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Identifying High Risk Patients With Syncope

Primary Purpose

Cardiovascular Diseases, Arrhythmia, Death, Sudden, Cardiac

Status
Completed
Phase
Locations
Study Type
Observational
Intervention
Sponsored by
National Heart, Lung, and Blood Institute (NHLBI)
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an observational trial for Cardiovascular Diseases

Eligibility Criteria

undefined - 100 Years (Child, Adult, Older Adult)MaleDoes not accept healthy volunteers

No eligibility criteria

Sites / Locations

    Outcomes

    Primary Outcome Measures

    Secondary Outcome Measures

    Full Information

    First Posted
    May 25, 2000
    Last Updated
    May 12, 2016
    Sponsor
    National Heart, Lung, and Blood Institute (NHLBI)
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    1. Study Identification

    Unique Protocol Identification Number
    NCT00005202
    Brief Title
    Identifying High Risk Patients With Syncope
    Study Type
    Observational

    2. Study Status

    Record Verification Date
    May 2000
    Overall Recruitment Status
    Completed
    Study Start Date
    July 1987 (undefined)
    Primary Completion Date
    undefined (undefined)
    Study Completion Date
    June 1992 (Actual)

    3. Sponsor/Collaborators

    Name of the Sponsor
    National Heart, Lung, and Blood Institute (NHLBI)

    4. Oversight

    5. Study Description

    Brief Summary
    To validate two models which categorized patients with syncope into high and low risk for either sudden death or diagnostic arrhythmias based on data available from the initial history, physical examination, and electrocardiogram.
    Detailed Description
    BACKGROUND: Syncope is a common medical problem with up to 30 percent of normal individuals reporting one or more syncopal episodes. Thus, physicians of all specialties are frequently confronted by patients with syncope. The spectrum of diseases which may cause syncope is broad, ranging from common benign problems to severe life-threatening disorders. Because of the complexity of the clinical situation when an obvious cause for syncope is not found, patients may be subjected to a significant period of hospitalization and a large number of diagnostic tests. Retrospective and prospective studies have shown that many diagnostic tests are frequently employed but are infrequently diagnostic of a cause of syncope. Thus, studies have shown that when a cause is established or suggested, the majority of diagnoses are assigned based on initial history and physical examination. An initial electrocardiogram is helpful in assigning a cause of syncope in only approximately five percent of additional patients. In a prior study prolonged electrocardiographic monitoring was helpful in assigning a cause of syncope in approximately fifteen percent of patients. Other studies of prolonged electrocardiographic monitoring in patients with syncope reveal that arrhythmias as a potential cause of syncope are found in eleven to sixty-four percent of patients. Diagnostic procedures such as EEG, head CT scan, brain scan, cerebral angiography, echocardiography, and cardiac catheterization rarely establish a cause of syncope but are useful when employed selectively for diagnosis of specific etiologies of syncope. These studies of diagnostic evaluation of syncope, therefore, clearly indicate that there is a subgroup of patients with syncope who have arrhythmias as a cause of their syncope which were not apparent from initial history, physical examination, and EKG. Therefore, prolonged electrocardiographic monitoring has assumed a central role in the diagnostic evaluation of this group of patients for detection of arrhythmias. Because of the prognostic and therapeutic importance of arrhythmias causing syncope, it is important to identify patients who are likely to have arrhythmias from the data available at presentation. There were no studies prior to 1987 attempting to identify such patients at presentation. The predictors of diagnostic arrhythmias at presentation may be helpful for four reasons. First, the variables suggesting high likelihood of arrhythmias may provide a basis for decisions regarding the need for hospital admission. Secondly, predictors of diagnostic arrhythmias may identify patients who may need to be monitored immediately as opposed to electively. Thirdly, patients who have predictors of diagnostic arrhythmias may be more appropriate candidates for invasive diagnostic testing such as intracardiac electrophysiologic studies. Fourthly, since patients with arrhythmias are at high risk of sudden death, these predictors may identify an appropriate subset of patients for further studies involving therapeutic interventions. Since many patients with syncope have multiple risk factors for sudden death, the development of a multifactorial model to more effectively and expeditiously predict the degree of risk of sudden death may be important in the management of patients with syncope after initial presentation. DESIGN NARRATIVE: Two models were validated in this longitudinal study including one which predicted sudden death and one which predicted diagnostic arrhythmias on monitoring. The model for prediction of sudden death was developed in patients in whom a cause of syncope was not established by initial history and physical examination. The predictors in this model included a history of diabetes mellitus, renal insufficiency, left ventricular hypertrophy, left bundle branch block, and left axis deviation. The model of predictors of diagnostic arrhythmias was developed in patients in whom a cause of syncope was not established from initial history, physical examination, or EKG and included a history of ventricular tachycardia and an abnormal EKG by specific criteria. Patients with syncope were accrued from the emergency room, the inpatient services and the ambulatory clinics of the Presbyterian University Hospital of Pittsburgh. All patients underwent a basic standardized evaluation consisting of a history, physical examination, baseline laboratory tests, electrocardiogram, prolonged electrocardiographic monitoring, and special diagnostic tests as necessary. Diagnosis of a cause of syncope was assigned by standardized criteria. Follow-up information regarding sudden death and mortality was obtained at three-month intervals until the end of the study. Causes of death were assigned in a standardized manner. The study completion date listed in this record was obtained from the "End Date" entered in the Protocol Registration and Results System (PRS) record.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Cardiovascular Diseases, Arrhythmia, Death, Sudden, Cardiac, Heart Diseases, Syncope

