New-Onset Syncope in Older Adults: Focus on Age and Etiology

The authors explored the differences in clinical presentation, etiology, mortality, and recurrences of new-onset syncope in 502 patients across 3 age groups: middle-aged (36–60 years), older (61–75 years), and elderly (older than 75 years). Clinical features of syncopal episodes were similar except for more frequent presyncopal episodes in patients older than 75 years. Yield of diagnostic tests was similarly low except for higher incidence of positive tilt-table test (60%) in older patients. Syncope remained unexplained more frequently in the elderly (54% vs 37% in middle-aged and 43% in older adults, P=.01). Syncope recurrence was higher in the middle-aged and elderly groups. Overall mortality for the 3 age groups was similar to that recorded in the general population after adjustment for age and comorbidities. Etiology of syncope was not associated with age- and comorbidity-adjusted all-cause mortality. Cardiovascular mortality was significantly higher in patients with cardiogenic syncope (adjusted hazard ratio, 2.44; P=.044).