Materiały źródłowe

• #1 Syncope: epidemiology, etiology, and prognosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4258989/

  Syncope is a common medical problem, with a frequency between 15% and 39%. […] In the general population, the annual number episodes are 18.139.7 per 1000 patients, with similar incidence between genders. […] The first report of the incidence of syncope is 6.2 per 1000 person-years. However, there is a significant increase in the incidence of syncope after 70 years of age with rate annual 19.5 per thousand individuals after 80 years. […] It presents a recurrence rate of 35% and 29% of physical injury. […] This framework is responsible for 35% of emergency department visits, with a hospitalization rate in about 40% of cases, with an average stay of 5.5 days. […] Beyond this morbidity, there is a recurrence rate of approximately 35% and 29% of physical injury, and major trauma in 4.7% of patients.

• #2 Syncope in adults: Epidemiology, pathogenesis, and etiologies – UpToDate

  https://www.uptodate.com/contents/syncope-in-adults-epidemiology-pathogenesis-and-etiologies

  Syncope/collapse is a common clinical problem, with a lifetime prevalence of at least one syncopal event in the population of approximately 20 percent. […] The epidemiology, pathogenesis, and etiologies of syncope will be reviewed here.

• #3 Syncope or fainting

  https://www.finapres.com/blog/syncope-or-fainting

  Syncope is more common than you might think! About 30-40% of all people will faint at least once in their life, and syncope is the reason for 1-3% of all visits to emergency departments and hospital admissions. […] Therefore, continuous non-invasive blood pressure monitoring can be an effective method to support the diagnosis of syncope!

• #4 Blackout/Transient Loss of Consciousness (T- LoC) and Syncope Epidemiology | STARS

  http://www.starstloc.org/why_set_up_a_t-loc_clinic/t-_loc_epidemiology

  Blackouts/T-LoCs commonly result from three main types of cause: cardiovascular, neurological or psychogenic. Each of these causes is associated to a specific medical condition. […] The underlying cause of syncope is a temporary but sudden reduction in blood supply, and hence oxygen, to the brain as a result of cardiovascular conditions. […] Most T-LoC cases presented to primary care or emergency departments are in fact syncope. […] Syncope is a very common, yet little known condition: up to 50 percent of people experience syncope at least once during their lives. […] According to the European Society of Cardiology Guidelines, identifying the cardiac causes of syncope is of critical importance, as many arrhythmias and other types of cardiac disease are now treatable with drugs and other devices.

• #5 Syncope: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/811669-overview

  Data regarding epidemiology and demographics of syncope vary with the populations under investigation as well as with how syncope is defined and/or characterized. Estimated prevalence has been reported to be as high at 41%, with a 13.5% prevalence of recurrent syncope. In adults, vasovagal syncope is the most common form of syncope. […] An estimated 1 million plus US emergency department visits are from syncope or presyncope. Framingham data demonstrated a first occurrence rate of 6.2 cases per 1000 patient-years. Syncope reoccurs in 3% of affected individuals, and approximately 10% of affected individuals have a cardiac etiology. […] Data from Europe and Japan suggest an occurrence rates similar to that in the United States, accounting for 1-3.5% of ED visits. In a 2024 report of findings from a multicenter European prospective study of 952 adults aged at least 18 years who presented to EDs with undifferentiated or suspected syncopal-related transient loss of consciousness (TLOC), Reed et al found a 1% prevalence of syncope in the ED, with about 4 in 10 patients admitted. This Syncope Evaluation in the Emergency Department (SEED) study noted admission rates rose with the presence of increasing high-risk factors (on the basis of the European Society of Cardiology criteria. See the Guidelines section.), which 75% of patients exhibited.

• #6 Syncope (medicine) – Wikipedia

  https://en.wikipedia.org/wiki/Syncope_(medicine)

  There are 18.139.7 syncope episodes per 1000 people in the general population. Rates are highest between the ages of 10-30 years old. This is likely because of the high rates of vasovagal syncope in the young adult population. Older adults are more likely to have orthostatic or cardiac syncope. […] Syncope affects about three to six out of every thousand people each year. It is more common in older people and females. It is the reason for 25% of visits to emergency departments and admissions to hospital. Up to half of women over the age of 80 and a third of medical students describe at least one event at some point in their lives. […] Of those presenting with syncope to an emergency department, about 4% died in the next 30 days. The risk of a poor outcome, however, depends very much on the underlying cause. Situational syncope is not at increased risk of death or adverse outcomes. Cardiac syncope is associated with worse prognosis compared to noncardiac syncope. Factors associated with poor outcomes include history of heart failure, history of myocardial infarction, ECG abnormalities, palpitations, signs of hemorrhage, syncope during exertion, and advanced age.

• #7 Syncope – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK442006/

  Syncope accounts for around 1 to 3.5% of visits to emergency department visits in the US. […] Syncope is more common in older patients due to multiple comorbidities and multiple medications. […] There is no significant difference in incidence between men and women.

