Abstract
BackgroundSyncope could be related to high risk of falls and injury in adults, but documentation is sparse. We examined the association between syncope and subsequent fall-related injuries in a nationwide cohort.MethodsBy cross-linkage of nationwide registers, all residents ≥18 years with a first-time diagnosis of syncope were identified between 1997–2012. Syncope patients were matched 1:1 with individuals from the general population. The absolute one-year risk of fall-related injuries, defined as fractures and traumatic head injuries requiring hospitalization, was calculated using Aalen-Johansen estimator. Ratios of the absolute one-year risk of fall-related injuries (ARR) were assessed by absolute risk regression analysis.ResultsWe identified 125,763 patients with syncope: median age 65 years (interquartile range 46–78). At one year, follow-up was complete for 99.8% where a total of 8394 (6.7%) patients sustained a fall-related injury requiring hospitalization, of which 1606 (19.1%) suffered hip fracture. In the reference group, 4049 (3.2%) persons had a fall-related injury. The one-year ARR of a fall-related injury was 1.79 (95% confidence interval 1.72–1.87, P<0.001) in patients with syncope compared with the reference group; however, increased ARR was not exclusively in older patients. Factors independently associated with increased ARR of fall-related injuries in the syncope population were: injury in past 12 months, 2.39 (2.26–2.53, P<0.001), injury in relation to the syncope episode, 1.62 (1.49–1.77, P<0.001), and depression, 1.37 (1.30–1.45, P<0.001)ConclusionPatients with syncope were at 80% increased risk of severe fall-related injuries within the year following discharge. Notably, increased risk was not exclusively in older patients.
Highlights
Syncope episodes are frequent in both young and older adults, [1,2,3] and characterized by a total loss of consciousness due to transiently reduced cerebral blood flow with subsequent complete recovery. [4, 5] episodes do often lead to falls, and syncope could be related to an increased risk of injuries
The oneyear absolute one-year risk of fall-related injuries (ARR) of a fall-related injury was 1.79 (95% confidence interval 1.72–1.87, P
Factors independently associated with increased ARR of fall-related injuries in the syncope population were: injury in past 12 months, 2.39
Summary
Syncope episodes are frequent in both young and older adults, [1,2,3] and characterized by a total loss of consciousness due to transiently reduced cerebral blood flow with subsequent complete recovery. [4, 5] episodes do often lead to falls, and syncope could be related to an increased risk of injuries. [15, 16] several studies have observed high prevalence of cardiovascular conditions among older persons presenting with unexplained falls. [17] Some of these conditions, carotid sinus syndrome and orthostatic hypotension, are observed risk factors for unexplained falls and fall injuries, and important causes of syncope in the elderly. [22] previous studies among adult patients with syncope report that 26% to 39% suffer from injuries in relation to their syncope episode, [23, 24] but whether this is exclusively in older adults is unknown. We conducted a nationwide study of adult patients with a first-time diagnosis of syncope, to provide longitudinal population-based data on the association between syncope and subsequent fall-related injuries. We examined the association between syncope and subsequent fall-related injuries in a nationwide cohort
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