MORTALITY RATES AND COST OF HOSPITAL ADMISSIONS FOR SYNCOPE IN THE UNITED STATES

Abstract

Background: Syncope is one of the most common reasons for emergency department visits and hospitalizations. We investigated the implications of such presentations from a large volume, nation-wide perspective, particularly to determine the trends in admissions, cost, and mortality. Methods: Data were collected from the Nationwide Inpatient Sample between 2002 and 2013. Subjects were identifed by ICD-9 code. Admissions for a primary and secondary diagnosis of syncope were collected. Primary composite outcomes included mortality, length of stay, cost, and need for invasive procedures. Results: There were 738,092 (weighted 3,632,213) admissions. The mean age was 68.5 + 17.3 years and Charlson's comorbidity score was 0.9 + 1.3. The most common etiology was cardiac, dysrhythmias (25.90%) and conduction abnormalities (7.87%). Angiography, PCI, pacemakers, CRT, and ICD use remained below 0.5%. Average mortality rate was low at 0.25% with a downtrend (p<0.001). Mortality predictors included age (OR=6.62, 2.64-16.01, p<0.001), Charlson score > 1 (OR=1.87, 1.6-2.18, p<0.001), cardiac arrhythmias (OR=2.59, 2.32-2.90, p<0.001), myocardial infarction (OR=12.46, 10.34-15.02, p<0.001), pulmonary embolism (OR=15.81, 11.34-22.06, p<0.001), and pacemaker implantation (OR=9.06, 4.04-20.29, p<0.001). Echocardiography was performed in 5.52%, EP studies in 1.60%, and nuclear stress tests in 1.38% cases. The total cost averaged $4,385millions (nationally $21,657 M). Conclusions: Admissions due to syncope are associated with low mortality or need for procedures. The need for devices has continued to decrease; however, their use correlates with protracted and more expensive hospitalizations. Better defnitions, guidelines, and applicability of scoring systems may help us discriminate among individuals who beneft from hospitalization while safely curtailing expenses.