• #8

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/syncope/

  The prevalence of syncope differs based on the clinical setting and the age of the patient. It is estimated that 3% of men and 3.5% of women experience syncope during their lifetime. Syncope has been estimated to account for 1% to 3% of emergency department visits and 1% to 6% of hospital admissions. The prevalence of syncope increases with age and is estimated to be 0.7% in patients age 35 to 44 compared with 4% to 6% in patients 75 and older. In the Framingham study, the incidence of syncope increased after the age of 70, from 5.7 per 1,000 events person-years in men aged 60 to 69 to 11.1 per 1,000 events person-years in men 70 to 79. […] The overall prognosis of syncope depends on the underlying cause. Patients with syncope with structural heart disease and primary electrical disease are at high risk of overall mortality and sudden cardiac death. Young patients with reflex syncope have an excellent prognosis.

• #9 Evaluation of Syncope | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0915/p640.html

  A retrospective study of more than 70,000 patients in the Netherlands compared the evaluation of syncope in the primary care setting versus the emergency department. The event rate for syncope in general practice exceeded the rate in the emergency department by a factor of 13 (9.3 versus 0.7 per 1,000 patient-years). […] Approximately 20 to 50 percent of patients have unexplained syncope after intensive diagnostic evaluation. […] Standardized clinical evaluations have been developed to stratify risk and determine which patients benefit from hospitalization and diagnostic evaluation. […] Patients with syncope have an increased risk of death from any cause (hazard ratio [HR] = 1.3; 95% confidence interval [CI], 1.1 to 1.5) and cardiovascular events (HR = 1.3; 95% CI, 1.0 to 1.6). […] Several clinical decision rules have been developed to aid physicians in determining the short-term risk of death.

• #10

  https://link.springer.com/article/10.1007/s10286-004-1003-3

  Cost-effective diagnostic approaches to reflex syncope require knowledge of its frequency and causes in different age groups. […] For this purpose we reviewed the available literature dealing with the epidemiology of reflex syncope. […] The incidence pattern of reflex syncope in the general population and general practice is bimodal with peaks in teenagers and in the elderly. […] The life-time cumulative incidence in young females (50%) is about twice as high as in males (25%). […] In the elderly, cardiac causes, orthostatic and postprandial hypotension, and the effects of medications are common, whereas typical vasovagal syncope is less frequent. […] Reflex syncope, however, remains the most common cause of syncope, but all-cause mortality in subjects with reflex syncope is not higher than in the general population. […] This knowledge about the epidemiology of reflex syncope can serve as a benchmark to develop cost-effective diagnostic approaches.

• #11 Simple Education

  https://simpleeducation.co/moments/188/components/812/preview

  The General Practitioners Transition Project in the Netherlands demonstrated that the age distribution of patients presenting to their GP with syncope shows a peak in females at 15 years of age and a second peak in older patients. The Framingham Offspring study similarly demonstrates a bimodal peak of first syncope in mid-teens and over 70 years. […] The true prevalence of syncope is underestimated due to the phenomenon of amnesia for T-LOC. Amnesia has been reported in patients with vasovagal syncope (VVS) and carotid sinus syndrome (CSS), but is likely to be present in all causes of syncope. The overlap between syncope and falls also leads to under-reporting. […] The prevalence of unexplained syncope varies according to diagnostic facilities and age from 9 to 41 %. In the older patient, history may be less reliable and multiple causes of syncope may also be present. Multi-morbidity and polypharmacy are more common in older patients with syncope and can add to the complexity of identifying an attributable cause of events. […] In some studies up to 30 % of older patients with syncope have more than one possible attributable cause, emphasising the necessity for a full comprehensive assessment in the older patient.

• #12

  https://jaypeedigital.com/eReader/chapter/9789350909539/ch1

  A study that included first-degree relatives of syncopal patients came to the conclusion that the majority of first syncopal events had occurred by age 40, with 37% of the study population having experienced at least one syncopal event by age 60. […] The age distribution of syncope is bimodal, with the first peak in the 2nd decade of life, and the second peak in the 7th decade of life. […] On the other hand, vasovagal syncope is a less common cause of fainting after age 65, and more dangerous (cardiac) causes need to be strongly considered; older patients are more likely to present sooner after their first episode for evaluation. […] Estimates vary, but about 15% of all visits to the emergency room are for syncope, of which about 30-50% will be diagnosed with vasovagal syncope. […] The mean age of the syncopal patient seen in the emergency room is 60 years, considerably older than the mean age of first syncope in the general population.

• #13 Postural syncope: mechanisms and management | The Medical Journal of Australia

  https://www.mja.com.au/journal/2007/187/5/postural-syncope-mechanisms-and-management

  Postural syncope has a bimodal distribution in the general population. The first peak, at around 15 years, predominates in girls, with the vast majority of cases being due to vasovagal syncope. In the second peak, at over 60 years, vasovagal syncope, orthostatic hypotension and situational syncope (eg, during micturition or after meals) are predominant, but clinical presentations are often diverse, posing a diagnostic challenge. Cardiac syncope remains a major culprit in this age group and must be excluded. […] Various guidelines have been published for evaluating syncope. Our preferred diagnostic algorithm is shown in Box 4. The recent consensus statement of the American Heart Association and the American College of Cardiology Foundation is primarily useful for providing a diagnostic path for excluding cardiac causes of syncope associated with sudden death. It does not address diagnosis and management of postural syncope and is neglectful of the clinical importance of disorders of circulatory control.

