THE CARDIOGENIC SYNCOPE IN THE ELDERLY - A REVIEW ON THE EPIDEMIOLOGYAND SOCIAL COSTS

Although syncope is a common clinical problem in the elderly, little i s known of its epidemiology and social costs. According to some epidem iological enquiries, syncope is responsible for 3% of emergency room v isits and for 6% of the medical admissions in general hospitals. Altho ugh some types of syncope are benign and self-limited, those of trauma tic origin with abrupt loss of consciousness represent a considerable morbidity, particularly in elderly patients. The prevalence in 10 year s was of 23%, with an annual occurrence of 6-7% and a recurrence rate of 30%. Despite accurate investigations, syncope remains unexplained i n about 50% of the patients. The first year mortality for cardiac sync ope is 20-30%, against 5% for non-cardiac causes and 10% for syncope o f unknown origin. Sudden death occurred in 17% of cardiac syncope case s. An approximate cost analysis can be obtained through the survey of costs relative to the length of the hospitalization and to the number of the main diagnostic tests applied. It must be underlined, however, that the clinical history and physical examination supply the most imp ortant contribution to the diagnosis in old patients, and these often are more than sufficient to suggest the suitable choice among the inst rumental tests to be applied; this approach helps considerably to redu ce the hospital costs.