Syncope: recurrent bouts were common.

Clinical bottom line (level 1b)

  1. A third of patients with syncope had another episode, many within one year.
  2. Patients typically had more than one recurrence.
  3. No one specific cause of syncope favoured recurrence.
  4. Recurrent syncope was not clearly associated with an increase in death or major morbidity.
Kapoor et al: American Journal of Medicine 1987; 83: 700-707
Expires October 2004

The study

Prospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: teaching hospital, USA

433 patients (aged mean 56 years, 60% female) syncope (sudden transient loss of consciousness and unable to maintain postural tone)

Excluded if
  • required pharmacological or electric cardioversion
  • subsequent cardiac arrest




    • Multivariate regression analysis performed on risk factors.

    99% followed for mean 30 months
    Outcomes studied:
  • recurrent syncope

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    recurrent syncope mean 30 months 146/433 34%
    (29% to 38%)

    • 64% occurred within one year.
    • No one specific disorder recurred.
    • Subsequent diagnosis:
      • 67%: the same
      • 26% : related to treatment or a new diagnosis
      • 8/191: 4% of patients with no original diagnosis had one made following the recurrent episode.
    • Recurrent syncope is not an independent predictor of:
      • mortality
      • sudden death
      • major morbidity

    Citation

    1. Kapoor WN, Peterson J, Wieand HS, et al: Diagnostic and prognostic implications of recurrences in patients with syncope. American Journal of Medicine 1987; 83: 700-707
    Contributor: Chris Ball and Clare Wotton, October 2000
    Reviewer:

    Clinical Question.
    Patient syncope
    Intervention or Exposure prevalence
    Outcome recurrence