Study Design Summary: Multicenter, observational study of 3,500 adults ≥60 years old presenting to ED with syncope or presyncope. Primary outcome was rate of serious adverse events at 30 days compared between the syncope vs near syncope group.
Notes: The goal of the study was to determine if patients presenting with near syncope had similar adverse event rates compare to those presenting with syncope. Patients were included if ≥60 years old, presenting with either syncope or presyncope. Patients were excluded if symptoms caused by events such as intoxication, stroke, head trauma seizure or hypoglycemia, or if medical intervention such as defibrillation was needed. All patients had EKG done with preset criteria to determine if the EKG was considered abnormal. Testing of patients beyond baseline ECG was left up to the treating physician. Physicians were ask to give a probability that the patient would experience a 30 day cardiac event or death. It is unclear at exactly when during the encounter this was sought from the treating physicians.
The final cohort of patients came to 3,581 total patients, from an initial 10,306 screened. While reasons were given to most of the excluded patients, 502 were listed as “other” with no explanation. More patients in the near syncope group had CHF, CAD, dyspnea.
Primary outcome was composite outcome of 30 day all cause mortality or any of the predefined serious clinical events. The treating physician determined if the patient had syncope vs near syncope.
There were a total of 658 30-day serious events (18.4%) in the study cohort, with the percentage not different between the syncope (18.2%) vs near syncope (18.7%) groups. Authors report that the major categories of adverse events was similar between the two groups as well. There was also no difference between the groups after multivariate logistic regression analysis. History of arrhythmia, abnormal EKG result, and presence of dyspnea remained the highest predictors of 30-day serious clinical event per the authors.
Study Conclusion: Syncope and near syncope have similar 30 day serious adverse event rates for older patients.
Fusion Beat Bottom Line Impression: This observational study supports the notion that syncope and near syncope should be treated clinically as the same entity when evaluating older patients in the ED.
A Fusion Beat 