Evaluating the Impact of Orthostatic Syncope and Presyncope on Quality of Life: A Systematic Review and Meta-Analysis

Abstract

Purpose: Syncope (transient loss of consciousness and postural tone) and presyncope are common manifestations of autonomic dysfunction that are usually triggered by orthostasis. The global impact of syncope on quality of life (QoL) is unclear. In this systematic review, we report evidence on the impact of syncope and presyncope on QoL and QoL domains, identify key factors influencing QoL in patients with syncopal disorders, and combine available data to compare QoL between syncopal disorders and to population normative data.

Methods: A comprehensive literature search of academic databases (MEDLINE (PubMed), Web of Science, CINAHL, PsycINFO, and Embase) was conducted (February 2021) to identify peer-reviewed publications that evaluated the impact of vasovagal syncope (VVS), postural orthostatic tachycardia syndrome (POTS), or orthostatic hypotension (OH) on QoL. Two team members independently screened records for inclusion and extracted data relevant to the study objectives.

Results: From 12,258 unique records identified by the search, 36 studies met the inclusion criteria (VVS: n = 20; POTS: n = 13; VVS and POTS: n = 1; OH: n = 2); 12 distinct QoL instruments were used. Comparisons of QoL scores between patients with syncope/presyncope and a control group were performed in 16 studies; significant QoL impairments in patients with syncope/presyncope were observed in all studies. Increased syncopal event frequency, increased autonomic symptom severity, and the presence of mental health disorders and/or comorbidities were associated with lower QoL scores.

Conclusion: This review synthesizes the negative impact of syncope/presyncope on QoL and identifies research priorities to reduce the burden of these debilitating disorders and improve patient QoL.

Keywords: carotid sinus hypersensitivity; orthostatic hypotension; postural orthostatic tachycardia syndrome (POTS); quality of life; vasovagal syncope.

Figure 1

Flowchart depicting the study selection process. Studies were selected for inclusion using a two-stage approach. In stage one (screening), titles, then abstracts were screened to select studies published in peer-reviewed journals that investigated patients with syncopal disorders and provided an indication that quality of life was evaluated as an outcome measure. The emphasis at this stage was on excluding articles that were clearly unrelated to the research question. In stage two (eligibility), full-text papers for stage one inclusions were obtained and inclusion and exclusion criteria were firmly applied. Reasons for exclusion were recorded in the second stage of the study selection process. Adapted from PRISMA statement (2009) (24).

Figure 2

Meta-analysis of SF-36 summary scores in patients with VVS and POTS compared to normative data. Physical (A) and mental (B) component summary scores are shown for patients with VVS (–30, 56) (red) and POTS (, –46) (blue). Data for each study are presented as the mean (circle) and standard deviation (whiskers) with the size of the circle proportional to the study sample size. Weighted means and standard deviations for combined data for patients with VVS and POTS are indicated with black squares. Vertical lines and gray shading denote the mean and standard deviation based on US normative data (n = 2,474) (58). *Significantly different to US normative data at the 0.001 level of significance.^†Significantly different to the VVS group, at the 0.001 level of significance.

Figure 3

Meta-analysis of SF-36 domain scores in patients with VVS and POTS compared to normative data. SF-36 domain scores are shown for patients with VVS (–30) and POTS (9, 46). Bars represent weighted means and standard deviations for patients with VVS and POTS. Note that the two POTS studies did not report a measure of error; the mean scores from these studies are presented for reference, but have not been included in the statistical analysis. Horizontal line and gray shading denote the mean and standard deviation based on US normative data (n = 2,474) (58). *Significantly different to US normative data at the 0.001 level of significance.

Figure 4

Meta-analysis of EQ VAS in patients with VVS, POTS, and OH compared to United States normative data. EQ VAS scores are shown for patients with VVS (30, 31, 33, 34), POTS (48, 49) and OH (54). Circles represent mean scores from individual studies, with the size of the circle proportional to the study sample size. Weighted means and standard deviations for combined data for patients with VVS, POTS, and OH are indicated with black squares. Horizontal line and gray shading denote the mean and standard deviation based on US normative data (n = 38,678) (59). *Significantly different to US normative data at the 0.001 level of significance.^†Significantly different to the VVS group, at the 0.001 level of significance.^‡Significantly different to the OH group, at the 0.01 level of significance.