• #14 Syncope: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/811669-overview

  No significant differences regarding race are observed with respect to syncope risk. Although large prospective studies fail to show clinically significant differences between men and women, data from Olmsted County, Minnesota, found a higher prevalence reported among females. National Hospital Ambulatory Medical Care Survey (NHAMCS) data show that syncope occurs in all age groups but is most common in older adult populations. Noncardiac causes tend to be more common in young adults, whereas cardiac syncope is more common with male sex and becomes increasingly more frequent with advancing age. Syncope is relatively uncommon in pediatric populations. A retrospective study by Pratt and Fleisher reported a prevalence of less than 0.1% in children. Pediatric syncope warrants prompt detailed evaluation.

• #15

  https://jaypeedigital.com/eReader/chapter/9789350909539/ch1

  EPIDEMIOLOGY There are important challenges in considering the population of patients who experience syncope. The prevalence of syncope (proportion of people known to suffer from syncope at any given time in the general population) is difficult to assess, and various studies have reported varying results. […] The incidence of syncope (proportion of people experiencing syncope in a specified time frame) is different for different age groups, and the likely causes of syncope are also influenced by the age at presentation. […] In general, syncope in youth is most often benign, whereas syncope after age 60 years should prompt concern about cardiac causes of syncope. […] A study of medical students found that 39% admitted to at least one episode of fainting by age 25, with a near doubling of syncopal rates in women as compared to men (47% vs. 24%).

• #16 Evaluation of Syncope | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0915/p640.html

  Syncope is a transient and abrupt loss of consciousness with complete return to preexisting neurologic function. It is classified as neurally mediated (i.e., carotid sinus hypersensitivity, situational, or vasovagal), cardiac, orthostatic, or neurogenic. Older adults are more likely to have orthostatic, carotid sinus hypersensitivity, or cardiac syncope, whereas younger adults are more likely to have vasovagal syncope. […] The cumulative incidence of syncope is 3 to 6 percent over 10 years, and 80 percent of patients have their first episode before 30 years of age. The overall distribution of syncope is equal between men and women; however, women are more likely to have an event at the extremes of age. […] Population-based studies indicate that approximately 40 percent of adults have experienced syncope, with women being more likely to report a syncopal event.

• #17 Vasovagal fainting in teenagers and young adults | Syncopedia

  https://syncopedia.org/vasovagal-fainting-in-young-adults/

  A variety of triggers have been identified. […] By far the most common cause of transient loss of consciousness in young subjects is a reflex syncopal event and in particular a vasovagal faint. […] Two clinical scenarios in particular are known to provoke vasovagal faints in young subjects. […] The clinical presentation of vasovagal syncope may vary widely both within and among young patients. […] The incidence of syncope coming to medical attention appears to be clearly increased in two age groups i.e. in the young and in the old. […] An incidence peak occurs around the age of 15 years, with females having more than twice the incidence of males. […] The incidence of syncope in young subjects coming to medical attention varies from approximately 0.5 to 3 cases per 1000. […] Syncopal events which do not reach medical attention occur much more frequently.

• #18 Complexity of syncope in elderly people: a comprehensive geriatric approach | HKMJ

  https://www.hkmj.org/abstracts/v24n2/182.htm

  Syncope is a prevalent health problem among elderly people. […] The incidence of syncope increases sharply from 5.4 events per 1000 person-years in people aged 60 to 69 years to 11.1 events per 1000 person-years in those aged 70 to 79 years, and reaching 19.5 events per 1000 person-years in those aged 80 years or older. […] The prevalence of syncope is high for the institutionalised elderly, at 23%. […] Therefore, the true incidence and prevalence of syncope are expected to be higher than those estimated in some previous studies. […] The causes of syncope are highly age-dependent. […] Orthostatic hypotension (OH) is prevalent in elderly people and in those who are frail, affecting up to 18% of people aged 65 years or older and up to 52% of institutionalised elderly patients. […] Orthostatic hypotension is defined as a sustained reduction in systolic blood pressure of at least 20 mm Hg or in diastolic blood pressure of 10 mm Hg, within 3 minutes of standing.

• #19 Understanding Syncope in Geriatric Patients

  https://medictests.com/units/syncope

  EPIDEMIOLOGY: The incidence of syncope increases with age, with a sharp rise 70 years of age. […] This increased risk is due to age- and disease-related abnormalities that impair the ability to respond to physiologic stresses that would ordinarily not cause syncope in younger persons.

• #20 Complexity of syncope in elderly people: a comprehensive geriatric approach | HKMJ

  https://www.hkmj.org/abstracts/v24n2/182.htm

  Postprandial hypotension (PPH) is also common in the elderly people, with a prevalence reaching 59% in older Chinese men, especially in those older than 80 years. […] Cardiac syncope accounts for up to 15% of cases of syncope in the elderly people. […] The prevalence of unexplained syncope has decreased as the use of diagnostic techniques, such as the tilt-table test and CSM, has increased. […] Multiple causes of syncope are commonly observed in elderly patients: in 23.5% of those aged 65 or older and in 13.4% of those younger than 65 years. […] The presence of multiple causes also correlates with poor survival. […] Age-related change in the blood pressure regulatory mechanism increases the susceptibility to syncope in elderly people. […] The blunted baroreflex response and contracted blood volume, together with age-related diastolic dysfunction, can lead to low cardiac output and thus low cerebral blood flow.

