P5671Risk factors associated with recurrence of syncopal episodes in patients admitted to a syncope care unit

Abstract

Abstract Introduction Recurrent syncope takes a serious toll on quality of life, being compared to chronic diseases, particularly on the elderly. Objectives Identify recurrence predictors in patients treated attended at syncope units (SU). Method Study involving patients attended at SUs in the emergency care units of 11 hospitals over the period from May 2015 to July 2017. The SUs were provided around-the-clock dedicated phone support by specialists and a set of standardized protocols (SP) for diagnostic guidance and risk stratification based on current guidelines. In our statistical analysis, we implemented the parametric model for logistic regression (LR) and the non-parametric classification tree (CART) model. All 45 SP variables were included and subsequently selected through the use of elastic net regularization. In the LR, we considered significances of 5 and 10% for the recurrence outcome. These final variables were used to develop the classification trees (CART). Results We observed 1189, the majority of them (57.4%) were woman and the average age was 59 years old, with a wide range of variation (14–103). Cardiovascular and neurological diseases, as well as diabetes were more prevalent in men. The cause of syncopal episodes were diagnosticated in 81.1% of the patients, being reflex syncope the most common finding (59.4%). Episodes of recurrence were reported by 45.8%, with women representing 62.9% of this group, and 54.7% of them were younger than 59. In describing symptoms, 18.0% reported trauma associated with syncope, 38.2% showed no trigger incidents and 27.0% showed no prodromal symptoms. Women showed more prodromal symptoms, particularly dizziness, blurry vision, nausea and excessive sweating. In the variable analysis process, the LR highlighted: gender, diastolic blood pressure (DBP) and the incidence of: excessive sweating, blurry vision, palpitations, neurological diseases, changes in the conduction system detected by electrocardiogram and pacemakers (PM) as risk factors for recurrence. The CART classified the most relevant among these factors: age, DBP, sweating, blurry vision, neurological diseases and PM. Following the CART, it was detected that in female patients with signs of excessive sweating and normal DBP, the chance of recurrence was 59.6%, and when DBP ≤60 mmHg, that probability rose to 94.4%. In male patients with neurological diseases, the probability was 59%, but the chance of recurrence rose to 80% in patients with PM, even without concurrent neurological diseases. Conclusion The SUs and use of the SP allowed for the identification of high-risk patients and factors associated with higher probability of recurrence, improving overall approach towards syncope treatment. Acknowledgement/Funding OWN FINANCIAL SUPPORT