Monica Solbiati1, Giovanni Casazza2, Franca Dipaola3, Anna Maria Rusconi4, Giulia Cernuschi4, Franca Barbic3, Nicola Montano4, Robert Stanley Sheldon5, Raffaello Furlan3, Giorgio Costantino4. 1. Medicina ad Indirizzo Fisiopatologico, Dipartimento di Scienze Biomediche e Cliniche 'L. Sacco', Ospedale 'L. Sacco', Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milano, Italy monica.solbiati@gmail.com. 2. Dipartimento di Scienze Biomediche e Cliniche 'L. Sacco', Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milano, Italy. 3. Medicina Interna, Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, Humanitas Clinical and Research Center, Università degli Studi di Milano, Via A. Manzoni, 56, Rozzano, 20089 Milano, Italy. 4. Medicina ad Indirizzo Fisiopatologico, Dipartimento di Scienze Biomediche e Cliniche 'L. Sacco', Ospedale 'L. Sacco', Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milano, Italy. 5. Libin Cardiovascular Institute of Alberta, University of Calgary, 1403, 29 St NW, Calgary, AB, Canada T2N 2T9.
Abstract
AIMS: Data on adverse events and death rates following syncope are heterogeneous among studies, and knowledge of syncope prognosis could help to better define the correct management of patients. METHODS AND RESULTS: We performed a systematic review of literature by searching for prospective observational studies enrolling consecutive patients presenting to the Emergency Department because of syncope. The outcomes considered were syncope recurrence and short- and long-term mortality. Morbidity and a composite of morbidity and mortality were also assessed. Pooled event rates and 95% confidence intervals (CI) were calculated for each outcome using the random effects model. Twenty-five studies (11 158 patients) were included. The incidence of syncope relapse linearly increased from 0.3% at 30 days to 22% at 2 years follow-up. One-year mortality rate varied between 5.7 and 15.5%; the pooled estimate was 8.4% (95% CI: 6.7-10.2%). The incidence of adverse events (morbidity) varied between 6.1 and 25.2% at 10 days and 2 years, respectively. The short-term (10 days) pooled incidence of the composite of morbidity and mortality was 9.1% (95% CI: 6.6-12.5%). We found a high statistical heterogeneity between studies. CONCLUSION: This meta-analysis of prospective observational studies shows that the chance of being asymptomatic linearly progressively decreased over time after the first syncope. Short-term (10-30 days) mortality after syncope was <2% and that the overall 10-day rate of the composite endpoint of death and major events was ∼9%. The knowledge of syncope prognosis could help clinicians to understand syncope patients' prognosis and researchers to design future studies. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Data on adverse events and death rates following syncope are heterogeneous among studies, and knowledge of syncope prognosis could help to better define the correct management of patients. METHODS AND RESULTS: We performed a systematic review of literature by searching for prospective observational studies enrolling consecutive patients presenting to the Emergency Department because of syncope. The outcomes considered were syncope recurrence and short- and long-term mortality. Morbidity and a composite of morbidity and mortality were also assessed. Pooled event rates and 95% confidence intervals (CI) were calculated for each outcome using the random effects model. Twenty-five studies (11 158 patients) were included. The incidence of syncope relapse linearly increased from 0.3% at 30 days to 22% at 2 years follow-up. One-year mortality rate varied between 5.7 and 15.5%; the pooled estimate was 8.4% (95% CI: 6.7-10.2%). The incidence of adverse events (morbidity) varied between 6.1 and 25.2% at 10 days and 2 years, respectively. The short-term (10 days) pooled incidence of the composite of morbidity and mortality was 9.1% (95% CI: 6.6-12.5%). We found a high statistical heterogeneity between studies. CONCLUSION: This meta-analysis of prospective observational studies shows that the chance of being asymptomatic linearly progressively decreased over time after the first syncope. Short-term (10-30 days) mortality after syncope was <2% and that the overall 10-day rate of the composite endpoint of death and major events was ∼9%. The knowledge of syncope prognosis could help clinicians to understand syncopepatients' prognosis and researchers to design future studies. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Martin Huemer; Ann-Kristin Becker; Alexander Wutzler; Philipp Attanasio; Abdul S Parwani; Philipp Lacour; Leif-Hendrik Boldt; Burkert Pieske; Wilhelm Haverkamp; Florian Blaschke Journal: Cardiol J Date: 2018-02-05 Impact factor: 2.737
Authors: Monica Solbiati; Viviana Bozzano; Franca Barbic; Giovanni Casazza; Franca Dipaola; James V Quinn; Matthew J Reed; Robert S Sheldon; Win-Kuang Shen; Benjamin C Sun; Venkatesh Thiruganasambandamoorthy; Raffaello Furlan; Giorgio Costantino Journal: Intern Emerg Med Date: 2018-01-18 Impact factor: 3.397
Authors: Monica Solbiati; Giorgio Costantino; Giovanni Casazza; Franca Dipaola; Andrea Galli; Raffaello Furlan; Nicola Montano; Robert Sheldon Journal: Cochrane Database Syst Rev Date: 2016-04-19