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Long-term outcomes in syncope patients presenting to the emergency department: A systematic review

  • Cameron W. Leafloor (a1) (a2), Patrick Jiho Hong (a1), Muhammad Mukarram (a3), Lindsey Sikora (a1), Jesse Elliott (a4) and Venkatesh Thiruganasambandamoorthy (a3) (a5) (a2)...

Abstract

Introduction

Long-term outcomes among syncope patients are not well studied to guide physicians regarding outpatient testing and follow-up. The objective of this study was to conduct a systematic review for outcomes at 1-year or later among ED syncope patients.

Methods

We searched Cochrane Central, Medline, Medline in Process, PubMed, Embase, and the Cumulative Index to Nursing databases from inception to December 2018. We included studies that reported long-term outcomes among ED syncope patients. We excluded studies on patients <16 years old, studies that included syncope mimickers (pre-syncope, seizure, intoxication, loss of consciousness after head trauma), case reports, letters to the editor, non-English and review articles. Outcomes included death, syncope recurrence requiring hospitalization, arrhythmias and procedural interventions for arrhythmias. Meta-analysis was performed by pooling the outcomes using random effects model.

Results

Initial literature search generated 2,094 articles duplicate removal. Of the 50 articles selected for full-text review, 19 articles with 98,211 patients were included in this review: of which 12 were included in the 1-year outcome meta-analysis. Pooled analysis showed : 7.0% mortality; 16.0% syncope recurrence requiring hospitalization; 6.0% with device insertion. 1-year arrhythmias reported in two studies were 1.1 and 26.4%. Pooled analysis for outcome at 31 to 365 days showed: 5.0% mortality and 1% device insertion. Two studies reported 4.9% and 21% mortality at 30 months and 4.2 years follow-up.

Conclusions

An important proportion of ED syncope patients suffer long-term morbidity and mortality. Appropriate follow-up is needed and future research to identify patients at risk is needed.

Introduction

Les résultats à long terme observés chez les patients ayant subi une syncope sont mal connus et, de ce fait, ne peuvent guider les médecins quant aux examens en clinique externe et au suivi. L’étude visait donc à mener une revue systématique des résultats observés chez les patients traités au service des urgences (SU) pour une syncope, au bout de 1 an et plus.

Méthode

Des recherches ont été entreprises dans les bases de données Cochrane Central, Medline, Medline in Process, PubMed, Embase et Cumulative Index to Nursing, depuis leur début respectif jusqu’à décembre 2018. Ont été retenues les études qui faisaient état de résultats à long terme observés chez les patients traités au SU pour une syncope. En revanche, ont été exclus les études sur les patients de moins de 16 ans, celles portant sur des malaises simulant une syncope (présyncope, convulsions, intoxication, perte de connaissance à la suite d'un traumatisme crânien), les exposés de cas, les lettres à l’éditeur, les articles rédigés dans une autre langue que l'anglais et les articles de synthèse. Les résultats étudiés comprenaient la mort, l'hospitalisation pour de nouvelles syncopes, les arythmies et les interventions de réduction des arythmies. Le groupement des résultats obtenus dans la méta-analyse a été effectué à l'aide du modèle à effets aléatoires.

Résultats

La recherche documentaire initiale a permis de relever 2094 articles après le retrait des doubles. Cinquante d'entre eux ont été sélectionnés pour un examen en texte intégral; sur ce nombre, 19, totalisant 98 211 patients, ont été inclus dans l’étude, dont 12, dans la méta-analyse des résultats au bout de 1 an. L'analyse groupée a révélé un taux de 7,0% de mortalité, de 16,0% de nouvelles syncopes nécessitant une hospitalisation et de 6,0% de pose de dispositifs de régulation. Deux études ont fait état d'arythmies de 1,1% et 26,4%, au bout de 1 an. D'après l'analyse groupée des résultats observés sur une période variant de 31 à 365 jours, le taux de mortalité atteignait 5,0% et celui de la pose de dispositifs de régulation, 1%. Enfin, selon deux études, le taux de mortalité s’élevait à 4,9% et à 21% au bout de 30 mois, et la durée du suivi était de 4,2 ans.

Conclusion

Une proportion importante des patients traités au SU pour une syncope est sujette à une morbidité et à une mortalité éloignées. Un suivi approprié s'impose donc, et il faudrait approfondir la recherche pour repérer les patients prédisposés à ces troubles.

Copyright

Corresponding author

Correspondence to: Dr. Venkatesh Thiruganasambandamoorthy, The Ottawa Hospital Research Institute Clinical Epidemiology Unit, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, 6th Floor, Rm F650, Ottawa, ONo K1Y 4E9; Email: vthirug@ohri.ca

References

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Long-term outcomes in syncope patients presenting to the emergency department: A systematic review

  • Cameron W. Leafloor (a1) (a2), Patrick Jiho Hong (a1), Muhammad Mukarram (a3), Lindsey Sikora (a1), Jesse Elliott (a4) and Venkatesh Thiruganasambandamoorthy (a3) (a5) (a2)...

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