Highlights
- •Syncope is a frequent cause for referrals in hospitals.
- •The overall in-hospital mortality was 1.6%.
- •Syncope in PE, pneumonia, MI and stroke showed an in-hospital mortality rate > 8%.
- •Syncope in AF patients was accompanied by higher in-hospital mortality.
- •Syncope did not influence the risk to die in-hospital independently in AF patients.
Abstract
Aims
Syncope is a common phenomenon in the general population. Although most of the causes
are of benign origin, some comorbidities are accompanied by high mortality.
We aimed to compare the in-hospital mortality of patients with syncope related to
different comorbities and investigate the impact of syncope in patients with atrial
fibrillation/flutter (AF).
Methods
The nationwide inpatient sample of Germany of the years 2011–2014 was used for this
analysis. Patients with syncope (ICD-code R55) were stratified by presence of selected
comorbidities. Additionally, AF patients with and without syncope were compared. Incidence
of syncope and in-hospital mortality were calculated. Syncope as a predictor of adverse
outcome in AF patients was investigated.
Results
In total, 1,628,859 hospitalizations of patients with syncope were identified; incidence
was 504.6/100,000 citizens/year with case-fatality rate of 1.6%. Patients with syncope
revealed frequently comorbidities as AF, heart failure and pneumonia. In-hospital
mortality was high in syncope patients with pulmonary embolism (PE, 13.0%), pneumonia
(12.8%), myocardial infarction (MI, 9.7%) and stroke (8.5%).
We analysed 1,106,019 hospitalizations (52.9% females, 54.9% aged > 70 years) of patients
with AF (2011–2014). Among these, 23,694 (2.1%) were coded with syncope and 0.7% died.
Syncope had no significant impact on in-hospital mortality (OR 1.04, 95%CI 0.92–1.17,
P = .503) independently of age, sex and comorbidities, but was associated with PE (OR
1.83, 95%CI 1.42–2.36, P < .001), MI (OR 1.68, 95%CI 1.48–1.90, P < .001), stroke (OR 1.66, 95%CI 1.42–1.94, P < .001) and pneumonia (OR 1.26, 95%CI 1.16–1.37, P < .001).
Conclusions
Syncope is a frequent cause for referrals in hospitals. While the overall in-hospital
mortality rate is low (<2%), syncope in coprevalence with PE, pneumonia, MI and stroke
showed a mortality rate > 8%. Syncope in AF patients had no independent impact on
in-hospital mortality.
Keywords
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References
- Stellenwert der Kipptischuntersuchung in der Synkopenabklärung.Aust J Cardiol. 2003; 10: 473-480
- Guidelines for the diagnosis and management of syncope (version 2009).Eur Heart J. 2009; 30: 2631-2671
- Epidemiologic features of isolated syncope: the Framingham study.Stroke. 1985; 16: 626-629
- Cardiology patient page.Syncope Circ. 2006; 113: e715-e717
- Evaluation of syncope in the emergency department.Am J Clin Med. 2010; 7: 11-19
- Evaluation of syncope.Am Fam Physician. 2005; 72: 1492-1500
- AHA/ACCF scientific statement on the evaluation of syncope: from the American Heart Association councils on clinical cardiology, cardiovascular nursing, cardiovascular disease in the young, and stroke, and the quality of care and outcomes research interdisciplinary working group; and the American College of Cardiology Foundation in collaboration with the Heart Rhythm Society.J Am Coll Cardiol. 2006; 47: 473-484
- 2018 ESC guidelines for the diagnosis and management of syncope.Eur Heart J. 2018; 39: 1883-1948
- Alcohol-induced blackout.Int J Environ Res Public Health. 2009; 6: 2783-2792
- Ecstasy and neurodegeneration. Gamma-Hydroxybutyrate is a new recreational drug that may lead to loss of consciousness.BMJ. 1996; 313: 424
- Loss of consciousness and post-traumatic stress disorder. A clue to aetiology and treatment.Br J Psychiatry. 1998; 173: 102-104
- Prevalence of pulmonary embolism among patients hospitalized for Syncope.N Engl J Med. 2016; 375: 1524-1531
- Syncope and collapse in acute pulmonary embolism.Am J Emerg Med. 2016; 34: 1251-1257
- Incidence and prognosis of syncope.N Engl J Med. 2002; 347: 878-885
Internet page of the InEK GmbH – Institut für das Entgeltsystem im Krankenhaus vanO. Deutsche Kodierrichtlinien 2018 Druckversion A4 (PDF). https://wwwg-drgde/inek_site_de/layout/set/standard/Media/Files/G-DRG-System/G-DRG-System_2018/Deutsche_Kodierrichtlinien_2018_Druckversion_A4_PDF. 2018.
- Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with syncope.Ann Emerg Med. 2007; 49: 431-444
- Patients with syncope in a German emergency department: description of patients and processes.Dtsch Arztebl Int. 2012; 109: 58-65
- Syncope: epidemiology, etiology, and prognosis.Front Physiol. 2014; 5: 471
- Incidence and mortality rates of syncope in the United States.Am J Med. 2009; 122: 181-188
- Role of autonomic reflexes in syncope associated with paroxysmal atrial fibrillation.J Am Coll Cardiol. 1993; 22: 1123-1129
- An abnormal neural reflex plays a role in causing syncope in sinus bradycardia.J Am Coll Cardiol. 1993; 22: 1130-1134
- The pathophysiology of common causes of syncope.Postgrad Med J. 2000; 76: 750-753
- Syncope in patients with structural heart disease.J Intern Med. 2013; 273: 336-344
- Ventricular tachycardia and sudden cardiac death.Mayo Clin Proc. 2009; 84: 289-297
- Reentry as a cause of ventricular tachycardia in patients with chronic ischemic heart disease: electrophysiologic and anatomic correlation.Circulation. 1988; 77: 589-606
- Arrhythmias and sudden death in heart failure.Jpn Circ J. 1997; 61: 727-740
- Syncope and atrial fibrillation: which is the chicken and which is the egg?.J Atr Fibrillation. 2015; 8: 1175
- Atrial fibrillation and mechanisms of stroke: time for a new model.Stroke. 2016; 47: 895-900
- ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS: the task force for the management of atrial fibrillation of the European Society of Cardiology (ESC)developed with the special contribution of the European heart rhythm association (EHRA) of the ESC endorsed by the European stroke organisation (ESO).Eur Heart J. 2016; 2016
- Stroke prevention in atrial fibrillation: atrial appendage closure.Curr Cardiol Rep. 2011; 13: 159-166
- Syncope in advanced heart failure: high risk of sudden death regardless of origin of syncope.J Am Coll Cardiol. 1993; 21: 110-116
- A prospective evaluation and follow-up of patients with syncope.N Engl J Med. 1983; 309: 197-204
- Susceptibility to neuromediated syncope after acute myocardial infarction.Eur J Clin Invest. 2000; 30: 383-388
- ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (writing committee to revise the 2002 guidelines for the Management of Patients with Unstable Angina/non-ST-elevation myocardial infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine.J Am Coll Cardiol. 2007; 50: e1-e157
- Pulmonary embolism presenting as syncope: a case report.J Med Case Rep. 2009; 3: 7440
- Vagal syncope during recurrent pulmonary embolism.JAMA. 1983; 249: 390-393
- Syncope in acute pulmonary embolism.Ital Heart J. 2004; 5: 3-5
- Recurrent pulmonary embolism with second-degree atrioventricular block and near syncope.Am Heart J. 1993; 126: 731-732
- The Bezold-Jarisch reflex revisited: clinical implications of inhibitory reflexes originating in the heart.J Am Coll Cardiol. 1983; 1: 90-102
- Syncope in patients with pulmonary embolism: comparison between patients with syncope as the presenting symptom of pulmonary embolism and patients with pulmonary embolism without syncope.Vasc Med. 2003; 8: 257-261
- Reflex syncope and syncope secondary to orthostatic hypotension.Internist (Berl). 2015; 56: 12-19
- Cardiogenic syncope.Internist (Berl). 2015; 56: 20-28
- Heart disease may be a risk factor for pulmonary embolism without peripheral deep venous thrombosis.Circulation. 2011; 124: 1435-1441
- History of deep vein thrombosis is a discriminator for concomitant atrial fibrillation in pulmonary embolism.Thromb Res. 2015; 136: 899-906
- Clinical relevance of syncope in patients with pulmonary embolism.Thromb Res. 2018; 164: 85-89
- ESC guidelines on the diagnosis and management of acute pulmonary embolism: the task force for the diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)endorsed by the European Respiratory Society (ERS).Eur Heart J. 2014; : 2014
- Fibrinolysis for patients with intermediate-risk pulmonary embolism.N Engl J Med. 2014; 370: 1402-1411
- Comparison of clinical characteristics and performance of pneumonia severity score and CURB-65 among younger adults, elderly and very old subjects.Thorax. 2010; 65: 971-977
- CRB-65 predicts death from community-acquired pneumonia.J Intern Med. 2006; 260: 93-101
Article info
Publication history
Published online: February 13, 2019
Accepted:
February 10,
2019
Received in revised form:
January 14,
2019
Received:
August 26,
2018
Identification
Copyright
© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
