Author + information
- Franca Barbic, MD⁎ (, )
- Franca Dipaola, MD,
- Monica Solbiati, MD and
- Raffaello Furlan, MD
- ↵⁎Internal Medicine, Humanitas Clinical and Research Center, Via Manzoni, 56, 20089 Rozzano (MI), Italy
We read with great interest the paper by Ruwald et al. (1) dealing with the prognosis of healthy individuals discharged from the emergency department or hospital after a syncope episode.
Surprisingly, fainters 25 to 44 years of age had a risk of death higher than that of subjects older than 75 years of age, differing from what was previously reported (2). Moreover, in individuals 25 to 44 years of age with syncope, the long-term all-cause mortality rate was twice that observed in the syncope group older than 75 years. This is unexpected too because the long-term (1 year) prognosis of syncope was found to be related to aging and comorbidities (3) that are likely to be more frequent in elderly individuals.
The authors hypothesized that there could have been an underdiagnosis of unrecognized cardiovascular diseases in syncope patients 25 to 44 years of age (1).
Here we propose an additional potential explanation. A preliminary analysis of our STePS (Short-Term Prognosis of Syncope) (3) database indicated that 1-year syncope recurrence in working-age (18 to 65 years) patients was as high as 14%. Significant hazard ratio values of recurrent syncope were also reported by Ruwald et al. (1) in the 2 groups of syncope subjects 25 to 44 years of age and 45 to 74 years of age. In a setting of hazardous occupations, syncope recurrence might lead to fatal work accidents in the group of syncope patients 25 to 44 years in the present study who, potentially, are active workers. According to the EUROSTAT Health and Safety at Work in Europe report (4), most of work fatal accidents are classified as occurring after “loss of control,” “slipping,” “stumbling,” and “falling.” All these conditions might be the consequence of an occult syncope, producing a sudden loss of consciousness and postural tone.
We wonder whether work accidents, produced by a hidden syncope recurrence, might play any role in the increased risk of death found by Ruwald et al. (1) in patients 25 to 44 years of age. A potential answer might be found by matching the present study data with occupational accidents recordings. Should this hypothesis be confirmed, an unexplored scenario characterized by remarkable social implications could be opened.
- American College of Cardiology Foundation
- Ruwald M.H.,
- Hansen M.L.,
- Lamberts M.,
- et al.
- Costantino G.,
- Perego F.,
- Dipaola F.,
- et al.,
- STePS Investigators
- ↵(2010) Health and Safety at Work in Europe (1999–2007); EUROSTAT Statistical Books (Publications Office of the European Union, Luxembourg) http://epp.eurostat.ec.europa.eu/cache/ITY_OFFPUB/KS-31-09-290/EN/KS-31-09-290-EN.PDF. Accessed April 2013.