• #21 Syncope: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/811669-overview

  Advancing age is an independent risk factor for both syncope and death. Various studies suggest categorizing patients older than 45 years, 65 years, and 80 years as being at higher risk. Advancing age correlates with increasing frequency of coronary artery and myocardial disease, arrhythmia, vasomotor instability, autonomic failure, polyneuropathy, and use of polypharmacy. Predictors of recurrent syncope in this population include aortic stenosis, atrioventricular or left bundle branch block, atrial fibrillation, heart failure, impaired kidney function, and chronic obstructive pulmonary disorder.

• #22 Syncope | Doctor

  https://patient.info/doctor/syncope

  Syncope is common in all age groups and affects 40% of people during their lifetime. However, only a minority of people with syncope will seek medical attention. […] 1-3.5% of all emergency department visits and 6% of all hospital admissions in the USA. […] The lifetime risk of syncope is 42% with a peak prevalence between the age of 10-30 years, mainly NMS. […] Cardiac causes, orthostatic and postprandial hypotension and the effects of medications are common causes in the elderly, in whom syncope increases with age; there is an annual incidence of almost 2% of individuals over the age of 80. […] A definite diagnosis for the cause of syncope in the elderly can be made in the majority of patients.

• #23

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/syncope/

  The Task Force for the Diagnostic Management Syncope of the European Society of Cardiology (Task Force of the ESC) has classified syncope into 3 main categories: reflex syncope, syncope due to OH, and cardiac syncope. Prospective studies have found that neurally mediated causes of syncope account for the largest percentage of events (38% to 56%). Cardiovascular causes, separated into syncope due to OH (2% to 24%) and structural heart disease (11% to 23%) account for smaller percentages of cases. The cause of syncope is undetermined in 14% to 18% of events. […] Postural or OH is defined as reduction in systolic blood pressure of at least 20 mm Hg accompanied by a diastolic blood pressure decrease of at least 10 mm Hg with upright posture. OH syncope includes syncope due to various types of primary and secondary autonomic dysfunction.

• #24 Syncope • LITFL • CCC cardiology

  https://litfl.com/syncope/

  Syncope is transient, self-limited loss of consciousness with an inability to maintain postural tone that is followed by spontaneous recovery. […] common; about 35% of ED visits and 16% of hospital admission. […] underlying cause: unknown (34-36%), vasovagal (18-21%), and cardiac (9.5-18%). […] cardiac causes are much more common in the elderly and those with a history of cardiac disease, and these patients have the highest mortality.

• #25 Textbook | Vasovagal Syncope | Syncopedia

  https://syncopedia.org/vasovagal-syncope/

  Vasovagal syncope is the most common cause of syncope making up 60% of the cases. The prevalence in the general population is ~40%. Most people dont attend a physician after a common vasovagal faint. The age at which people experience their first faint shows two peaks: one in adolescents and one peak in people 60 years-old. […] The prevalence is high. In several questionnaire studies in medical students a prevalence of up to 40% was found.

• #26 Neurocardiogenic syncope epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Neurocardiogenic_syncope_epidemiology_and_demographics

  Neurocardiogenic syncope is the most common cause of syncope in children and adults and accounts for approximately 10-40% of all syncopal episodes. […] The prevalence is 22% in the general population. Approximately 50%-66% of syncope cases are classified as due to vasovagal syncope.

• #27

  https://savvysciencepublisher.com/index.php/jne/article/view/811

  Vasovagal syncope is the most common cause of syncope in pediatric patients. […] The present study is aim to provide a comprehensive literature review of the latest advances in the diagnosis and treatment of vasovagal syncope in children. […] Diagnosis of vasovagal syncope is based on clinical history. […] For patients with suspected VVS but lack of confident diagnosis after initial assessment, head-up tilt test is helpful. […] There are four options for treatment of vasovagal syncope: conservative therapy, pharmacologic therapy, pacemaker therapy, and catheter ablation of ganglionated plexi. […] Catheter ablation of ganglionated plexi is a new strategy, its efficacy and safety in pediatric patients should be verified by randomized controlled trials.

• #28 Epidemiology of reflex syncope. | EBSCOhost

  https://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=09599851&AN=14665425&h=J9pU1zdeLPdg8rsUBcI2BPW7Ff92DmZaLYM5jVDuhh5gWJz3HA0FFuxUQcBsp00hgnjWWpERJPgiqLWLNxFSPg%3D%3D&crl=f

  Cost-effective diagnostic approaches to reflex syncope require knowledge of its frequency and causes in different age groups. For this purpose we reviewed the available literature dealing with the epidemiology of reflex syncope. The incidence pattern of reflex syncope in the general population and general practice is bimodal with peaks in teenagers and in the elderly. In the young almost all cases of transient loss of consciousness are due to reflex syncope. The life-time cumulative incidence in young females (? 50 %) is about twice as high as in males (? 25 %). In the elderly, cardiac causes, orthostatic and postprandial hypotension, and the effects of medications are common, whereas typical vasovagal syncope is less frequent. In emergency departments, cardiac causes and orthostatic hypotension are more frequent especially in elderly subjects. Reflex syncope, however, remains the most common cause of syncope, but all-cause mortality in subjects with reflex syncope is not higher than in the general population. This knowledge about the epidemiology of reflex syncope can serve as a benchmark to develop cost-effective diagnostic approaches.