    7. Study Design

    10. Eligibility

    Sex
    Male
    Maximum Age & Unit of Time
    100 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    No eligibility criteria

    12. IPD Sharing Statement

    Citations:
    PubMed Identifier
    2432783
    Citation
    Kapoor WN, Cha R, Peterson JR, Wieand HS, Karpf M. Prolonged electrocardiographic monitoring in patients with syncope. Importance of frequent or repetitive ventricular ectopy. Am J Med. 1987 Jan;82(1):20-8. doi: 10.1016/0002-9343(87)90372-x.
    Results Reference
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    PubMed Identifier
    3310742
    Citation
    Fine MJ, Kapoor W, Falanga V. Cholesterol crystal embolization: a review of 221 cases in the English literature. Angiology. 1987 Oct;38(10):769-84. doi: 10.1177/000331978703801007.
    Results Reference
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    PubMed Identifier
    3800534
    Citation
    Martin DC, Miller J, Kapoor W, Karpf M, Boller F. Clinical prediction rules for computed tomographic scanning in senile dementia. Arch Intern Med. 1987 Jan;147(1):77-80.
    Results Reference
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    PubMed Identifier
    3674057
    Citation
    Kapoor WN, Peterson J, Wieand HS, Karpf M. Diagnostic and prognostic implications of recurrences in patients with syncope. Am J Med. 1987 Oct;83(4):700-8. doi: 10.1016/0002-9343(87)90901-6.
    Results Reference
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    PubMed Identifier
    3611575
    Citation
    Kapoor WN. Evaluation of syncope in the elderly. J Am Geriatr Soc. 1987 Aug;35(8):826-8. doi: 10.1111/j.1532-5415.1987.tb06364.x. No abstract available.
    Results Reference
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    PubMed Identifier
    3675243
    Citation
    Martin DC, Miller JK, Kapoor W, Arena VC, Boller F. A controlled study of survival with dementia. Arch Neurol. 1987 Nov;44(11):1122-6. doi: 10.1001/archneur.1987.00520230012006. Erratum In: Arch Neurol 1988 Jun;45(6):619.
    Results Reference
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    Citation
    Bankowitz R, Blumenfeld B, Bettinsoli N, Parker R, McNeil M, Challinor S, Massarie F, Kapoor WN, Arena V, Miller R: User Variability in Abstracting and Entering Patient Case Histories Using Quick Medical Reference (QMR). Proc 11th Ann Symp on Computer Applications in Medical Care, p 68-73, 1987
    Results Reference
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    Citation
    Kapoor W: Use of Electrophysiologic Studies in Unexplained Syncope. Pract Cardiol, 1113:53-63, 1987
    Results Reference
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    Citation
    Kapoor WN: Syncope and Hypotension. Emergency Decisions, 1987
    Results Reference
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    Citation
    Kapoor WN: Electrocardiographic Monitoring in Syncope. Cardiol Board Rev, 4:57-75, 1987
    Results Reference
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    PubMed Identifier
    3195480
    Citation
    Bass EB, Elson JJ, Fogoros RN, Peterson J, Arena VC, Kapoor WN. Long-term prognosis of patients undergoing electrophysiologic studies for syncope of unknown origin. Am J Cardiol. 1988 Dec 1;62(17):1186-91. doi: 10.1016/0002-9149(88)90257-3.
    Results Reference
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    PubMed Identifier
    2653156
    Citation
    Bankowitz RA, McNeil MA, Challinor SM, Parker RC, Kapoor WN, Miller RA. A computer-assisted medical diagnostic consultation service. Implementation and prospective evaluation of a prototype. Ann Intern Med. 1989 May 15;110(10):824-32. doi: 10.7326/0003-4819-110-10-824.
    Results Reference
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    PubMed Identifier
    2646899
