Patterns and Preexisting Risk Factors of 30-Day Mortality After a Primary Discharge Diagnosis of Syncope or Near Syncope
Academic Emergency Medicine, 05/18/2012
Derose SF et al. – The low risk of death after an ED visit for syncope or near syncope in patients younger than 60years old without heart failure may be helpful when deciding who to admit for inpatient evaluation. The presence of one or more comorbidities that predict death and a prior visit for syncope should be considered in clinical decisions and risk stratification tools for patients with syncope. Close clinical follow–up seems advisable in patients 60years and older due to a prolonged risk of death.Methods
- A retrospective cohort study was performed of adult members of Kaiser Permanente Southern California seen at 11 EDs from 2002 to 2006 with a primary discharge diagnosis of syncope or near syncope.
- The outcome was 30–day mortality.
- Proportional hazards time–to–event regression models were used to identify risk factors.
- There were 22,189 participants with 23,951 ED visits, resulting in 307 deaths by 30days.
- A relatively lower risk of death was reached within 2weeks for ages 18 to 59years, but not until 3 months or more for ages 60 and older.
- Preexisting comorbidities associated with increased mortality included heart failure (hazard ratio [HR]=14.3 in ages 18 to 59years, HR=3.09 in ages 60 to 79years, HR=2.34 in ages 80years plus; all p<0.001), diabetes (HR =1.49, p=0.002), seizure (HR=1.65, p=0.016), and dementia (HR=1.41, p=0.034).
- If the index visit followed one or more visits for syncope in the previous 30days, it was associated with increased mortality (HR=1.86, p=0.024).
- Absolute risk of death at 30 days was under 0.2% in those under 60years without heart failure and more than 2.5% across all ages in those with heart failure.