• #29

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/syncope/

  Syndromes of orthostatic intolerance, which may cause syncope, include classic OH, initial OH, delayed or progressive OH, and postural tachycardia syndrome (POTS). […] Classic OH typically presents 30 seconds to 3 minutes after standing and is caused by impaired increase in systemic vascular resistance due to autonomic dysfunction or severe volume depletion over-riding reflex adjustments. Classic OH is more common in the elderly, associated with diuretic use, and frequently preceded by presyncope. […] POTS is characterized by an excessive heart rate after standing. As defined by the Heart Rhythm Society, POTS is a clinical syndrome characterized by frequent symptoms that occur with standing (ie, lightheadedness, palpitations, tremor, blurred vision, weakness, fatigue), an increase in heart rate of greater than 30 beats per minute, or a standing heart rate greater than 120 beats per minute.

• #30 Syncope: epidemiology, etiology, and prognosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4258989/

  The diagnosis of syncope can be made by clinical method associated with the electrocardiogram in up 50% of patients. […] Its prognosis is determined by the underlying etiology specifically the presence and severity of cardiac disease. […] The annual mortality can reach between 18 and 33% if cardiac cause, and between 0 and 12% if the non-cardiac cause. […] Thus, prognosis is determined by the underlying etiology specifically the presence and severity of cardiac disease. And it is imperative to identify its cause and risk stratification for positive impact in reducing morbidity and mortality.

• #31 DOAJ Logotype

  https://doaj.org/article/1a38ce0d0e734d6cb421be6691f11395

  Syncope is a common medical problem, with a frequency between 15% and 39%. In the general population, the annual number episodes are 18.1 to 39.7 per 1000 patients, with similar incidence between genders. The first report of the incidence of syncope is 6.2 per 1000 person-years. However, there is a significant increase in the incidence of syncope after 70 years of age with rate annual 19.5 per thousand individuals after 80 years. It presents a recurrence rate of 35% and 29% of physical injury. […] The diagnosis of syncope can be made by clinical method associated with the electrocardiogram in up 50% of patients. Its prognosis is determined by the underlying etiology specifically the presence and severity of cardiac disease. The annual mortality can reach between 18 and 33% if cardiac cause, and between 0 and 12% if the noncardiac cause. Thus, it is imperative to identify its cause and risk stratification for positive impact in reducing morbidity and mortality.

• #32 Complexity of syncope in elderly people: a comprehensive geriatric approach | HKMJ

  https://www.hkmj.org/abstracts/v24n2/182.htm

  All of the above pathophysiological processes can act together to impair cardiovascular compensation for haemodynamic stress in elderly people and thereby complicate the management of syncope. […] Among patients with syncope, mortality generally tends to increase with advancing age and in those with cardiac syncope and OH. […] The presence of multiple potential causes of syncope also predicts a lower survival rate as compared with a single cause of syncope. […] Patients with syncope have a 20% recurrence rate at 1 year, compared with a 2% rate of syncope in patients without prior syncope. […] The overlap between syncope and falls in the elderly people; syncope causes falls and some falls are due to syncope. […] Considering that syncope may be a component of fall in elderly patients, especially in those with unwitnessed or recurrent unexplained fall, assessment of cardiovascular status and postural blood pressure, as well as further investigation for accurate diagnosis and treatment, are recommended.

• #33

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/syncope/

  Morbidity in patients with syncope is associated with recurrence of episodes and physical injury. In population studies, approximately a third of patients have recurrence of syncope in 3 years of follow up, and the rate of recurrence seems to be dependent on the number of previous episodes, but independent of gender, tilt test results, severity and presence of heart disease. The predicted recurrence in 1 to 2 years for patients with 1 or 2 syncope episodes is 15% to 20% whereas for patients with 3 syncope episodes it is 36% to 45%. Young patients with psychiatric disease have high rates of recurrence of pseudosyncope. […] In patients with syncope presenting to the emergency department, 29.1% have minor trauma, 4.7% have major trauma, and in older patients with carotid disease, 43% have major trauma. Morbidity is particularly high in the elderly, and is associated with loss of confidence, fear of falling, depression, fractures, and institutionalization.

• #34 Blackout/Transient Loss of Consciousness (T- LoC) and Syncope Epidemiology | STARS

  http://www.starstloc.org/why_set_up_a_t-loc_clinic/t-_loc_epidemiology

  Some T-LoC can be a first symptom of fatal arrhythmia, which causes over 100,000 deaths every year in the UK. […] Sudden cardiac death is often attributed to cardiac arrhythmia and is today recognised as the most common killer in the US, accounting for around 350,000 deaths annually. […] Recurrent syncope impacts patients quality of life to the same degree as other chronic diseases such as rheumatoid arthritis. […] Syncope may result in injuries to the patients or to others as a result of accidents, leading to e.g. fractures.

