Multiple causes of syncope in the elderly: diagnostic outcomes of a Dutch multidisciplinary syncope pathway

Ruiter, Susanne C. de; Wold, J.F.H.; Germans, Tjeerd; Ruiter, Jaap H.; Jansen, René W. M. M.

doi:10.1093/europace/eux099

Cited by 25 publications

(18 citation statements)

References 17 publications

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“…As syncope and symptoms of falls overlap, syncope in older persons is often mistaken for falls (45). Recent research on falls and syncope in older persons has shown that a multidisciplinary comprehensive assessment at a falls and syncope clinic consisting of a 12-lead ECG, blood pressure measurements (supine and active standing), echocardiogram, 24-hour Holter monitoring, and tilt testing with carotid sinus massage (on indication) could identify possible causes for falls and syncope in 94% of the patients (20). Eighty-three percent of the patients were diagnosed with hypotension, 44% of the patients had a cardiac cause for syncope, and 21% had reflex syncope.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Cardiovascular Evaluations and Interventions on Fall Risk: A Scoping Review

Luiting

Jansen

Seppälä

et al. 2019

The Journal of nutrition, health and aging

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Objective cardiovascular abnormalities are consistently associated with fall risk in older people. However, little research has been done to assess the effect of cardiovascular interventions on fall risk. The aim of this scoping review is to explore the current literature on the effectiveness of cardiovascular evaluations and interventions in reducing fall risk in older people. Design scoping review. Data sources Medline, Cochrane Library, and WHO ICTRP Search Portal were systematically searched. Selection criteria randomized controlled trials (RCTs) and intervention studies of community-dwelling adults aged ≥50 years or with a mean age of >60 years that assessed the effect of a cardiovascular assessment and interventions in reducing fall risk. Key search concepts were “falls” and “aged”, and terms for different cardiovascular evaluations and interventions were included. The Cochrane Checklist for risk of bias and the ROBINS-I tool were used to assess the quality of the studies. Results seven studies were included. The majority showed a reduction in falls after cardiovascular evaluation and intervention. Two out of four studies that focused on carotid sinus hypersensitivity (CSH) as a modifiable cardiovascular risk factor for falls, showed a significant reduction in falls after pacemaker implantation. Two studies that looked at sinus node dysfunction (SND) both showed a significant reduction in falls after pacemaker implantation. One study showed that 33% of the patients experienced a fall after cardiovascular evaluation and intervention, whereas all patients fell before assessment. Conclusions the majority of the included studies showed a reduction in falls after the intervention. However, the number of published papers regarding the effect of cardiovascular assessment and interventions on falls is small. A standardized assessment of cardiovascular risk factors may be essential in preventing falls in older adults and could consequently reduce injuries, loss of quality of life, deaths, and fall-related expenditures. Electronic Supplementary Material Supplementary material is available for this article at 10.1007/s12603-019-1165-2 and is accessible for authorized users.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Cardiovascular Evaluations and Interventions on Fall Risk: A Scoping Review

Luiting

Jansen

Seppälä

et al. 2019

The Journal of nutrition, health and aging

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“…Our study is congruent with these results, demonstrating a strong association between a higher BMI and more observed PPH events. Previous work has suggested that the various neuroautonomic etiologies for syncope (such as orthostatic hypotension and PPH) have a tendency to cluster in the same patients (De Ruiter, Wold, Germans, Ruiter, & Jansen, 2018). Our results support this, as we were able to demonstrate an association between a higher orthostatic drop and both larger observed maximal PPH responses and a larger number of observed PPH events.…”

Section: Discussionmentioning

confidence: 99%

Characteristics Associated with the Postprandial Hypotensive Response in Falling Older Adults

