Predictors of Mortality, Rehospitalization for Syncope, and Cardiac Syncope in 352 Consecutive Elderly Patients With Syncope

Khera, Sahil; Palaniswamy, Chandrasekar; Aronow, Wilbert S.; Sule, Sachin; Doshi, Jay; Adapa, Sreedhar; Balasubramaniyam, Nivas; Ahn, Chul; Peterson, Stephen J.; Nabors, Christopher

doi:10.1016/j.jamda.2012.12.001

Cited by 30 publications

(17 citation statements)

References 21 publications

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“…Published reports have shown that male sex, older age, history of drug abuse, and major comorbidities such as CHF and cerebrovascular disease correlate with higher risk of short‐term adverse outcomes 8, 10, 11, 23. In our study, we noticed similar outcomes, as male sex, high‐risk comorbidities (especially cardiovascular diseases), and prolonged LOS were all found to have a higher risk of 30‐day readmission.…”

Section: Discussionsupporting

confidence: 80%

“…Studies evaluating syncope/collapse outcomes in general and readmission in particular vary in what they report according to the study population and methodology; thus, a wide range of readmission rates have been reported in the literature. Khera et al11 reported a 24‐month readmission rate of 3% among elderly populations. Sule et al12 studied 242 patients with syncope and reported a 17‐month readmission rate of 2%.…”

Section: Discussionmentioning

confidence: 99%

“…In a Canadian national study, 9% of patients hospitalized for syncope were readmitted,10 while readmission rates ranged from 2% to 3% in small‐sample studies,11, 12 and in a higher‐risk population (those who presented with syncope and acute coronary syndrome) the rate reached 30% 13. However, these studies were not representative of a US cohort of patients.…”

Section: Introductionmentioning

confidence: 99%

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Causes and Predictors of 30‐Day Readmission in Patients With Syncope/Collapse: A Nationwide Cohort Study

Kadri

Abuamsha

Nusairat

et al. 2018

JAHA

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BackgroundSyncope accounts for 0.6% to 1.5% of hospitalizations in the United States. We sought to determine the causes and predictors of 30‐day readmission in patients with syncope.Methods and ResultsWe identified 323 250 encounters with a primary diagnosis of syncope/collapse in the 2013–2014 Nationwide Readmissions Database. We excluded patients younger than 18 years, those discharged in December, those who died during hospitalization, hospital transfers, and those whose length of stay was missing. We used multivariable logistic regression analysis to evaluate the association between baseline characteristics and 30‐day readmission. A total of 282 311 syncope admissions were included. The median age was 72 years (interquartile range, 58–83), 53.9% were women, and 9.3% had 30‐day readmission. The most common cause of 30‐day readmissions was syncope/collapse, followed by cardiac, neurological, and infectious causes. Characteristics associated with 30‐day readmissions were age 65 years and older (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.6–0.7), female sex (OR, 0.9; 95% CI, 0.8–0.9), congestive heart failure (OR, 1.5; 95% CI, 1.2–1.9), atrial fibrillation/flutter (OR, 1.3; 95% CI, 1.3–1.4), diabetes mellitus (OR, 1.2; 95% CI, 1.2–1.3), coronary artery disease (OR, 1.2; 95% CI, 1.2–1.3), anemia (OR, 1.4; 95% CI, 1.4–1.5), chronic obstructive pulmonary disease (OR, 1.4; 95% CI, 1.3–1.4), home with home healthcare disposition (OR, 1.5; 95% CI, 1.5–1.6), leaving against medical advice (OR, 1.7; 95% CI, 1.6–1.9), length of stay of 3 to 5 days (OR, 1.5; 95% CI, 1.4–1.6) or >5 days (OR, 2; 95% CI, 1.8–2), and having private insurance (OR, 0.6; 95% CI, 0.6–0.7).ConclusionsThe 30‐day readmission rate after syncope/collapse was 9.3%. We identified causes and risk factors associated with readmission. Future prospective studies are needed to derive risk‐stratification models to reduce the high burden of readmissions.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Causes and Predictors of 30‐Day Readmission in Patients With Syncope/Collapse: A Nationwide Cohort Study

Kadri

Abuamsha

Nusairat

et al. 2018

JAHA

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“…Other criteria used in scores - some even classified as highest scoring criteria - such as palpitations, pre- syncope, syncope during physical exertion, valvulopathies, dyspnea and physical examination revealing signs of heart failure revealed no statistical significance for hospitalization in our sample 10,11 . This fact demonstrates how much scores can vary among themselves having a low external validity.…”

Section: Discussionmentioning

confidence: 67%

Predictors of Hospitalization in Patients with Syncope Assisted in Specialized Cardiology Hospital

