Fabrizio Ricci1, Lamberto Manzoli, Richard Sutton, Olle Melander, Maria E Flacco, Sabina Gallina, Raffaele De Caterina, Artur Fedorowski. 1. aInstitute of Cardiology bDepartment of Neuroscience and Imaging cITAB, Institute of Advanced Biomedical Technologies dDepartment of Medical Sciences, University of Ferrara, Ferrara, Italy eNational Heart and Lung Institute, Imperial College, St Mary's Hospital Campus, London, UK fDepartment of Clinical Sciences, Malmö, Faculty of Medicine, Lund University gDepartment of Cardiology, Skåne University Hospital, Malmö, Sweden.
Abstract
OBJECTIVE(S): We explored incidence, predictors, and long-term prognosis of hospital admissions attributed to reflex syncope and orthostatic hypotension. METHODS: We analyzed a cohort of 32 628 individuals (68.2% men; age, 45.6 ± 7.4 years) without prevalent cardiovascular disease over a follow-up period of 26.6 ± 7.5 years. RESULTS: One thousand and fourteen persons (3.1%, 1.2 per 1000 person-years) had at least 1 hospitalization for orthostatic hypotension (n = 462, 1.42%) or syncope (n = 632, 1.94%). Orthostatic hypotension-related hospitalizations were predicted by age [per 1-year increase, hazard ratio 1.14, 95% confidence interval (CI): 1.12-1.16], smoking (hazard ratio 1.35, 95% CI: 1.12-1.64), diabetes (hazard ratio 1.50, 95% CI: 1.00-2.25), baseline orthostatic hypotension (hazard ratio 1.45, 95% CI: 1.05-1.98), in particular, by SBP fall at least 30 mmHg (hazard ratio 3.93, 95% CI: 2.14-7.23), whereas syncope hospitalizations by age (per 1-year increase, hazard ratio 1.09, 95% CI: 1.07-1.11), smoking (hazard ratio 1.27, 95% CI: 1.08-1.49), and hypertension (hazard ratio 1.42, 95% CI: 1.20-1.69). Both syncope-hospitalized and orthostatic hypotension hospitalized patients had higher burden of hospital admissions for other reasons such as cardiovascular, pulmonary, renal disease, or diabetes. During the follow-up, 10 727 (32.9%) died, with 419 deaths preceded by syncope/orthostatic hypotension hospitalization. After adjustment for traditional risk factors, syncope-hospitalization predicted all-cause mortality (hazard ratio 1.16, 95% CI: 1.02-1.31), whereas orthostatic hypotension hospitalization predicted cardiovascular mortality (hazard ratio 1.13, 95% CI: 1.07-1.19). CONCLUSION: Hospital admissions due to syncope and orthostatic hypotension occur in ≈3% of older individuals and increase with age and comorbidities. Admissions due to syncope are associated with prevalent hypertension, whereas those due to orthostatic hypotension overlap with diabetes and previously identified orthostatic hypotension. Syncope-related admissions predict higher all-cause mortality, whereas orthostatic hypotension-related admissions herald increased cardiovascular mortality.
OBJECTIVE(S): We explored incidence, predictors, and long-term prognosis of hospital admissions attributed to reflex syncope and orthostatic hypotension. METHODS: We analyzed a cohort of 32 628 individuals (68.2% men; age, 45.6 ± 7.4 years) without prevalent cardiovascular disease over a follow-up period of 26.6 ± 7.5 years. RESULTS: One thousand and fourteen persons (3.1%, 1.2 per 1000 person-years) had at least 1 hospitalization for orthostatic hypotension (n = 462, 1.42%) or syncope (n = 632, 1.94%). Orthostatic hypotension-related hospitalizations were predicted by age [per 1-year increase, hazard ratio 1.14, 95% confidence interval (CI): 1.12-1.16], smoking (hazard ratio 1.35, 95% CI: 1.12-1.64), diabetes (hazard ratio 1.50, 95% CI: 1.00-2.25), baseline orthostatic hypotension (hazard ratio 1.45, 95% CI: 1.05-1.98), in particular, by SBP fall at least 30 mmHg (hazard ratio 3.93, 95% CI: 2.14-7.23), whereas syncope hospitalizations by age (per 1-year increase, hazard ratio 1.09, 95% CI: 1.07-1.11), smoking (hazard ratio 1.27, 95% CI: 1.08-1.49), and hypertension (hazard ratio 1.42, 95% CI: 1.20-1.69). Both syncope-hospitalized and orthostatic hypotension hospitalized patients had higher burden of hospital admissions for other reasons such as cardiovascular, pulmonary, renal disease, or diabetes. During the follow-up, 10 727 (32.9%) died, with 419 deaths preceded by syncope/orthostatic hypotension hospitalization. After adjustment for traditional risk factors, syncope-hospitalization predicted all-cause mortality (hazard ratio 1.16, 95% CI: 1.02-1.31), whereas orthostatic hypotension hospitalization predicted cardiovascular mortality (hazard ratio 1.13, 95% CI: 1.07-1.19). CONCLUSION: Hospital admissions due to syncope and orthostatic hypotension occur in ≈3% of older individuals and increase with age and comorbidities. Admissions due to syncope are associated with prevalent hypertension, whereas those due to orthostatic hypotension overlap with diabetes and previously identified orthostatic hypotension. Syncope-related admissions predict higher all-cause mortality, whereas orthostatic hypotension-related admissions herald increased cardiovascular mortality.
Authors: Taliesin E Ryan-Atwood; Mieke Hutchinson-Kern; Jenni Ilomäki; Michael J Dooley; Susan G Poole; Carl M Kirkpatrick; Elizabeth Manias; Biswadev Mitra; J Simon Bell Journal: Drugs Aging Date: 2017-08 Impact factor: 3.923
Authors: Artur Fedorowski; Fabrizio Ricci; Viktor Hamrefors; Kristin E Sandau; Tae Hwan Chung; James A S Muldowney; Rakesh Gopinathannair; Brian Olshansky Journal: Circ Arrhythm Electrophysiol Date: 2022-02-25
Authors: Juan A Divisón-Garrote; Juan J de la Cruz; Alejandro de la Sierra; Ernest Vinyoles; Manuel Gorostidi; Carlos Escobar-Cervantes; Julián Segura; Vivencio Barrios; Luis M Ruilope; José R Banegas Journal: Hypertens Res Date: 2020-05-12 Impact factor: 3.872