2019

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RÉSUMÉIl a été démontré que l’intensité de la réponse hypotensive postprandiale (RHP) peut constituer un facteur de risque pour les chutes, les fractures et le décès. Bien que ce risque ait été bien établi, les cliniques de chutes font rarement des analyses liées aux repas, en raison de contraintes logistiques. Afin de mieux cibler les patients à risque de RHP parmi les personnes âgées affectées par des chutes, cette étude a examiné les caractéristiques individuelles associées à des RHP plus intenses. Cinquante-deux patients (âge moyen : 77,8 ± 0,9 ans, 29 femmes, 23 hommes) référés par des cliniques de prévention des chutes ont été recrutés pour un repas-test de 90 minutes. Les variables significatives ont ensuite été insérées dans un modèle linéaire multivarié incluant l’âge, le sexe, la présence de diabète, la présence d’hypertension, la pression systolique de base (PSB) et la chute de la PSB orthostatique. Bien que de plus amples recherches soient nécessaires, notre étude suggère que les hommes, les patients présentant une tension artérielle élevée et ceux avec une chute orthostatique pourraient être plus à risque de réponses hémodynamiques postprandiales plus intenses.

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“…The majority of patients also undergo a 24 h Holter registration. The details and outcomes of this two-day program have been published earlier [6,19,20]. The ethical board concluded that the study could be exempted because this study uses archival data of standard geriatric evaluations, and had no implications on therapeutic decisions.…”

Section: Methodsmentioning

confidence: 99%

“…The literature specifically on the incidence and prevalence and types of AF among geriatric patients is scarce. Geriatric patients are the frailest among the old and have multiple chronic conditions such as cognitive impairment, heart failure, diabetes mellitus, and hypertension [6] making them susceptible for the development and complications of AF. In older people, AF occurs often without clear symptoms [2] and it is unknown to which extent AF is paroxysmal [7].…”

Section: Introductionmentioning

confidence: 99%

Atrial Fibrillation, Anticoagulation, and Major Bleeding Episodes in Geriatric Patients at the Risk of Falling

Zwart¹,

Germans²,

Şimşek³

et al. 2019

obm geriatr

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Background: Geriatric patients are at risk of atrial fibrillation (AF) and stroke, and the risk of oral anticoagulation (OAC) related bleeding is also presumed to be higher. Detailed knowledge about the prevalence of AF and bleeding pattern in this population is scarce. This study sought to assess the prevalence of AF, use of OAC, and the rate of major bleeding in geriatric patients who are prone to frequent falls. We expect to find a higher prevalence of AF among geriatric patients compared to elderly people of comparable age. Methods: This was an observational cohort study conducted at the Fall and Syncope Clinic. Inclusion criteria: age >65 years, availability of both electrocardiogram (ECG) and Holter registration. The use and reasons to withhold OAC and the rate of major bleeding were retrieved from the medical files. Results: A total of 428 patients with the mean age of 79.8 years were analyzed. The mean number of morbidities was 11 ±5. AF was known in 98 (23%) patients, first diagnosed in 10 (2%). Among them, AF was paroxysmal in 45 (45%) patients, and 50% of them were first diagnosed cases. Of patients with AF, 84% were using OAC. The rate of major bleeding episodes was 1.1 per 100 treatment years. Major bleeding episodes were not different between the patients using antiplatelet agents (APA), OAC, or no antithrombotic medication. Conclusions: In this geriatric population, 23% of patients had AF and almost half were paroxysmal. Compared to previous studies, the use of OAC has substantially increased to 84% and no differences were found in the rate of major bleeding episodes between those using APA, OAC, or no antithrombotic medication.

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Multiple causes of syncope in the elderly: diagnostic outcomes of a Dutch multidisciplinary syncope pathway

Cited by 25 publications

References 17 publications

Effectiveness of Cardiovascular Evaluations and Interventions on Fall Risk: A Scoping Review

Effectiveness of Cardiovascular Evaluations and Interventions on Fall Risk: A Scoping Review

Characteristics Associated with the Postprandial Hypotensive Response in Falling Older Adults

Atrial Fibrillation, Anticoagulation, and Major Bleeding Episodes in Geriatric Patients at the Risk of Falling

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