Early and late-onset syncope: insight into mechanisms
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Published version
Author(s)
Type
Journal Article
Abstract
AIMS: Unexplained syncope is an important clinical challenge. The influence of age at first syncope on the final syncope diagnosis is not well studied. METHODS AND RESULTS: Consecutive head-up tilt patients (n = 1928) evaluated for unexplained syncope were stratified into age groups <30, 30-59, and ≥60 years based on age at first syncope. Clinical characteristics and final syncope diagnosis were analysed in relation to age at first syncope and age at investigation. The age at first syncope had a bimodal distribution with peaks at 15 and 70 years. Prodromes (64 vs. 26%, P < 0.001) and vasovagal syncope (VVS, 59 vs. 19%, P < 0.001) were more common in early-onset (<30 years) compared with late-onset (≥60 years) syncope. Orthostatic hypotension (OH, 3 vs. 23%, P < 0.001), carotid sinus syndrome (CSS, 0.6 vs. 9%, P < 0.001), and complex syncope (>1 concurrent diagnosis; 14 vs. 26%, P < 0.001) were more common in late-onset syncope. In patients aged ≥60 years, 12% had early-onset and 70% had late-onset syncope; older age at first syncope was associated with higher odds of OH (+31% per 10-year increase, P < 0.001) and CSS (+26%, P = 0.004). Younger age at first syncope was associated with the presence of prodromes (+23%, P < 0.001) and the diagnoses of VVS (+22%, P < 0.001) and complex syncope (+9%, P = 0.018). CONCLUSION: In patients with unexplained syncope, first-ever syncope incidence has a bimodal lifetime pattern with peaks at 15 and 70 years. The majority of older patients present only recent syncope; OH and CSS are more common in this group. In patients with early-onset syncope, prodromes, VVS, and complex syncope are more common. KEY QUESTION: Does the age at which patients experience syncope for the first time impact the final syncope diagnosis? KEY FINDING: The first-ever syncope incidence has a bimodal lifetime pattern. The majority of older patients present recent syncope; orthostatic hypotension and carotid sinus syndrome are more common in this group. In patients with early-onset syncope, vasovagal and complex syncope are more common. TAKE-HOME MESSAGE: The age at first syncope impacts the final diagnosis. A detailed syncope history remains essential in elderly patients evaluated for syncope.
Date Issued
2022-06-07
Date Acceptance
2022-01-06
ISSN
0195-668X
Publisher
European Society of Cardiology
Start Page
2116
End Page
2123
Journal / Book Title
European Heart Journal
Volume
43
Issue
22
Copyright Statement
© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact
journals.permissions@oup.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact
journals.permissions@oup.com
Identifier
https://academic.oup.com/eurheartj/article/43/22/2116/6525339
https://www.ncbi.nlm.nih.gov/pubmed/35139180
6525339
Subjects
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Vasovagal syncope
Head-up tilt test
Age at first syncope
Ageing
VASOVAGAL SYNCOPE
OLDER
POPULATION
PREVALENCE
EPIDEMIOLOGY
HYPOTENSION
OUTCOMES
YOUNGER
FALLS
AGE
Age at first syncope
Ageing
Head-up tilt test
Vasovagal syncope
Humans
Hypotension, Orthostatic
Incidence
Syncope
Syncope, Vasovagal
Tilt-Table Test
Humans
Syncope
Syncope, Vasovagal
Hypotension, Orthostatic
Tilt-Table Test
Incidence
Age at first syncope
Ageing
Head-up tilt test
Vasovagal syncope
1102 Cardiorespiratory Medicine and Haematology
1103 Clinical Sciences
Cardiovascular System & Hematology
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2022-02-09