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

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
Susanne C de RuiterRené W M M Jansen

Abstract

To assess the diagnostic outcomes of a multidisciplinary pathway for elderly syncope patients. Observational cohort study at a Fall and Syncope Clinic, including consecutive syncope patients aged ≥65 years between 2011 and 2014. Measurements: The sort, number, and accuracy of diagnoses resulting in syncope. Secondary outcomes: reliability of the medical history and the number of electrocardiogram (ECG) abnormalities. The 117 included patients (72% females) had a mean age of 80 ± 6.5 years and a mean of 11 ± 5 (mainly cardiovascular) comorbidities. We found 212 contributing diagnoses. Symptomatic orthostatic/postprandial hypotension was present in 45%, cardiac causes in 44% (rhythm or conduction disorders 24%, aortic stenosis 4%, cardiomyopathies 2%, suspected cardiac causes 15%), and reflex syncope in 21%; 6% remained without any explanation. The diagnosis of the cause of syncope was uncertain in 34.2%, probable in 15.4%, and definite/most likely in 50.4%. Cognitive impaired patients were less likely to give a reliable medical history regarding their syncope (72% vs. 98% in cognitive intact patients, P = 0.001). In only 25% of patients a useful eyewitness account was available. 64% of ECGs showed relevant abnormalities; 26% was...Continue Reading

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Citations

Apr 2, 2019·The Journal of Nutrition, Health & Aging·S LuitingN van der Velde
Oct 18, 2019·Herz·T SeewösterG Hindricks
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May 23, 2020·The Canadian Journal of Cardiology·Jaume Francisco-PascualIgnacio Ferreira-González
May 21, 2021·QJM : Monthly Journal of the Association of Physicians·Neasa Fitzpatrick, Roman Romero-Ortuno

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