• #35 Do Vaccines Cause Syncope? – Institute for Vaccine Safety

  https://www.vaccinesafety.edu/do-vaccines-cause-syncope/

  Vaccines currently routinely recommended to the general population in the U.S. can rarely cause syncope up to an hour after vaccination, most frequently among adolescents, and especially among females 11-18 years of age. […] The 2012 report by the Institute of Medicine (IOM), now called the National Academy of Medicine (NAM), found no relevant studies of quality in the literature assessing an association between vaccination and syncope, since the only applicable studies available either had limited power or serious methodological limitations, or used passive surveillance systems and therefore lacked an unvaccinated comparison group. […] A 2013 study by the U.S. Armed Forces estimated annual rates of syncope associated with immunization to be between 4.4 and 14.1 events per 100,000 immunizations. […] Syncope following vaccination has also occasionally been reported via passive surveillance systems.

• #36 Syncope and seizures following human papillomavirus vaccination: a retrospective case series | The Medical Journal of Australia

  https://www.mja.com.au/journal/2011/194/1/syncope-and-seizures-following-human-papillomavirus-vaccination-retrospective

  Objective: To quantify and characterise the reports of syncope and seizures following quadrivalent (4v) human papillomavirus (HPV) vaccination. […] Design and setting: Retrospective case series of notifications to SAEFVIC (Surveillance of Adverse Events Following Vaccination In the Community), May 2007 April 2009. […] Main outcome measures: Incidence of syncope and seizure following 4vHPV vaccination; clinical outcomes. […] The reporting rate after 4vHPV vaccine for syncope and syncopal seizures was 7.8/100 000 and 2.6/100 000 doses distributed, respectively. […] Syncope and syncopal seizures occurred after 4vHPV vaccination in Victoria at rates similar to those seen internationally. […] With a high level of international interest in AEFI after HPV vaccination, the aim of this study was to analyse detailed clinical information on SAEFVIC (Surveillance of Adverse Events Following Vaccination In the Community) cases of syncope and seizures after 4vHPV vaccination.

• #37 Syncope and seizures following human papillomavirus vaccination: a retrospective case series | The Medical Journal of Australia

  https://www.mja.com.au/journal/2011/194/1/syncope-and-seizures-following-human-papillomavirus-vaccination-retrospective

  The overall reporting rate following 4vHPV was 7.8 per 100 000 doses distributed for syncope and 2.6 per 100 000 for syncopal seizures. […] The Victorian reporting rate of syncope after 4vHPV vaccine of 7.8 per 100 000 doses distributed is similar to the United States Vaccine Adverse Event Reporting System (VAERS) reporting rate of 8.2 per 100 000. […] The reporting rate of syncopal seizures after 4vHPV vaccine found in our study was 2.6 per 100 000 doses distributed. […] Monitoring for significant AEFI is a crucial part of post-licensure surveillance.

• #38

  https://journals.lww.com/cjsportsmed/fulltext/2024/03000/convulsive_syncope_as_a_complication_of_outpatient.9.aspx

  Sports medicine providers often perform various outpatient procedures to manage musculoskeletal and neuropathic conditions. Vasovagal syncope is a rare but a possible complication. […] Convulsive syncope is one subtype that involves brief extensor stiffening and nonsustained myoclonus and can be easily mistaken for seizures. […] We aim to describe how to identify this condition, and offer risk stratification and management strategies to mitigate the risks of this complication. Sports medicine providers who routinely practice outpatient procedures should be aware of this complication. […] The incidence of vasovagal reactions ranged from 0.6% to 2.6%. […] Syncope accounts for 1% to 6% of emergency department visits and 1% to 3% hospital admissions. […] Syncope is well described in the existing literature; however, convulsive syncope in the context of in-office procedures is lacking.

• #39

  https://journals.lww.com/cjsportsmed/fulltext/2024/03000/convulsive_syncope_as_a_complication_of_outpatient.9.aspx

  Based on literature review, vasovagal reactions occurred between a range of 0.6% to 2.6% after any type of injection with zero reports of convulsive syncope. […] After a convulsive syncope episode, the primary objectives of the clinician should be to secure patient safety and capture the risk of morbidity and mortality, particularly the likelihood of underlying cardiovascular disease. […] Special care should be reviewed by clinicians during an intervention that could trigger vagus nerve stimulation. […] This case series and discussion highlight the importance of clinician readiness for convulsive syncope in an outpatient setting.

• #40 Blood donor fainting, vasovagal reactions | www.notifylibrary.org

  https://www.notifylibrary.org/incident/1657

  Estimated frequency: 10-40/10,000 with an average of about 30/10,000 depending upon the age and population. […] Rates for vasovagal and vasovagal syncope vary depending upon the donor population with rates of syncope roughly between 2-40/10,000 donation with an average around 30/10,000. […] In general, syncope occurs statistically more frequently in young donors (20 years old) (Eder): rates among young donors occur at 10.7/10,000, 8.310,000 and 2.8/10,000 in, respectively, 16-17 year olds, 18-19 year olds and donors 20 years old or older. […] Because multiple factors influence the rate and timing of syncopal reactions, interventions to prevent, abort or treat such reactions must address these psychological and physiological factors.

