Clinical Benefit of Hospitalization for Older Adults With Unexplained Syncope: A Propensity-Matched Analysis

Abstract

Study objective: Many adults with syncope are hospitalized solely for observation and testing. We seek to determine whether hospitalization versus outpatient management for older adults with unexplained syncope is associated with a reduction in postdisposition serious adverse events at 30 days.

Methods: We performed a propensity score analysis using data from a prospective, observational study of older adults with unexplained syncope or near syncope who presented to 11 emergency departments (EDs) in the United States. We enrolled adults (≥60 years) who presented with syncope or near syncope. We excluded patients with a serious diagnosis identified in the ED. Clinical and laboratory data were collected on all patients. The primary outcome was rate of post-ED serious adverse events at 30 days.

Results: We enrolled 2,492 older adults with syncope and no serious ED diagnosis from April 2013 to September 2016. Mean age was 73 years (SD 8.9 years), and 51% were women. The incidence of serious adverse events within 30 days after the index visit was 7.4% for hospitalized patients and 3.19% for discharged patients, representing an unadjusted difference of 4.2% (95% confidence interval 2.38% to 6.02%). After propensity score matching on risk of hospitalization, there was no statistically significant difference in serious adverse events at 30 days between the hospitalized group (4.89%) and the discharged group (2.82%) (risk difference 2.07%; 95% confidence interval -0.24% to 4.38%).

Conclusion: In our propensity-matched sample of older adults with unexplained syncope, for those with clinical characteristics similar to that of the discharged cohort, hospitalization was not associated with improvement in 30-day serious adverse event rates.

Trial registration: ClinicalTrials.gov NCT01802398.

Conflict of interest statement

Conflicts of Interest: The authors have no financial conflicts of interest to declare. The authors have the following disclosures. MNS reports research funding from Roche and Omron, Inc. DHA has received research funding from Roche. AB has received research funding from Radiometer and Portola and has been a consultant for Portola. CWB has received advisory board and speaker’s fees from Roche, research funding from Janssen and Boehringer Ingelheim, and consulting and advisory board fees from Janssen. 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. CLC is also 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. DKN has received honorarium from Pfizer. ABS is a consultant for Siemens and Quidel and is on the Data and Safety Monitoring Board for Trevena. BCS is a consultant for Medtronic. The remaining authors have no financial disclosures.

Copyright © 2019 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1:

Study Flow Chart RA: Research Assistant; AMA: Against Medical Advice; ED: Emergency Department; SSDI: Social Security Death Index