Adlan Ahmed M, Eftekhari Helen, Paul Geeta, Hayat Sajad, Osman Faizel
Department of Cardiology University Hospitals Coventry & Warwickshire NHS Trust Coventry UK.
Department of Adult Cardiology Heart Hospital Hamad Medical Corporation Doha Qatar.
J Arrhythm. 2020 Aug 31;36(5):854-862. doi: 10.1002/joa3.12420. eCollection 2020 Oct.
Syncope is a leading cause of hospital admission and is associated with significant morbidity and mortality. Our Syncope Clinic commenced in 2014 and we sought to evaluate its impact on outcomes (1-yr mortality and syncope re-hospitalization) in patients discharged following syncope admission.
A single-center study of all consecutive patients discharged with syncope (ICD-10 R55) between April 2012 and 2017. Patient demographics, comorbidities, hospital stay, syncope re-hospitalization, and mortality at one-year were collected. Those subsequently referred and seen in Syncope Clinic were compared with those who were not and predictors of poor outcome were evaluated.
In total 2950 patients were discharged from hospital with syncope (median age: 73years, 51% male) with 1220 (41%) discharged same-day; after commencement of Syncope Clinic 231were subsequently reviewed here. Overall mortality was 11%, which was lower in the Syncope Clinic group (3% vs 12%, < .001). Temporal analysis revealed reduced re-hospitalization following commencement of Syncope Clinic (2% vs 6%, = .027). Independent predictors of mortality were increasing age (HR 1.03, 95% CI 1.03-1.04), AF (HR 1.6, 95% CI 1.2-2.1), HF (HR 2.2, 95% CI 1.6-3.0), COPD (HR 1.9, 95% CI 1.4-2.7), and CHADS score ≥ 1 (HR 1.45, 95% CI 1,12-1.87). Syncope Clinic attendance was associated with reduced mortality (HR 0.3, 95% CI 0.1-0.6).
Syncope patients discharged from hospital had reduced 1yr mortality if seen in subsequent Syncope Clinic. Independent predictors of mortality were COPD, HF, AF, and CHADS ≥1. Prospective randomized trials of Syncope Clinics are warranted.
晕厥是住院的主要原因之一，且与显著的发病率和死亡率相关。我们的晕厥诊所于2014年开业，我们试图评估其对晕厥入院后出院患者的预后（1年死亡率和晕厥再住院率）的影响。
对2012年4月至2017年间所有因晕厥（国际疾病分类第十版R55）连续出院的患者进行单中心研究。收集患者的人口统计学资料、合并症、住院时间、晕厥再住院情况以及1年时的死亡率。将随后转诊至晕厥诊所并就诊的患者与未就诊的患者进行比较，并评估不良预后的预测因素。
共有2950例患者因晕厥出院（中位年龄：73岁，51%为男性），其中1220例（41%）当日出院；晕厥诊所开业后，有231例患者随后在此接受了复查。总体死亡率为11%，晕厥诊所组的死亡率较低（3%对12%，<0.001）。时间分析显示，晕厥诊所开业后再住院率降低（2%对6%，P = 0.027）。死亡率的独立预测因素包括年龄增长（风险比1.03，95%置信区间1.03 - 1.04）、房颤（风险比1.6，95%置信区间1.2 - 2.1）、心力衰竭（风险比2.2，95%置信区间1.6 - 3.0）、慢性阻塞性肺疾病（风险比1.9，95%置信区间1.4 - 2.7）以及CHADS评分≥1（风险比1.45，95%置信区间1.12 - 1.87）。就诊于晕厥诊所与死亡率降低相关（风险比0.3，95%置信区间0.1 - 0.6）。
从医院出院的晕厥患者，如果随后在晕厥诊所就诊，其1年死亡率会降低。死亡率的独立预测因素为慢性阻塞性肺疾病、心力衰竭、房颤以及CHADS≥1。有必要对晕厥诊所进行前瞻性随机试验。
