Department of Geriatric Medicine, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands.
Department of Cardiology, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands.
Europace. 2018 May 1;20(5):867-872. doi: 10.1093/europace/eux099.
To assess the diagnostic outcomes of a multidisciplinary pathway for elderly syncope patients.
Observational cohort study at a Fall and Syncope Clinic, including consecutive syncope patients aged ≥65 years between 2011 and 2014. Measurements: The sort, number, and accuracy of diagnoses resulting in syncope. Secondary outcomes: reliability of the medical history and the number of electrocardiogram (ECG) abnormalities. The 117 included patients (72% females) had a mean age of 80 ± 6.5 years and a mean of 11 ± 5 (mainly cardiovascular) comorbidities. We found 212 contributing diagnoses. Symptomatic orthostatic/postprandial hypotension was present in 45%, cardiac causes in 44% (rhythm or conduction disorders 24%, aortic stenosis 4%, cardiomyopathies 2%, suspected cardiac causes 15%), and reflex syncope in 21%; 6% remained without any explanation. The diagnosis of the cause of syncope was uncertain in 34.2%, probable in 15.4%, and definite/most likely in 50.4%. Cognitive impaired patients were less likely to give a reliable medical history regarding their syncope (72% vs. 98% in cognitive intact patients, P = 0.001). In only 25% of patients a useful eyewitness account was available. 64% of ECGs showed relevant abnormalities; 26% was suggestive of cardiac syncope, of which 20% showed an indication for device implantation.
The majority of our elderly syncope patients had multiple contributing factors, often in addition to their primary diagnosis. Orthostatic/postprandial hypotension and cardiac disorders were the most frequent. Using a multidisciplinary approach, one or more possible explanations for the syncope were found in 94% of patients, with a definite diagnosis in 50%.
评估老年晕厥患者多学科路径的诊断结果。
在跌倒和晕厥诊所进行观察性队列研究，纳入 2011 年至 2014 年间连续就诊的年龄≥65 岁的晕厥患者。测量指标：导致晕厥的诊断分类、数量和准确性。次要结局：病史的可靠性和心电图（ECG）异常的数量。117 例纳入患者（72%为女性）平均年龄 80±6.5 岁，平均合并 11±5 种（主要为心血管）共存疾病。我们发现 212 个促成诊断。体位性/餐后低血压的症状性晕厥占 45%，心源性晕厥占 44%（节律或传导障碍 24%，主动脉瓣狭窄 4%，心肌病 2%，疑似心源性病因 15%），反射性晕厥占 21%；6%仍无任何解释。晕厥病因诊断不确定的占 34.2%，可能的占 15.4%，明确/最可能的占 50.4%。认知障碍患者更不可能提供有关晕厥的可靠病史（72% vs. 认知正常患者 98%，P=0.001）。仅 25%的患者有有用的目击者陈述。64%的心电图显示相关异常；26%提示心源性晕厥，其中 20%有装置植入指征。
我们的大多数老年晕厥患者有多种促成因素，通常除了主要诊断之外还有其他因素。体位性/餐后低血压和心脏疾病是最常见的。采用多学科方法，94%的患者找到了一个或多个可能导致晕厥的解释，其中 50%的患者得到了明确诊断。