• #41 Surveillance of blood in Norway. Blood donor complications 2011 – NIPH

  https://www.fhi.no/en/publ/2013/surveillance-of-blood-in-norway.-blood-donor-complications-2011

  According to the definitions proposed by the Norwegian Haemovigilance Working Group (11), a total of 53 events were defined as serious (24 per 100 000 blood donations). […] Among the systemic complications, there were 97 reports on donor fainting (44 per 100 000 blood donations) and 16 reports on serious vasovagal reactions without fainting (7,3 per 100 000 blood donations). […] In 13 cases the donor needed to stay for some hours in the hospital for medical observation, mainly because of a vasovagal reaction with or without fainting.

• #42 Mass faintings among Cambodian workers may have multiple, intermingled causes – School of Public Health – University of Minnesota

  https://www.sph.umn.edu/news/mass-faintings-among-cambodian-workers-may-have-multiple-intermingled-causes/

  Mass faintings among Cambodian workers may have multiple, intermingled causes. Every year, more than a thousand workers faint for unexplained reasons in garment factories in Cambodia. In 2018, a single incident involved more than 200 workers at a shoe factory fainting at the same time. School of Public Health Assistant Professor Hyun Kim recently led a commentary on research into the mass faintings and suggests that investigators should consider the possibility that the illnesses are caused by multiple factors. […] Mass fainting in workplaces are often due to poor work environments, such as exposing workers to chemicals without providing adequate ventilation or personal protective equipment, said Kim. However, the mass faintings among Cambodian garment workers are very mysterious. […] The authors recommend using a classical epidemiology concept, known as the sufficient component cause model, to guide researchers to think about the entire problem using a systems approach. The model implies that there may be multiple contributing factors within several sufficient causes that act together to result in an illness. Removing one of the contributing factors from one of the sufficient causes can prevent some, but perhaps not all, cases of the disease. By considering the problem more holistically, it may be possible to identify several contributing causes, and therefore, employ multiple interventions to stop the mass faintings, said Kim.

• #43 Epidemic of Acute Illness–West Bank

  https://www.cdc.gov/mmwr/preview/mmwrhtml/00000068.htm

  From March 21 to April 3, 1983, 943 cases of an acute, non-fatal illness characterized by headache, dizziness, photophobia, blurred vision, abdominal pain, myalgia, weakness, difficulty breathing, fainting, mydriasis, and peripheral cyanosis occurred in residents of communities throughout the West Bank. […] Clinical, epidemiologic, and toxicologic analyses indicated the illness was of psychogenic origin and was induced by stress. […] Sinus tachycardia, mild hypertension, hyperventilation, mydriasis, and peripheral cyanosis were commonly observed in early stages of illness. […] Negative evidence in support of the diagnosis of stress-induced illness was provided by normal physical examinations, including those of patients in considerable distress, by normal results of clinical laboratory studies, and by negative findings of toxicologic analyses.

• #44 Epidemic of Acute Illness–West Bank

  https://www.cdc.gov/mmwr/preview/mmwrhtml/00000068.htm

  Positive support for the diagnosis of stress-induced disease was provided by clustering of cases among adolescent women. […] Previous studies of psychogenic illness outbreaks have emphasized that perception of strange odors or gases by affected individuals has frequently preceded onset of illness. […] Such patterns suggest the existence of a subconsciously learned response.

• #45 Postural syncope: mechanisms and management | The Medical Journal of Australia

  https://www.mja.com.au/journal/2007/187/5/postural-syncope-mechanisms-and-management

  Disorders of circulatory control are frequently disabling and difficult to treat. Recognising the various subgroups is helpful for matching treatment to the patients specific disorder. […] Tilt-table testing is a widely used method for evaluating postural syncope. It is predominantly used to diagnose vasovagal syncope. It may also be used to train patients to recognise the vasovagal prodrome some patients can then abort a vasovagal event using counter-manoeuvres such as leg-crossing. The diagnosis should only be made if the event during tilt-table testing reproduces the patients real-world event. The use of tilt-table testing remains controversial: publications report a wide range of sensitivity and specificity, with lack of specificity being a particular problem. The use of provocation testing with isoprenaline is of questionable merit it is possible to induce vasovagal syncope in almost anyone with an adequately aggressive tilt test. In a patient with a normal ECG, structurally normal heart, no neurological features, normal supine blood pressure and a negative tilt test, vasovagal syncope is still the likely diagnosis.

• #46 Role of tilt-table testing in syncope diagnosis and management

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-13/role-of-tilt-table-testing-in-syncope-diagnosis-and-management

  Tilt-table testing (TTT) plays a major role during the evaluation of syncope patients, helps to differentiate syncope subtypes and to discriminate between syncope and other common conditions such as epilepsy, and could be useful in guiding treatment. […] TLOC/syncope is extremely common in the general population with a cumulative incidence of first syncope episode around 10% up to 80 years. […] Tilt-testing enables the reproduction of reflex syncope in a laboratory setting. […] The most common indication for TTT is to confirm a diagnosis of reflex syncope in patients in whom this diagnosis has been suspected but not confirmed by the initial evaluation. […] Compared with other diagnostic tests, TTT has one of the highest diagnostic yields if the result is abnormal, with the test being diagnostic in more than 50% of cases.

