Home > Uncategorized > Prognosis of Unexplained Syncope and Orthostatic Hypotension

Prognosis of Unexplained Syncope and Orthostatic Hypotension

Yasa et al (Yasa E, Ricci F, Magnusson M, et al. Heart Published Online
First: doi:10.1136/heartjnl-2017-31185) report a prospective population study to assess the outcome of patients with discharge diagnoses of unexplained syncope or orthostatic hypotension.

Abstract

Objective

To investigate the relationship of hospital
admissions due to unexplained syncope and orthostatic
hypotension (OH) with subsequent cardiovascular events
and mortality.

Methods

We analysed a population-based prospective
cohort of 30 528 middle-aged individuals (age 58±8
years; males, 40%). Adjusted Cox regression models
were applied to assess the impact of unexplained
syncope/OH hospitalisations on cardiovascular events
and mortality, excluding subjects with prevalent
cardiovascular disease.

Results

After a median follow-up of 15±4 years, 524
(1.7%) and 504 (1.7%) participants were hospitalised
for syncope or OH, respectively, yielding 1.2 hospital
admissions per 1000 person-years for each diagnosis.
Syncope hospitalisations increased with age (HR, per
1 year: 1.07, 95% CI 1.05 to 1.09), higher systolic
blood pressure (HR, per 10 mm Hg: 1.06, 95% CI 1.01
to 1.12), antihypertensive treatment (HR: 1.26, 95% CI
1.00 to 1.59), use of diuretics (HR: 1.77, 95% CI 1.31
to 2.38) and prevalent cardiovascular disease (HR: 1.59,
95% CI 1.14 to 2.23), whereas OH hospitalisations
increased with age (HR: 1.11, 95% CI 1.08 to 1.12) and
prevalent diabetes (HR: 1.82, 95% CI 1.23 to 2.70). After
exclusion of 1399 patients with prevalent cardiovascular
disease, a total of 473/464 patients were hospitalised
for unexplained syncope/OH before any cardiovascular
event. Hospitalisation for unexplained syncope predicted
coronary events (HR: 1.85, 95% CI 1.49 to 2.30), heart
failure (HR: 2.24, 95% CI 1.65 to 3.04), atrial fibrillation
(HR: 1.84, 95% CI 1.50 to 2.26), aortic valve stenosis
(HR: 2.06, 95% CI 1.28 to 3.32), all-cause mortality (HR:
1.22, 95% CI 1.09 to 1.37) and cardiovascular death
(HR: 1.72, 95% CI 1.23 to 2.42). OH-hospitalisation
predicted stroke (HR: 1.66, 95% CI 1.24 to 2.23), heart
failure (HR: 1.78, 95% CI 1.21 to 2.62), atrial fibrillation
(HR: 1.89, 95% CI 1.48 to 2.41) and all-cause mortality
(HR: 1.14, 95% CI 1.01 to 1.30).

Conclusions

Patients discharged with the diagnosis
of unexplained syncope or OH show higher incidence of
cardiovascular disease and mortality with only partial
overlap between these two conditions

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