The cardiogenic syncope in the elderly: a review on the epidemiology and social costs

Although syncope is a common clinical problem in the elderly, little is known of its epidemiology and social costs. According to some epidemiological enquiries, syncope is responsible for 3% of emergency room visits and for 6% of the medical admissions in general hospitals. Although some types of syncope are benign and self-limited, those of traumatic origin with abrupt loss of consciousness represent a considerable morbidity, particularly in elderly patients. The prevalence in 10 years was of 23%, with an annual occurrence of 6–7% and a recurrence rate of 30%. Despite accurate investigations, syncope remains unexplained in about 50% of the patients. The first year mortality for cardiac syncope is 20–30%, against 5% for non-cardiac causes and 10% for syncope of unknown origin. Sudden death occurred in 17% of cardiac syncope cases. An approximate cost analysis can be obtained through the survey of costs relative to the length of the hospitalization and to the number of the main diagnostic tests applied. It must be underlined, however, that the clinical history and physical examination supply the most important contribution to the diagnosis in old patients, and these often are more than sufficient to suggest the suitable choice among the instrumental tests to be applied; this approach helps considerably to reduce the hospital costs.