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Diagnosis and Characteristics of Syncope in Older Patients Referred to Geriatric Departments
Author(s) -
Ungar Andrea,
Mussi Chiara,
Del Rosso Attilio,
Noro Gabriele,
Abete Pasquale,
Ghirelli Loredana,
Cellai Tommaso,
Landi Annalisa,
Salvioli Gianfranco,
Rengo Franco,
Marchionni Niccolò,
Masotti Giulio
Publication year - 2006
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2006.00891.x
Subject(s) - medicine , syncope (phonology) , orthostatic vital signs , etiology , vasovagal syncope , pediatrics , observational study , population , cross sectional study , outpatient clinic , complication , emergency medicine , blood pressure , environmental health , pathology
OBJECTIVES: To test the applicability and safety of a standardized diagnostic algorithm in geriatric departments and to define the prevalence of different causes of syncope in older patients. DESIGN: Multicenter cross‐sectional observational study. SETTING: In‐hospital geriatric acute care departments and outpatient clinics. PARTICIPANTS: Two hundred forty‐two patients (aged ≥65, mean±standard deviation =79±7, range 65–98) consecutively referred for evaluation of transient loss of consciousness to any of six clinical centers participating in the study. Of these, 11 had a syncope‐like condition (5 transient ischemic attack; 6 seizures), and 231 had syncope (aged 65–74, n=71; aged ≥75, n=160). MEASUREMENTS: Protocol designed to define etiology and clinical characteristics of syncope derived from European Society of Cardiology Guidelines on syncope. RESULTS: No major complication occurred with use of the protocol. Neurally mediated was the more prevalent form of syncope in this population (66.6%). Cardiac causes accounted for 14.7% of all cases. The neuroreflex form of syncope (vasovagal, situational, and carotid sinus syndrome) was more common in younger than in older patients (62.3% vs 36.2%; P =.001), whereas orthostatic syncope was more frequent in the older than in the younger group (30.5% vs 4.2%; P <.001). In only 10.4% of cases, syncope remained of unexplained origin. After initial evaluation, a definite diagnosis was possible in 40.1% of the cases, and a suspected diagnosis was obtained in 57.9%. Syncope of suspected cardiac origin after initial evaluation was confirmed in 43.7% of cases, and neuromediated causes were confirmed in 83.5% of the cases. CONCLUSION: The protocol is applicable even beyond the age of 90 in geriatric departments. The standardized protocol is associated with a reduction in the frequency of unexplained syncope to about 10%.