Older patients (≥65 years) with atypical syncope experienced higher all-cause mortality (28% vs 3.6%, p=0.0001) and syncope recurrence (32% vs 22%, p=0.03) than younger patients.
Cohort (n=489)
No
Does older age (≥65 years) affect the underlying causes and clinical outcomes of atypical syncope compared to younger patients?
In patients with atypical syncope, older age is associated with different underlying etiologies (more carotid sinus syndrome), higher recurrence rates, and increased mortality, with polypharmacy serving as a significant predictor of fatal events.
Absolute Event Rate: 28% vs 3.6%
p-value: p=0.0001
The aim of this study was to assess whether syncope with atypical presentation in elderly would be associated to different outcome respect to younger pts. Out of 1031 consecutive pts referred to our Syncope Unit, 489 pts with history of al least one syncope without any identifiable trigger or prodomal symptoms were studied. All pts were evaluated according to the recommendations of the ESC Task Force on Syncope. Pts were assigned to 2 age groups: <65 yrs (Gr. A: 136 pts, mean age 45±15 yrs) and ≥ 65 yrs (Gr. B: 353 pts, mean age 77±7 yrs). Compared to pts of Gr. A, those of Gr. B had a older age of first faint (41±17 yrs Gr. A vs 74±11 yrs Gr. B p = 0.0001), a higher rate of comorbidities (21% Gr. A vs 60% Gr. B, p=0.0001), and a higher number of drugs (0.93±1.3 Gr. A vs 2.33±2.0 Gr. B, p=0.001). After clinical evaluation nitrate-potentiated HUT was performed in 363 pts (positive 38% Gr. A vs 39% Gr. B, p=n.s.), carotid sinus massage in 451 pts (positive 4.5% Gr. A vs 19% Gr. B, p=0.003), EPS in 39 pts (6.6% Gr. A vs 8% Gr. B, p=n.s.), ILRs in 34 pts (5% Gr. A vs 7.6% Gr. B, p=n.s.). A final diagnosis was obtained in 115 pts of Gr. A and in 269 pts of Gr. B vasovagal syncope 48% Gr. A vs 27% Gr. B (p=0.002), orthostatic hypotension 1.4% Gr. A vs 4% Gr. B (p=n.s.), arrhythmic cause 12% Gr. A vs 12% del Gr. B (p=n.s.), heart disease cause 3% Gr. A vs 9% Gr. B (p=0.03), non sincopal condition 12% Gr. A vs 5% Gr. B (p=0.03), carotid sinus syncope 7% Gr. A vs 18% Gr. B (p=0.002). Syncope was unexplained in 15% (Gr. A) and 24% of the pts (Gr. B) (p=0.02). On follow-up (mean 54±17 months, median 49) syncope recurrence was noted in 142 pts (22% Gr. A vs 32% Gr. B, p=0.03), major therapeutic procedures (pacemaker, ICD and ablation) in 96 pts (8% Gr. A vs 24% Gr. B, p=0.001) and all-cause mortality in 105 pts (3.6% Gr. A vs 28% Gr. B, p=0001). On multivariate Cox analysis the number of drugs (Wald χ2 = 9.515, p = 0.002, Exp (β) = 1.380, IC 95% 1,125-1,693) in the Gr. A and the age of first faint (Wald χ2 = 8.304, p = 0.004, Exp (β) = 1.068, IC 95% 1,021-1,118) and the number of drugs (Wald χ2 = 6.709, p = 0.01, Exp (β) = 1.380, IC 95% 1,172-1,321) in the Gr. B were found to be predictive of all-cause mortality. In conclusion a) the older pts have more often a carotid sinus syndrome as syncopal cause, but also a higher rate of unexplained syncope, a more frequent syncope recurrence than the younger pts; b) politherapy is a common risk factor for fatal events in both groups, suggesting a considerable role of comorbidities, but also possible cause of adverse events.
Petix et al. (Fri,) conducted a cohort in Atypical syncope (n=489). Older age (≥65 years) vs. Younger age (<65 years) was evaluated on All-cause mortality (p=0.0001). Older patients (≥65 years) with atypical syncope experienced higher all-cause mortality (28% vs 3.6%, p=0.0001) and syncope recurrence (32% vs 22%, p=0.03) than younger patients.