Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Sep 23:S0196-0644(25)01155-2.
doi: 10.1016/j.annemergmed.2025.08.014. Online ahead of print.

Serious Cardiac Outcomes and Physician Estimation of Risk in Emergency Department Patients With Presyncope Versus Syncope

Edward H Suh  1 , Dana L Sacco  2 , Carolyn Winskill  3 , John DeAngelis  4 , Daniel Nishijima  5 , Jonathan Schimmel  6 , Alan Storrow  7 , Venkatesh Thiruganasambandamoorthy  8 , Robert E Weiss  3 , Nancy Wood  4 , Marc A Probst  2
Affiliations

Serious Cardiac Outcomes and Physician Estimation of Risk in Emergency Department Patients With Presyncope Versus Syncope

Edward H Suh et al. Ann Emerg Med. .

Abstract

Study objective: Previous research suggests that the short-term incidence of adverse events is similar in emergency department (ED) patients with presyncope and syncope. However, admission rates for presyncope are lower, which could imply clinicians underestimate its risk. We sought to compare physician risk estimates and the 30-day rate of serious cardiac outcomes between patients with syncope and presyncope.

Methods: We conducted a secondary analysis of a prospective, observational, multicenter study of patients aged ≥40 years presenting to ED with presyncope or syncope. Patients with serious ED diagnoses were excluded. Descriptive statistics and multivariable regression analyses were used to compare the physician-estimated risk, ED disposition, and 30-day rate of adverse outcomes.

Results: Of the 1,263 patients analyzed, 721 (57%) had syncope and 542 (43%) had presyncope. Baseline characteristics were similar between groups. At 30 days, 34 (4.7%) syncope patients and 28 (5.2%) presyncope patients experienced a serious cardiac outcome; logistic regression showed no difference in the odds (odds ratio 1.13; 95% confidence interval 0.66 to 1.79) of serious cardiac outcomes between syncope and presyncope patients. The mean physician-estimated risk of serious cardiac outcomes was 7.6% in syncope, versus 5.3% in presyncope (risk difference 2.3% [0.89%, 3.7%]); this difference remained significant after adjustment for clinical characteristics. Admission rate was lower in presyncope, 38.2% versus 49.5% (risk difference 11.3% [1.2%, 21.5%]).

Conclusion: Patients with unexplained presyncope and syncope had similar rates of 30-day serious cardiac outcomes after ED visit. Patients with presyncope were less likely to be admitted and had a lower mean physician-estimated risk of adverse outcomes.

Keywords: Near syncope; Physician risk estimation; Presyncope; Risk stratification; Syncope.

PubMed Disclaimer

Conflict of interest statement

MAP received a one-time research donation from Roche Diagnostics in 2023. AS is currently supported by grants from NIH/NHLBI (R61HL155810), (T32HL170986), (R01HL145293), (R01HL157596), PCORI 202-2025, AHRQ (R18 HS25931), and VICTR (UL1TR002243). DS is currently supported by a KL2 grant from the CTSA (KL2 TR001874). DN served as a consultant for Pfizer in 2023. All other authors report no potential conflicts of interest.

References

    1. Kapoor WN. Syncope. N Engl J Med. Dec 21 2000;343(25):1856–62. doi: 10.1056/nejm200012213432507 - DOI - PubMed
    1. Probst MA, Gibson T, Weiss RE, et al. Risk Stratification of Older Adults Who Present to the Emergency Department With Syncope: The FAINT Score. Ann Emerg Med. Feb 2020;75(2):147–158. doi: 10.1016/j.annemergmed.2019.08.429 - DOI - PMC - PubMed
    1. Thiruganasambandamoorthy V, Sivilotti MLA, Le Sage N, et al. Multicenter Emergency Department Validation of the Canadian Syncope Risk Score. JAMA Intern Med. May 1 2020;180(5):737–744. doi: 10.1001/jamainternmed.2020.0288 - DOI - PMC - PubMed
    1. Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. Aug 1 2017;136(5):e25–e59. doi: 10.1161/cir.0000000000000498 - DOI - PubMed
    1. Mirfazaelian H, Stiell I, Masoomi R, Garjani K, Thiruganasambandamoorthy V. Serious outcomes among emergency department patients with presyncope: A systematic review. Acad Emerg Med. Jun 9 2024;doi: 10.1111/acem.14943 - DOI - PubMed

LinkOut - more resources