On the September 18 issue of the New England Journal of Medicine, researchers from the Framingham Heart Study report that the risk of dying after an episode of syncope (fainting) is related to the underlying cause of the fainting episode.
The investigators looked at the causes of syncope and the subsequent outcomes among 7814 individuals enrolled in the Framingham study over a 17-year period. As a group, these patients had a 30% increase in the risk of early death when compared to patients who had not had syncope. However, almost all of the excess deaths were seen in the patients who proved to have underlying cardiac disease. Importantly, patients who had vasovagal syncope, orthostatic syncope, or syncope related to medication had no increase in the risk of death.
The authors of this report, and the authors of an accompanying editorial in the same issue, point out that many of the deaths that subsequently occur in patients presenting with syncope are potentially preventable, if the doctor would only make the effort to aggressively pursue the cause of syncope, and make aggressive efforts to treat that underlying cause. They further suggest that many cases of "unexplained syncope" (that is, syncope whose cause is unknown after an evaluation) may be related to the failure to diagnose underlying heart disease. The failure to adequately evaluate such patients for underlying heart disease is often a lethal mistake.
Individuals who experience syncope need to press their doctors to do a full evaluation, especially if they have risk factors for heart disease. If you want to learn more, click here for articles on what you need to know about syncope and its evaluation.
