • weakness • intense sweating • horseradish consumption • Dx?

“…14 consciousness with VVS may be associated with injury in 33% of cases. 15 ❚ The recovery with awareness of time, place, and person may be a feature of VVS, which would differentiate it from seizures and brainstem vascular events. Autonomic prodromal symptoms-including abdominal discomfort, pallor, sweating, and nauseamay precede the loss of consciousness.…”

El midodrine disminuye la recurrencia de síncope vasovagal en pacientes jóvenes

“…El síncope vasovagal es un problema frecuente, que puede producir daño en quienes lo experimentan, por traumatismos secundarios a las caídas, y que además deteriora la calidad de vida 2,3 . Sin embargo, previo al estudio comentado, se carecía de información de alta calidad sobre qué fármacos podrían ser utilizados para prevenirlos.…”

Implementation of supervised physical training to reduce vasovagal syncope recurrence: A randomized controlled trial

“…The most common cause is vasovagal syncope (VVS), accounting for 66% of syncope‐related emergency department presentations 3,4 . VVS is a benign condition usually not associated with increased cardiovascular risk 4 ; however, frequently recurring VVS can lead to significant reductions in quality of life, a higher risk of depression and anxiety, impairment of daily activities, put patients at risk of physical injuries, and impose a financial burden on the healthcare system 5–7 . Even with treatment, many patients are still at risk for recurrent episodes, 8,9 thus investigation of new therapeutic approaches to further mitigate the burden of syncope is important.…”