Comparison of 30-Day Serious Adverse Clinical Events for Elderly Patients Presenting to the Emergency Department With Near-Syncope Versus Syncope

Abstract

Study objective: Controversy remains in regard to the risk of adverse events for patients presenting with syncope compared with near-syncope. The purpose of our study is to describe the difference in outcomes between these groups in a large multicenter cohort of older emergency department (ED) patients.

Methods: From April 28, 2013, to September 21, 2016, we conducted a prospective, observational study across 11 EDs in adults (≥60 years) with syncope or near-syncope. A standardized data extraction tool was used to collect information during their index visit and at 30-day follow-up. Our primary outcome was the incidence of 30-day death or serious clinical events. Data were analyzed with descriptive statistics and multivariate logistic regression analysis adjusting for relevant demographic or historical variables.

Results: A total of 3,581 patients (mean age 72.8 years; 51.6% men) were enrolled in the study. There were 1,380 patients (39%) presenting with near-syncope and 2,201 (61%) presenting with syncope. Baseline characteristics revealed a greater incidence of congestive heart failure, coronary artery disease, previous arrhythmia, nonwhite race, and presenting dyspnea in the near-syncope compared with syncope cohort. There were no differences in the primary outcome between the groups (near-syncope 18.7% versus syncope 18.2%). A multivariate logistic regression analysis identified no difference in 30-day serious outcomes for patients with near-syncope (odds ratio 0.94; 95% confidence interval 0.78 to 1.14) compared with syncope.

Conclusion: Near-syncope confers risk to patients similar to that of syncope for the composite outcome of 30-day death or serious clinical event.

Trial registration: ClinicalTrials.gov NCT01802398.

Conflict of interest statement

Conflicts of Interest:

AB has received research funding from Radiometer and Portola. He has been a consultant for Portola.

ES reports no conflict of interest.

DHA has received funding from Roche.

JMC has received funding from Astra Zeneca

CLC has received research funding from Radiometer, Ortho Clinical Trials, Janssen, Pfizer, NIH, Portola, Biocryst, Glaxo Smith Klein, Hospital Quality Foundation, and Abbott. She is a consultant for Portola, Janssen, and Hospital Quality Foundation.

DBD is a consultant for Janssen and Roche, has received institutional research support from Novartis, Ortho Scientific, and Roche, and is on the editorial board for Academic Emergency Medicine and Circulation.

JEH has received research funding from Alere, Siemens, Roche, Portola, and Trinity.

SEM reports no conflict of interest.

BAN reports no conflict of interest.

DKN has received honorarium from Pfizer.

MNS reports no conflict of interest.

KAS reports no conflict of interest.

ABS is a consultant for Siemens and Quidel and is on the Data and Safety Monitoring Board for Trevena.

STW reports no conflict of interest.

ANY reports no conflict of interest.

REW reports no conflict of interest.

BCS is a consultant for Medtronic.

Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Enrollment Diagram