Objective(s): We explored incidence, predictors, and longterm prognosis of hospital admissions attributed to reflex syncope and orthostatic hypotension.Methods: We analyzed a cohort of 32 628 individuals (68.2% men; age, 45.6 +/- 7.4 years) without prevalent cardiovascular disease over a follow-up period of 26.6 +/- 7.5 years.Results: One thousand and fourteen persons (3.1%, 1.2 per 1000 person-years) had at least 1 hospitalization for orthostatic hypotension (n = 462, 1.42%) or syncope (n = 632, 1.94%). Orthostatic hypotension-related hospitalizations were predicted by age [ per 1-year increase, hazard ratio 1.14, 95% confidence interval (CI): 1.12-1.16], smoking (hazard ratio 1.35, 95% CI: 1.12-1.64), diabetes (hazard ratio 1.50, 95% CI: 1.00-2.25), baseline orthostatic hypotension (hazard ratio 1.45, 95% CI: 1.05-1.98), in particular, by SBP fall at least 30 mmHg (hazard ratio 3.93, 95% CI: 2.14-7.23), whereas syncope hospitalizations by age (per 1-year increase, hazard ratio 1.09, 95% CI: 1.07-1.11), smoking (hazard ratio 1.27, 95% CI: 1.08-1.49), and hypertension (hazard ratio 1.42, 95% CI: 1.20-1.69). Both syncope-hospitalized and orthostatic hypotension hospitalized patients had higher burden of hospital admissions for other reasons such as cardiovascular, pulmonary, renal disease, or diabetes. During the follow-up, 10 727 (32.9%) died, with 419 deaths preceded by syncope/orthostatic hypotension hospitalization. After adjustment for traditional risk factors, syncope-hospitalization predicted all-cause mortality (hazard ratio 1.16, 95% CI: 1.02-1.31), whereas orthostatic hypotension hospitalization predicted cardiovascular mortality (hazard ratio 1.13, 95% CI: 1.071.19).Conclusion: Hospital admissions due to syncope and orthostatic hypotension occur in approximate to 3% of older individuals and increase with age and comorbidities. Admissions due to syncope are associated with prevalent hypertension, whereas those due to orthostatic hypotension overlap with diabetes and previously identified orthostatic hypotension. Syncope-related admissions predict higher all-cause mortality, whereas orthostatic hypotension-related admissions herald increased cardiovascular mortality.

Hospital admissions for orthostatic hypotension and syncope in later life: insights from the Malmo Preventive Project

MANZOLI, Lamberto
Secondo
;
Flacco, Maria E.;
2017

Abstract

Objective(s): We explored incidence, predictors, and longterm prognosis of hospital admissions attributed to reflex syncope and orthostatic hypotension.Methods: We analyzed a cohort of 32 628 individuals (68.2% men; age, 45.6 +/- 7.4 years) without prevalent cardiovascular disease over a follow-up period of 26.6 +/- 7.5 years.Results: One thousand and fourteen persons (3.1%, 1.2 per 1000 person-years) had at least 1 hospitalization for orthostatic hypotension (n = 462, 1.42%) or syncope (n = 632, 1.94%). Orthostatic hypotension-related hospitalizations were predicted by age [ per 1-year increase, hazard ratio 1.14, 95% confidence interval (CI): 1.12-1.16], smoking (hazard ratio 1.35, 95% CI: 1.12-1.64), diabetes (hazard ratio 1.50, 95% CI: 1.00-2.25), baseline orthostatic hypotension (hazard ratio 1.45, 95% CI: 1.05-1.98), in particular, by SBP fall at least 30 mmHg (hazard ratio 3.93, 95% CI: 2.14-7.23), whereas syncope hospitalizations by age (per 1-year increase, hazard ratio 1.09, 95% CI: 1.07-1.11), smoking (hazard ratio 1.27, 95% CI: 1.08-1.49), and hypertension (hazard ratio 1.42, 95% CI: 1.20-1.69). Both syncope-hospitalized and orthostatic hypotension hospitalized patients had higher burden of hospital admissions for other reasons such as cardiovascular, pulmonary, renal disease, or diabetes. During the follow-up, 10 727 (32.9%) died, with 419 deaths preceded by syncope/orthostatic hypotension hospitalization. After adjustment for traditional risk factors, syncope-hospitalization predicted all-cause mortality (hazard ratio 1.16, 95% CI: 1.02-1.31), whereas orthostatic hypotension hospitalization predicted cardiovascular mortality (hazard ratio 1.13, 95% CI: 1.071.19).Conclusion: Hospital admissions due to syncope and orthostatic hypotension occur in approximate to 3% of older individuals and increase with age and comorbidities. Admissions due to syncope are associated with prevalent hypertension, whereas those due to orthostatic hypotension overlap with diabetes and previously identified orthostatic hypotension. Syncope-related admissions predict higher all-cause mortality, whereas orthostatic hypotension-related admissions herald increased cardiovascular mortality.
2017
Ricci, Fabrizio; Manzoli, Lamberto; Sutton, Richard; Melander, Olle; Flacco, Maria E.; Gallina, Sabina; de Caterina, Raffaele; Fedorowski, Artur
File in questo prodotto:
File Dimensione Formato  
Manzoli L J Hypertension 2016 (Proof).pdf

solo gestori archivio

Descrizione: Article proofs
Tipologia: Altro materiale allegato
Licenza: NON PUBBLICO - Accesso privato/ristretto
Dimensione 152.49 kB
Formato Adobe PDF
152.49 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
ricci2016.pdf

solo gestori archivio

Descrizione: versione editoriale
Tipologia: Full text (versione editoriale)
Licenza: NON PUBBLICO - Accesso privato/ristretto
Dimensione 333.2 kB
Formato Adobe PDF
333.2 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
MPP2-2-RS.pdf

solo gestori archivio

Descrizione: post print
Tipologia: Post-print
Licenza: NON PUBBLICO - Accesso privato/ristretto
Dimensione 2.05 MB
Formato Adobe PDF
2.05 MB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11392/2362685
Citazioni
  • ???jsp.display-item.citation.pmc??? 8
  • Scopus 18
  • ???jsp.display-item.citation.isi??? 17
social impact