Epidemiology of syncope in hospitalized patients.
OBJECTIVE
To describe the etiologies of syncope in hospitalized patients and determine the factors that influence survival after discharge.


METHODS
Observational retrospective cohort.


METHODS
Department of Veterans Affairs hospital, group-model HMO, and Medicare population in Oregon.


METHODS
Hospitalized individuals (n = 1,516; mean age +/- SD, 73.0 +/- 13.4 years) with an admission or discharge diagnosis of syncope (ICD-9-CM 780.2) during 1992, 1993, or 1994.


RESULTS
During a median hospital stay of 3 days, most individuals received an electrocardiogram (97%) and prolonged electrocardiographic monitoring (90%), but few underwent electrophysiology testing (2%) or tilt-table testing (0. 7%). The treating clinicians identified cardiovascular causes of syncope in 19% of individuals and noncardiovascular causes in 40%. The remaining 42% of individuals were discharged with unexplained syncope. Complete heart block (2.4%) and ventricular tachycardia (2. 3%) were rarely identified as the cause of syncope. Pacemakers were implanted in 28% of the patients with cardiovascular syncope and 0. 4% of the others. No patient received an implantable defibrillator. All-cause mortality +/- SE was 1.1% +/- 0.3% during the admission, 13% +/- 1% at 1 year, and 41% +/- 2% at 4 years. The adjusted relative risk (RR) of dying for individuals with cardiovascular syncope (RR 1.18; 95% confidence interval [CI] 0.92, 1.50) did not differ from that for unexplained syncope (RR 1.0) and noncardiovascular syncope (RR 0.94; 95% CI 0.77, 1.16).


CONCLUSIONS
Among these elderly patients hospitalized with syncope, noncardiovascular causes were twice as common as cardiovascular causes. Because survival was not related to the cause of syncope, clinicians cannot be reassured that hospitalized elderly patients with noncardiovascular and unexplained syncope will have excellent outcomes.
Getchell
W S
WS
Department of Public Health and Preventive Medicine, Oregon Health Sciences University, Portland 97207, USA.
Larsen
G C
GC
Morris
C D
CD
McAnulty
J H
JH
D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D011379:Prognosis; D012189:Retrospective Studies; D013575:Syncope / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors; D014481:United States