    Citation
    Kapoor WN, Hammill SC, Gersh BJ. Diagnosis and natural history of syncope and the role of invasive electrophysiologic testing. Am J Cardiol. 1989 Mar 15;63(11):730-4. doi: 10.1016/0002-9149(89)90260-9. No abstract available.
    Results Reference
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    PubMed Identifier
    2331188
    Citation
    Bass EB, Curtiss EI, Arena VC, Hanusa BH, Cecchetti A, Karpf M, Kapoor WN. The duration of Holter monitoring in patients with syncope. Is 24 hours enough? Arch Intern Med. 1990 May;150(5):1073-8.
    Results Reference
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    PubMed Identifier
    2189056
    Citation
    Kapoor WN. Evaluation and outcome of patients with syncope. Medicine (Baltimore). 1990 May;69(3):160-75. doi: 10.1097/00005792-199005000-00004.
    Results Reference
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    PubMed Identifier
    1986595
    Citation
    Kapoor WN. Diagnostic evaluation of syncope. Am J Med. 1991 Jan;90(1):91-106. doi: 10.1016/0002-9343(91)90511-u.
    Results Reference
    background
    Citation
    Kapoor W: Syncope. In: Straub, WH (Ed) Manual of Diagnostic Imaging. Little, Brown and Co., 2nd Edition, 1989.
    Results Reference
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    PubMed Identifier
    1404823
    Citation
    Kapoor WN. Evaluation and management of the patient with syncope. JAMA. 1992 Nov 11;268(18):2553-60.
    Results Reference
    background
    PubMed Identifier
    1736767
    Citation
    Kapoor WN, Brant N. Evaluation of syncope by upright tilt testing with isoproterenol. A nonspecific test. Ann Intern Med. 1992 Mar 1;116(5):358-63. doi: 10.7326/0003-4819-116-5-358.
    Results Reference
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    PubMed Identifier
    1867243
    Citation
    Atkins D, Hanusa B, Sefcik T, Kapoor W. Syncope and orthostatic hypotension. Am J Med. 1991 Aug;91(2):179-85. doi: 10.1016/0002-9343(91)90012-m.
    Results Reference
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    PubMed Identifier
    9095005
    Citation
    Martin TP, Hanusa BH, Kapoor WN. Risk stratification of patients with syncope. Ann Emerg Med. 1997 Apr;29(4):459-66. doi: 10.1016/s0196-0644(97)70217-8.
    Results Reference
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    PubMed Identifier
    2195886
    Citation
    Fine MJ, Orloff JJ, Arisumi D, Fang GD, Arena VC, Hanusa BH, Yu VL, Singer DE, Kapoor WN. Prognosis of patients hospitalized with community-acquired pneumonia. Am J Med. 1990 May;88(5N):1N-8N.
    Results Reference
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    PubMed Identifier
    7485208
    Citation
    Kapoor WN, Fortunato M, Hanusa BH, Schulberg HC. Psychiatric illnesses in patients with syncope. Am J Med. 1995 Nov;99(5):505-12. doi: 10.1016/s0002-9343(99)80227-7.
    Results Reference
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    PubMed Identifier
    7695662
    Citation
    Levy MA, Arnold RM, Fine MJ, Kapoor WN. Professional courtesy--current practices and attitudes. N Engl J Med. 1993 Nov 25;329(22):1627-31. doi: 10.1056/NEJM199311253292207.
    Results Reference
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    PubMed Identifier
    8030660
    Citation
    Kapoor WN, Smith MA, Miller NL. Upright tilt testing in evaluating syncope: a comprehensive literature review. Am J Med. 1994 Jul;97(1):78-88. doi: 10.1016/0002-9343(94)90051-5.
    Results Reference
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    PubMed Identifier
    8144829
    Citation
    Kapoor WN. Syncope in older persons. J Am Geriatr Soc. 1994 Apr;42(4):426-36. doi: 10.1111/j.1532-5415.1994.tb07493.x. No abstract available.
    Results Reference
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