Prevalence of Pulmonary #Embolism among Patients Hospitalized for #Syncope
http://www.nejm.org/doi/full/10.1056/NEJMoa1602172
CONCLUSIONS
Pulmonary embolism was identified in nearly one of every six patients hospitalized for a first episode of syncope.
http://www.nejm.org/doi/full/10.1056/NEJMoa1602172
CONCLUSIONS
Pulmonary embolism was identified in nearly one of every six patients hospitalized for a first episode of syncope.
The New England Journal of Medicine
Prevalence of Pulmonary Embolism among Patients Hospitalized for Syncope | NEJM
The prevalence of pulmonary embolism among patients hospitalized for syncope is not
well documented, and current guidelines pay little attention to a diagnostic workup
for pulmonary embolism in the...
well documented, and current guidelines pay little attention to a diagnostic workup
for pulmonary embolism in the...
2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With #Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice #Guidelines, and the Heart Rhythm Society
http://circ.ahajournals.org/content/early/2017/03/09/CIR.0000000000000499
http://circ.ahajournals.org/content/early/2017/03/09/CIR.0000000000000499
Prevalence of Pulmonary #Embolism in Patients With #Syncope
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2670036
A total of 1 671 944 unselected adults who presented to the ED for syncope were included. The prevalence of PE, according to administrative data, ranged from 0.06% (95% CI, 0.05%-0.06%) to 0.55% (95% CI, 0.50%-0.61%) for all patients and from 0.15% (95% CI, 0.14%-0.16%) to 2.10% (95% CI, 1.84%-2.39%) for hospitalized patients. The prevalence of PE at 90 days of follow-up ranged from 0.14% (95% CI, 0.13%-0.14%) to 0.83% (95% CI, 0.80%-0.86%) for all patients and from 0.35% (95% CI, 0.34%-0.37%) to 2.63% (95% CI, 2.34%-2.95%) for hospitalized patients. Finally, the prevalence of venous thromboembolism at 90 days ranged from 0.30% (95% CI, 0.29%-0.31%) to 1.37% (95% CI, 1.33%-1.41%) for all patients and from 0.75% (95% CI, 0.73%-0.78%) to 3.86% (95% CI, 3.51%-4.24%) for hospitalized patients.
Conclusions and Relevance Pulmonary embolism was rarely identified in patients with syncope. Although PE should be considered in every patient, not all patients should undergo evaluation for PE
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2670036
A total of 1 671 944 unselected adults who presented to the ED for syncope were included. The prevalence of PE, according to administrative data, ranged from 0.06% (95% CI, 0.05%-0.06%) to 0.55% (95% CI, 0.50%-0.61%) for all patients and from 0.15% (95% CI, 0.14%-0.16%) to 2.10% (95% CI, 1.84%-2.39%) for hospitalized patients. The prevalence of PE at 90 days of follow-up ranged from 0.14% (95% CI, 0.13%-0.14%) to 0.83% (95% CI, 0.80%-0.86%) for all patients and from 0.35% (95% CI, 0.34%-0.37%) to 2.63% (95% CI, 2.34%-2.95%) for hospitalized patients. Finally, the prevalence of venous thromboembolism at 90 days ranged from 0.30% (95% CI, 0.29%-0.31%) to 1.37% (95% CI, 1.33%-1.41%) for all patients and from 0.75% (95% CI, 0.73%-0.78%) to 3.86% (95% CI, 3.51%-4.24%) for hospitalized patients.
Conclusions and Relevance Pulmonary embolism was rarely identified in patients with syncope. Although PE should be considered in every patient, not all patients should undergo evaluation for PE
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Differential impact of #syncope on the prognosis of patients with acute pulmonary #embolism: a systematic review and meta-analysis
https://academic.oup.com/eurheartj/advance-article-abstract/doi/10.1093/eurheartj/ehy631/5137116?redirectedFrom=fulltext
Syncope was associated with higher prevalence of haemodynamic instability [odds ratio (OR) 3.50; 95% confidence interval (CI) 2.67–4.58], as well as with echocardiographic signs of right ventricular (RV) dysfunction (OR 2.10; CI 1.60–2.77) at presentation. Patients with syncope had a higher risks of all-cause early (either in-hospital or within 30 days) death (OR 1.73; CI 1.22–2.47) and PE-related 30-day adverse outcomes (OR 2.00; CI 1.11–3.60). The absolute risk difference (95% CI) for all-cause death was +6% (+1% to +10%) in studies including unselected patients, but it was −1% (−2% to +1%) in studies restricted to normotensive patients. We observed no prognostic impact of syncope in studies with a lower score at formal quality assessment and in those conducted retrospectively.
