Evaluation of the current prognostic role of heart diseases in the history of patients with syncope.
OBJECTIVE
Pivotal studies showed that the 1-year mortality was consistently higher in cardiogenic than in non-cardiogenic syncope 10 years later, further studies questioned these evidences, showing that the risk of death was only predicted by underlying heart disease and not from the syncope itself. Accordingly, nearly all the prognostic scales now include cardiovascular variables, but their definition is often neither unique nor precise and it might lead to an excessive hospitalization.


RESULTS
This is a prospective cohort study aimed to compare the prognosis of syncopal patients with vs. without heart diseases, considered both in a broad (all cardiovascular diseases) and limited sense (only high-risk diseases, that is coronary heart diseases, heart failure, severe aortic stenosis, cardiomyopathies, and primarily arrhythmic diseases). We studied 200 patients consecutively admitted to the emergency department of the University Hospital of Parma. At 1 month and 1 year after discharge, we compared the incidence of syncopal recurrences with trauma, major procedures, cardiovascular events, and death for any reason in patients with vs. without heart diseases, considered both in a broad and limited sense. The presence of heart diseases in a broad sense was not associated with the endpoints, both at short and long term. Conversely, high-risk heart diseases were strongly associated with the presence of serious outcomes at short time.


CONCLUSIONS
We recommend that emergency department physicians adopt a strict definition of heart diseases considered at risk to promptly identify all patients at risk for serious events, while avoiding an excessive hospitalization.
Emergency Department, University Hospital of Parma, via Gramsci 14, 43126 Parma, Italy fnumeroso@ao.pr.it.
Filippo
F
Numeroso
Emergency Department, University Hospital of Parma, via Gramsci 14, 43126 Parma, Italy.
Gianluigi
G
Mossini
Department of Pathology and Laboratory Medicine, University Hospital of Parma, via Gramsci 14, 43126 Parma, Italy.
Giuseppe
G
Lippi
Emergency Department, University Hospital of Parma, via Gramsci 14, 43126 Parma, Italy.
Gianfranco
G
Cervellin
D000368:Aged; D015331:Cohort Studies; D006331:Heart Diseases / Q000175:diagnosis* / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013575:Syncope / Q000175:diagnosis* / Q000401:mortality*
Emergency department; Heart diseases; Prognosis; Syncope