Long-term outcomes in syncope patients presenting to the emergency department: A systematic review

Leafloor, Cameron W; Hong, Patrick Jiho; Mukarram, Muhammad; Sikora, Lindsey; Elliott, Jesse; Thiruganasambandamoorthy, Venkatesh

doi:10.1017/cem.2019.393

Cited by 6 publications

(4 citation statements)

References 35 publications

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“…As for the 1-year risk of death, our 5.9% rate is in line with previous systematic reviews showing a mortality rate of 8.4% [14] and 7% [24]. Unlike the other endpoints that show little increase after day 3, long-term mortality continues to rise.…”

Section: Discussionsupporting

confidence: 90%

“…Knowledge of short and medium-term outcomes might aid decision making with respect to hospital admission and syncope units [8][9][10]. Previous attempts have been made to describe the incidence of adverse events after syncope by using meta-analyses [14,24]. However, the heterogeneity of both syncope and outcome definitions and the lack of standardized follow-up durations made it difficult to combine data from different studies.…”

Section: Discussionmentioning

confidence: 99%

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Syncope Time Frames for Adverse Events after Emergency Department Presentation: An Individual Patient Data Meta-Analysis

et al. 2021

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Background and Objectives: Knowledge of the incidence and time frames of the adverse events of patients presenting syncope at the ED is essential for developing effective management strategies. The aim of the present study was to perform a meta-analysis of the incidence and time frames of adverse events of syncope patients. Materials and Methods: We combined individual patients’ data from prospective observational studies including adult patients who presented syncope at the ED. We assessed the pooled rate of adverse events at 24 h, 72 h, 7–10 days, 1 month and 1 year after ED evaluation. Results: We included nine studies that enrolled 12,269 patients. The mean age varied between 53 and 73 years, with 42% to 57% females. The pooled rate of adverse events was 5.1% (95% CI 3.4% to 7.7%) at 24 h, 7.0% (95% CI 4.9% to 9.9%) at 72 h, 8.4% (95% CI 6.2% to 11.3%) at 7–10 days, 10.3% (95% CI 7.8% to 13.3%) at 1 month and 21.3% (95% CI 15.8% to 28.0%) at 1 year. The pooled death rate was 0.2% (95% CI 0.1% to 0.5%) at 24 h, 0.3% (95% CI 0.1% to 0.7%) at 72 h, 0.5% (95% CI 0.3% to 0.9%) at 7–10 days, 1% (95% CI 0.6% to 1.7%) at 1 month and 5.9% (95% CI 4.5% to 7.7%) at 1 year. The most common adverse event was arrhythmia, for which its rate was 3.1% (95% CI 2.0% to 4.9%) at 24 h, 4.8% (95% CI 3.5% to 6.7%) at 72 h, 5.8% (95% CI 4.2% to 7.9%) at 7–10 days, 6.9% (95% CI 5.3% to 9.1%) at 1 month and 9.9% (95% CI 5.5% to 17) at 1 year. Ventricular arrhythmia was rare. Conclusions: The risk of death or life-threatening adverse event is rare in patients presenting syncope at the ED. The most common adverse events are brady and supraventricular arrhythmias, which occur during the first 3 days. Prolonged ECG monitoring in the ED in a short stay unit with ECG monitoring facilities may, therefore, be beneficial.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Syncope Time Frames for Adverse Events after Emergency Department Presentation: An Individual Patient Data Meta-Analysis

et al. 2021

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“…La elevada tasa de mortalidad hospitalaria es acorde con el hecho de que, hasta el momento, el ingreso hospitalario no ha demostrado reducir la mortalidad en los pacientes con síncope 1 . El pronóstico a largo plazo de estos pacientes está determinado por su enfermedad de base, no por la intervención hospitalaria; de hecho, el 60% de los pacientes ingresados por un episodio sincopal son dados de alta sin ninguna intervención terapéutica para el síncope 3,4 .…”

Section: Management Of Syncope In Older Adults: Still a Long Way To Gounclassified

“…El sincope es una pérdida de conciencia transitoria debida a una hipoperfusión cerebral global, de aparición brusca, duración corta y recuperación espontánea y completa 1 . La relevancia clínica y social del síncope viene dada por su elevada frecuentación, en particular en los servicios de urgencias (SU) donde constituye el 1-1,5% de las urgencias generales (se estima que en España entre 250 000 y 350 000 pacientes con síncope acuden cada año a los SU) 2 , y asocia unos elevados costes sanitarios (2.400 millones de dólares en costes directos de atención médica anualmente en los Estados Unidos) y sociales, en relación con los ingresos, discapacidad residual tras los traumatismos o por las recurrencias del sincope y por la relevante mortalidad que asocia (en particular el síncope cardiaco) [3][4][5][6] .…”

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