• #47 Role of tilt-table testing in syncope diagnosis and management

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-13/role-of-tilt-table-testing-in-syncope-diagnosis-and-management

  However, this is the situation which exists in specialized syncope centres and units, where a diagnosis can be established in more than 50% of patients with a mean of three tests per patient. […] There have been concerns that the diagnostic utility of TTT is not high enough, and that a positive TTT suggests the presence of hypotensive susceptibility rather than providing a diagnosis of reflex syncope. […] Generally, these tests have a much lower diagnostic yield compared with tilt-testing. […] The type of response to tilt-testing could guide patient management.

• #48 Syncope | Thoracic Key

  https://thoracickey.com/syncope-4/

  Syncope is a common clinical problem accounting for 1% to 3% of all emergency department visits and 6% of hospital admissions in the United States and Europe. Individuals have a cumulative lifetime incidence of syncope of 30% to 40%. It is estimated that $2.4 billion are spent on syncope-related hospitalizations annually. Reflex syncope is most commonly diagnosed. First vasovagal fainting episodes typically occur in characteristic age ranges, peaking in early adolescence and again in elderly men and women older than 70 years. Women are more likely to faint than men. The workup and prognosis associated with syncope is dictated by the history, physical examination, and ultimately the condition that resulted in syncope. […] Syncope prevalence varies significantly according to patient age and study setting. Despite the fact that referral bias is present when comparing populations of individuals in an emergency department compared with those in the general population, several generalizations can be made. Reflex syncope is most commonly diagnosed and found to have an excellent prognosis in most studies. Depending on the patient population and study setting, either orthostasis or cardiac syncope are the second most common etiologies. Studies enrolling patients admitted to the hospital for syncope consistently report a 20% prevalence of cardiac syncope. […] Epidemiologic data obtained with a survey is often dependent on patient recall. Given the fact that almost half of individuals with syncope do not seek medical attention, data sets taken from general population surveys are often skewed.

• #49 Syncope (fainting) in children and young people :: Kingston and Richmond NHS Foundation Trust

  https://www.kingstonandrichmond.nhs.uk/patients-and-families/patient-leaflets/syncope-fainting-children-and-young-people

  Syncope is common. About 15% of children will experience fainting at least once before they reach adulthood. […] The most common type of syncope is vasovagal syncope, which is a simple faint. It comes on quickly and children lose consciousness for only a few seconds. They make a fast and complete recovery afterwards. Vasovagal syncope is not dangerous for your child. […] There are different causes of fainting, as follows. […] In most cases, syncope is not dangerous, but there are some (rare) causes of syncope which will require you to seek medical attention.

• #50 Dysautonomia International:

  https://www.dysautonomiainternational.org/page.php?ID=34

  POTS impacts millions of people around the world too, but we don’t have good epidemiology data in other countries. […] NCS impacts tens of millions of individuals worldwide. […] Individuals with moderate to severe NCS have difficulty engaging in work, school and social activities due to the frequent fainting attacks.

• #51 Syncope as a sign of occult cancers: a population-based cohort study | British Journal of Cancer

  https://www.nature.com/articles/s41416-019-0692-2

  We examined if syncope was a marker of an occult cancer by comparing the risk in patients with a syncope episode with that of the general population. […] Using Danish population-based medical registries, we identified all patients diagnosed with syncope during 1994-2013 and followed them until a cancer diagnosis, emigration, death or end of follow-up, whichever came first. […] Among 208,361 patients with syncope, 20,278 subsequent cancers were observed. […] The 6-month cumulative risk of any cancer was 1.2%, increasing to 17.9 % for 120 years of follow-up. […] The highest cumulative risks after 6 months of follow-up were lung cancer (0.2%), colorectal cancer (0.2%), prostate cancer (0.1%) and brain cancer (0.1%). […] Syncope was a weak marker of an occult cancer. […] In short-term the highest cumulative risks were observed for lung, colorectal, prostate and brain cancers.

• #52 Syncope as a sign of occult cancers: a population-based cohort study | British Journal of Cancer

  https://www.nature.com/articles/s41416-019-0692-2

  The association between syncope as marker of occult cancer has been sparsely documented in the literature. […] Our findings support this notion, i.e., the most frequent occult cancers found in the syncope cohort were cancers of the lung, particularly in the short-term. […] In this population-based study, an episode of syncope was a weak marker of an occult cancer diagnosed within the following 6 months, mainly driven by lung, colorectal, prostate and brain cancers.

• #53 Evaluation of Syncope | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0915/p640.html

  Risk stratification can aid in determining the need for hospitalization. […] The AHA/ACCF Scientific Statement on the Evaluation of Syncope, the European Society of Cardiology Task Force on Syncope, and the American College of Emergency Physicians clinical policy offer guidelines for the evaluation of patients with syncope.

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