Background: Syncope results in significant patient morbidity, healthcare burden and can be associated with increased mortality. The reported mortality risk following syncope hospitalisation is highly variable, ranging from 2–13 % at 1 year.
Purpose: We sought to determine the 1-year mortality risk in patients discharged with a primary diagnosis of syncope at University Hospital Coventry and identify potential predictors.
Methods: Patients discharged with a primary diagnosis of syncope (ICD-10 ’R55‘) between 2012 and 2017 were identified using hospital database records. Baseline demographics, relevant comorbidities (derived from secondary diagnoses ICD-10 codes at time of admission) and admission-related data were analysed. Syncope clinic attendance was determined using outpatient clinic codes. Date of death was obtained from National Health Service digital records and used to determine 1-year all-cause mortality. Cox-proportional regression analysis was performed to identify significant predictors.
Results: In total, 2,950 patients were identified (median age 73 years, range 53–84 yrs, 51% male). Comorbidities included hypertension (38%), ischaemic heart disease (17%), diabetes (16%), atrial fibrillation (AF) (12%), chronic obstructive pulmonary disease (COPD) (5%) heart failure (4%) and epilepsy (3%). Common discharging specialties included general medicine (51%), emergency medicine (18%) and cardiology (12%). The majority of patients were admitted for ≥1 day (59%). One-year mortality was 11%. Independent predictors of 1-year-mortality included older age (HR 1.033, 95 % CI 1.026–1.041), AF (HR 1.60, 1.2–2.1), heart failure (HR 2.2, 1.6–3.0) and COPD (HR 1.9, 1.4–2.7). Predictors of reduced mortality risk included discharging specialty of cardiology (HR 0.4, 0.2–0.6) and outpatient Syncope Clinic attendance post-discharge (HR 0.3, 0.1–0.6).
Conclusions: Syncope hospitalisation was associated with significant mortality. In our cohort of patients hospitalised with syncope, advanced age and comorbidities (heart failure, AF and COPD) were independent predictors of increased mortality risk. Cardiology input during admission and in Syncope Clinic post-discharge was associated with lower mortality risk.