Fischer¹,

Dutra²,

Mantovani³

et al. 2013

Arquivos Brasileiros De Cardiologia

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BackgroundRisk stratification of a syncopal episode is necessary to better differentiate patients needing hospitalization of those who can be safely sent home from the emergency department. Currently there are no strict guidelines from our Brazilian medical societies to guide the cardiologist that evaluate patients in an emergency setting.ObjectivesTo analyze the criteria adopted for defining the need for hospitalization and compare them with the predictors of high risk for adverse outcome defined by the OESIL score that is already validated in the medical literature for assessing syncope.MethodsA cross-sectional study of patients diagnosed with syncope during emergency department evaluation at our institution in the year 2011.ResultsOf the 46,476 emergency visits made in that year, 216 were due to syncope. Of the 216 patients analyzed, 39% were hospitalized. The variables associated with the need of hospital admission were - having health care insurance, previous known cardiovascular disease, no history of prior stroke, previous syncope and abnormal electrocardiograms during the presentation. Patients classified in OESIL scores of 0-1 had a greater chance of emergency discharge; 2-3 scores showed greater association with the need of hospitalization. A score ≥ 2 OESIL provided an odds ratio 7.8 times higher for hospitalization compared to score 0 (p <0.001, 95% CI:4,03-15,11). In approximately 39% no etiological cause for syncope was found and in 18% cardiac cause was identified.ConclusionsFactors such as cardiovascular disease, prior history of syncope, health insurance, no previous stroke and abnormal electrocardiograms, were the criteria used by doctors to indicate hospital admission. There was a good correlation between the clinical judgment and the OESIL criteria for high risk described in literature.

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“…Among the elderly population, the most common causes of syncope are orthostatic hypotension, volume depletion, cardiovascular events, vasovagal reflex, and idiopathic. 25,26 These data suggest that acute changes in mental health as well as those factors that lead to syncope may lead to sporadic vision loss. One may wonder if patients who are “sicker” overall at baseline are more likely to have sporadic vision loss, but we could not find a clear association of this through our use of a Functional Comorbidity Index.…”

Section: Discussionmentioning

confidence: 94%

Sporadic Visual Acuity Loss in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT)

Kim

Ying

Huang

et al. 2014

American Journal of Ophthalmology

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Purpose To evaluate transient, large visual acuity (VA) decreases, termed sporadic vision loss, during anti-vascular endothelial growth factor treatment for neovascular age-related macular degeneration (AMD). Design Cohort within a randomized clinical trial. Methods Setting Comparison of AMD Treatments Trials (CATT). Study Population 1185 CATT patients. Main Outcome Measures incidence of sporadic vision loss and odds ratio (OR) for association with patient and ocular factors. Sporadic vision loss was a decline of ≥ 15 letters from the previous visit, followed by a return at the next visit to no more than 5 letters worse than the visit before the VA loss. Results There were 143 sporadic vision loss events in 122/1185 (10.3%) patients. Mean VA at two years for those with and without sporadic vision loss was 58.5 (~20/63) and 68.4 (~20/40) letters, respectively (P < 0.001). Among patients treated pro re nata, no injection was given for 27.6% (27/98) of sporadic vision loss events. Multivariate analysis demonstrated that baseline predictors for sporadic vision loss included worse baseline VA (OR 2.92, 95%CI:1.65–5.17 for ≤ 20/200 compared with ≥ 20/40), scar (OR 2.21, 95%CI:1.22–4.01), intraretinal foveal fluid on optical coherence tomography (OR 1.80, 95%CI:1.11–2.91), and medical history of anxiety (OR 1.90, 95%CI:1.12–3.24) and syncope (OR 2.75, 95%CI:1.45–5.22). Refraction decreased the likelihood of sporadic vision loss (OR 0.62, 95%CI:0.42–0.91). Conclusions Approximately 10% of CATT patients had sporadic vision loss. Baseline predictors included AMD-related factors and factors independent of AMD. These data are relevant for clinicians in practice and those involved in clinical trials.

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Predictors of Mortality, Rehospitalization for Syncope, and Cardiac Syncope in 352 Consecutive Elderly Patients With Syncope

Cited by 30 publications

References 21 publications

Causes and Predictors of 30‐Day Readmission in Patients With Syncope/Collapse: A Nationwide Cohort Study

Causes and Predictors of 30‐Day Readmission in Patients With Syncope/Collapse: A Nationwide Cohort Study

Predictors of Hospitalization in Patients with Syncope Assisted in Specialized Cardiology Hospital

Sporadic Visual Acuity Loss in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT)

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