OBJECTIVES: To test the applicability and safety of a standardized diagnostic algorithm in geriatric departments and to define the prevalence of different causes of syncope in older patients. DESIGN: Multicenter cross-sectional observational study. SETTING: In-hospital geriatric acute care departments and outpatient clinics. PARTICIPANTS: Two hundred forty-two patients (aged>or=65, mean+/-standard deviation=79+/-7, range 65-98) consecutively referred for evaluation of transient loss of consciousness to any of six clinical centers participating in the study. Of these, 11 had a syncope-like condition (5 transient ischemic attack; 6 seizures), and 231 had syncope (aged 65-74, n=71; aged>or=75, n=160). MEASUREMENTS: Protocol designed to define etiology and clinical characteristics of syncope derived from European Society of Cardiology Guidelines on syncope. RESULTS: No major complication occurred with use of the protocol. Neurally mediated was the more prevalent form of syncope in this population (66.6%). Cardiac causes accounted for 14.7% of all cases. The neuroreflex form of syncope (vasovagal, situational, and carotid sinus syndrome) was more common in younger than in older patients (62.3% vs 36.2%; P=.001), whereas orthostatic syncope was more frequent in the older than in the younger group (30.5% vs 4.2%; P<.001). In only 10.4% of cases, syncope remained of unexplained origin. After initial evaluation, a definite diagnosis was possible in 40.1% of the cases, and a suspected diagnosis was obtained in 57.9%. Syncope of suspected cardiac origin after initial evaluation was confirmed in 43.7% of cases, and neuromediated causes were confirmed in 83.5% of the cases. CONCLUSION: The protocol is applicable even beyond the age of 90 in geriatric departments. The standardized protocol is associated with a reduction in the frequency of unexplained syncope to about 10%.

Diagnosis and characteristics of syncope in older patients referred to geriatric departments / Ungar, Andrea; Mussi, Chiara; Del Rosso, Attilio; Noro, Gabriele; Abete, Pasquale; Ghirelli, Loredana; Cellai, Tommaso; Landi, Annalisa; Salvioli, Gianfranco; Rengo, Franco; Marchionni, Niccolò; Masotti, Giulio. - In: JOURNAL OF THE AMERICAN GERIATRICS SOCIETY. - ISSN 0002-8614. - 54:10(2006), pp. 1531-1536. [10.1111/j.1532-5415.2006.00891.x]

Diagnosis and characteristics of syncope in older patients referred to geriatric departments

MUSSI, Chiara;SALVIOLI, Gianfranco;
2006

Abstract

OBJECTIVES: To test the applicability and safety of a standardized diagnostic algorithm in geriatric departments and to define the prevalence of different causes of syncope in older patients. DESIGN: Multicenter cross-sectional observational study. SETTING: In-hospital geriatric acute care departments and outpatient clinics. PARTICIPANTS: Two hundred forty-two patients (aged>or=65, mean+/-standard deviation=79+/-7, range 65-98) consecutively referred for evaluation of transient loss of consciousness to any of six clinical centers participating in the study. Of these, 11 had a syncope-like condition (5 transient ischemic attack; 6 seizures), and 231 had syncope (aged 65-74, n=71; aged>or=75, n=160). MEASUREMENTS: Protocol designed to define etiology and clinical characteristics of syncope derived from European Society of Cardiology Guidelines on syncope. RESULTS: No major complication occurred with use of the protocol. Neurally mediated was the more prevalent form of syncope in this population (66.6%). Cardiac causes accounted for 14.7% of all cases. The neuroreflex form of syncope (vasovagal, situational, and carotid sinus syndrome) was more common in younger than in older patients (62.3% vs 36.2%; P=.001), whereas orthostatic syncope was more frequent in the older than in the younger group (30.5% vs 4.2%; P<.001). In only 10.4% of cases, syncope remained of unexplained origin. After initial evaluation, a definite diagnosis was possible in 40.1% of the cases, and a suspected diagnosis was obtained in 57.9%. Syncope of suspected cardiac origin after initial evaluation was confirmed in 43.7% of cases, and neuromediated causes were confirmed in 83.5% of the cases. CONCLUSION: The protocol is applicable even beyond the age of 90 in geriatric departments. The standardized protocol is associated with a reduction in the frequency of unexplained syncope to about 10%.
2006
54
10
1531
1536
Diagnosis and characteristics of syncope in older patients referred to geriatric departments / Ungar, Andrea; Mussi, Chiara; Del Rosso, Attilio; Noro, Gabriele; Abete, Pasquale; Ghirelli, Loredana; Cellai, Tommaso; Landi, Annalisa; Salvioli, Gianfranco; Rengo, Franco; Marchionni, Niccolò; Masotti, Giulio. - In: JOURNAL OF THE AMERICAN GERIATRICS SOCIETY. - ISSN 0002-8614. - 54:10(2006), pp. 1531-1536. [10.1111/j.1532-5415.2006.00891.x]
Ungar, Andrea; Mussi, Chiara; Del Rosso, Attilio; Noro, Gabriele; Abete, Pasquale; Ghirelli, Loredana; Cellai, Tommaso; Landi, Annalisa; Salvioli, Gia...espandi
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1130031
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