Lack of benefit from hospitalization in patients with syncope: A propensity analysis

Study Objective:Patients with syncope are frequently admitted to the hospital,butwhetherthisimprovesoutcomeisunknown.Wetestedwhetherhospitalizationreducedmortalityinpatientswhopresentedtoemergencydepartments(EDs)withsyncope.Methods:Weconductedapropensityanalysisoftheoutcomesofpatients≥18yearsold presenting to EDs with a primary diagnosis of syncope in April 2004–March2013.Themodelused1:1nearest-neighbormatchingtopredictedadmissionusingage,sex,urbanresidence,householdincome,and14significantcomorbiditiesfrom4 administrative databases of the province of Alberta. The primary outcome wasdeath.Results:Therewere57,417EDpatientswithaprimarydiagnosisofsyncope;8864wereadmitted,and48,553weredischargedin<24hours.Admittedpatientswereolder(median76vs49years),male(53%vs45%),rural(23%vs18%),andhadlowerincome (median $58,599 vs $61,422); allP<0.001. All comorbidities were higherinadmittedpatients(meanCharlsonscores,1.9vs0.7;P<0.001).Thepropensity-matchedhospitalizedpatientshadhigher30-daymortality(3.5%vs1.0%)and1-yearmortality(14.1%vs8.6%);bothP<0.001.Mortalityinallpropensityquintileswashigherinthehospitalizedgroup(allP<0.001).Themostcommoncausesofdeathin 2719 patients included chronic ischemic heart disease, 14%; lung cancer, 7.1%;acutemyocardialinfarction,6.9%;stroke,3.7%;chronicobstructivepulmonarydis-ease,3.6%;dementia,2.6%;andheartfailure,2.5%.Conclusions:HospitaladmissiondidnotreduceearlyorlatemortalityinpatientswhopresentedtotheEDwithsyncope.Mortalityisassociatedwithcomorbiditie