Conclusion
Syncope as a manifestation of acute PE was associated with a higher prevalence of haemodynamic instability and RV dysfunction at presentation, and an elevated risk for early PE-related adverse outcomes. The association with an increased risk of early death appeared more prominent in studies including unselected patients, when compared with those focusing on normotensive patients only.
Differential impact of #syncope on the prognosis of patients with acute pulmonary #embolism: a systematic review and meta-analysis
https://academic.oup.com/eurheartj/advance-article-abstract/doi/10.1093/eurheartj/ehy631/5137116?redirectedFrom=fulltext
Syncope was associated with higher prevalence of haemodynamic instability [odds ratio (OR) 3.50; 95% confidence interval (CI) 2.67–4.58], as well as with echocardiographic signs of right ventricular (RV) dysfunction (OR 2.10; CI 1.60–2.77) at presentation. Patients with syncope had a higher risks of all-cause early (either in-hospital or within 30 days) death (OR 1.73; CI 1.22–2.47) and PE-related 30-day adverse outcomes (OR 2.00; CI 1.11–3.60). The absolute risk difference (95% CI) for all-cause death was +6% (+1% to +10%) in studies including unselected patients, but it was −1% (−2% to +1%) in studies restricted to normotensive patients. We observed no prognostic impact of syncope in studies with a lower score at formal quality assessment and in those conducted retrospectively.
Conclusion
Syncope as a manifestation of acute PE was associated with a higher prevalence of haemodynamic instability and RV dysfunction at presentation, and an elevated risk for early PE-related adverse outcomes. The association with an increased risk of early death appeared more prominent in studies including unselected patients, when compared with those focusing on normotensive patients only.
OUP Academic
Differential impact of syncope on the prognosis of patients with acute pulmonary embolism: a systematic review and meta-analysis…
AbstractAims. Controversial reports exist in the literature regarding the prognostic role and therapeutic implications of syncope in patients with acute pulmon
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Predictors of Clinically Significant #Echocardiography Findings in Older Adults with #Syncope: A Secondary Analysis
https://www.journalofhospitalmedicine.com/jhospmed/article/175074/hospital-medicine/predictors-clinically-significant-echocardiography
Regression analysis identified five predictors of significant findings: (1) history of congestive heart failure, (2) history of coronary artery disease, (3) abnormal electrocardiogram, (4) high-sensitivity troponin-T >14 pg/mL, and 5) N-terminal pro B-type natriuretic peptide >125 pg/mL. These five variables make up the ROMEO (Risk Of Major Echocardiography findings in Older adults with syncope) criteria. The sensitivity of a ROMEO score of zero for excluding significant findings on echocardiography was 99.5% (95% CI: 97.4%-99.9%) with a specificity of 15.4% (95% CI: 13.0%-18.1%).
CONCLUSIONS: If validated, this risk-stratification tool could help clinicians determine which syncope patients are at very low risk of having clinically significant findings on echocardiography.
Predictors of Clinically Significant #Echocardiography Findings in Older Adults with #Syncope: A Secondary Analysis
https://www.journalofhospitalmedicine.com/jhospmed/article/175074/hospital-medicine/predictors-clinically-significant-echocardiography
Regression analysis identified five predictors of significant findings: (1) history of congestive heart failure, (2) history of coronary artery disease, (3) abnormal electrocardiogram, (4) high-sensitivity troponin-T >14 pg/mL, and 5) N-terminal pro B-type natriuretic peptide >125 pg/mL. These five variables make up the ROMEO (Risk Of Major Echocardiography findings in Older adults with syncope) criteria. The sensitivity of a ROMEO score of zero for excluding significant findings on echocardiography was 99.5% (95% CI: 97.4%-99.9%) with a specificity of 15.4% (95% CI: 13.0%-18.1%).
CONCLUSIONS: If validated, this risk-stratification tool could help clinicians determine which syncope patients are at very low risk of having clinically significant findings on echocardiography.