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Staples JA, Erdelyi S, Merchant K, Yip C, Khan M, Maclure KM, Redelmeier DA, Chan H, Brubacher JR. Syncope and Traffic Crash: A Population-Based Case-Crossover Analysis. Can J Cardiol 2024; 40:554-561. [PMID: 37290537 DOI: 10.1016/j.cjca.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/05/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Among individuals with recent syncope, recurrence of syncope while driving might incapacitate a driver and cause a motor vehicle crash. Current driving restrictions assume that some forms of syncope transiently increase crash risk. We evaluated whether syncope is associated with a transient increase in crash risk. METHODS We performed a case-crossover analysis of linked administrative health and driving data from British Columbia, Canada (2010 to 2015). We included licensed drivers who visited an emergency department with "syncope and collapse" and who were involved as a driver in an eligible motor vehicle crash, both within the study interval. Using conditional logistic regression, we compared the rate of emergency visits for syncope in the 28 days before crash (the "pre-crash interval") with the rate of emergency visits for syncope in 3 self-matched 28-day control intervals (ending 6, 12, and 18 months before the crash). RESULTS Among eligible crash-involved drivers, 47 of 3026 pre-crash intervals and 112 of 9078 control intervals had emergency visits for syncope, indicating syncope was not significantly associated with subsequent crash (1.6% vs 1.2%; adjusted odds ratio [OR], 1.27; 95% confidence interval [CI], 0.90-1.79; P = 0.18). There was no significant association between syncope and crash in subgroups at higher risk for adverse outcomes after syncope (eg, age > 65 years, cardiovascular disease, cardiac syncope). CONCLUSIONS In the context of prevailing modifications of driving behaviour after syncope, an emergency department visit for syncope did not transiently increase the risk of subsequent traffic collision. Overall crash risks after syncope appear to be adequately addressed by current driving restrictions.
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Affiliation(s)
- John A Staples
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, British Columbia, Canada.
| | - Shannon Erdelyi
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ketki Merchant
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Candace Yip
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mayesha Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - K Malcolm Maclure
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald A Redelmeier
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Herbert Chan
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey R Brubacher
- Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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2
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Guerra PG, Simpson CS, Van Spall HGC, Asgar AW, Billia P, Cadrin-Tourigny J, Chakrabarti S, Cheung CC, Dore A, Fordyce CB, Gouda P, Hassan A, Krahn A, Luc JGY, Mak S, McMurtry S, Norris C, Philippon F, Sapp J, Sheldon R, Silversides C, Steinberg C, Wood DA. Canadian Cardiovascular Society 2023 Guidelines on the Fitness to Drive. Can J Cardiol 2024; 40:500-523. [PMID: 37820870 DOI: 10.1016/j.cjca.2023.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
Cardiovascular conditions are among the most frequent causes of impairment to drive, because they might induce unpredictable mental state alterations via diverse mechanisms like myocardial ischemia, cardiac arrhythmias, and vascular dysfunction. Accordingly, health professionals are often asked to assess patients' fitness to drive (FTD). The Canadian Cardiovascular Society previously published FTD guidelines in 2003-2004; herein, we present updated FTD guidelines. Because there are no randomized trials on FTD, observational studies were used to estimate the risk of driving impairment in each situation, and recommendations made on the basis of Canadian Cardiovascular Society Risk of Harm formula. More restrictive recommendations were made for commercial drivers, who spend longer average times behind the wheel, use larger vehicles, and might transport a larger number of passengers. We provide guidance for individuals with: (1) active coronary artery disease; (2) various forms of valvular heart disease; (3) heart failure, heart transplant, and left ventricular assist device situations; (4) arrhythmia syndromes; (5) implantable devices; (6) syncope history; and (7) congenital heart disease. We suggest appropriate waiting times after cardiac interventions or acute illnesses before driving resumption. When short-term driving cessation is recommended, recommendations are on the basis of expert consensus rather than the Risk of Harm formula because risk elevation is expected to be transient. These recommendations, although not a substitute for clinical judgement or governmental regulations, provide specialists, primary care providers, and allied health professionals with a comprehensive list of a wide range of cardiac conditions, with guidance provided on the basis of the level of risk of impairment, along with recommendations about ability to drive and the suggested duration of restrictions.
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Affiliation(s)
- Peter G Guerra
- Université de Montréal, Institut de Cardiologie de Montréal, Montréal, Québec, Canada.
| | | | - Harriette G C Van Spall
- McMaster University, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada, and Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Anita W Asgar
- Université de Montréal, Institut de Cardiologie de Montréal, Montréal, Québec, Canada
| | - Phyllis Billia
- University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Julia Cadrin-Tourigny
- Université de Montréal, Institut de Cardiologie de Montréal, Montréal, Québec, Canada
| | - Santabhanu Chakrabarti
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher C Cheung
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Annie Dore
- Université de Montréal, Institut de Cardiologie de Montréal, Montréal, Québec, Canada
| | - Christopher B Fordyce
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pishoy Gouda
- University of Alberta, Edmonton, Alberta, Canada
| | - Ansar Hassan
- Mitral Center of Excellence, Maine Medical Center, Portland, Maine, USA
| | - Andrew Krahn
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica G Y Luc
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Susanna Mak
- University of Toronto, Sinai Health, Toronto, Ontario, Canada
| | | | | | - Francois Philippon
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Hôpital Laval, Laval, Québec, Canada
| | - John Sapp
- Dalhousie University, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | | | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Hôpital Laval, Laval, Québec, Canada
| | - David A Wood
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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3
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Gao X, Zhang N, Lu L, Gao T, Chou OHI, Wong WT, Chang C, Wai AKC, Lip GYH, Zhang Q, Tse G, Liu T, Zhou J. New-onset syncope in diabetic patients treated with sodium-glucose cotransporter-2 inhibitors versus dipeptidyl peptidase-4 inhibitors: a Chinese population-based cohort study. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2024; 10:103-117. [PMID: 37962962 DOI: 10.1093/ehjcvp/pvad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/17/2023] [Accepted: 11/11/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND AND AIMS Syncope is a symptom that poses an important diagnostic and therapeutic challenge, and generates significant cost for the healthcare system. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated beneficial cardiovascular effects, but their possible effects on incident syncope have not been fully investigated. This study compared the effects of SGLT2i and dipeptidyl peptidase-4 inhibitors (DPP4i) on new-onset syncope. METHODS AND RESULTS This was a retrospective, territory-wide cohort study enrolling type 2 diabetes mellitus (T2DM) patients treated with SGLT2i or DPP4i between 1 January 2015 and 31 December 2020, in Hong Kong, China. The outcomes were hospitalization of new-onset syncope, cardiovascular mortality, and all-cause mortality. Multivariable Cox regression and different approaches using the propensity score were applied to evaluate the association between SGLT2i and DPP4i with incident syncope and mortality. After matching, a total of 37 502 patients with T2DM were included (18 751 SGLT2i users vs. 18 751 DPP4i users). During a median follow-up of 5.56 years, 907 patients were hospitalized for new-onset syncope (2.41%), and 2346 patients died from any cause (6.26%), among which 471 deaths (1.26%) were associated with cardiovascular causes. Compared with DPP4i users, SGLT2i therapy was associated with a 51% lower risk of new-onset syncope [HR 0.49; 95% confidence interval (CI) 0.41-0.57; P < 0.001], 65% lower risk of cardiovascular mortality (HR 0.35; 95% CI 0.26-0.46; P < 0.001), and a 70% lower risk of all-cause mortality (HR 0.30; 95% CI 0.26-0.34; P < 0.001) in the fully adjusted model. Similar associations with syncope were observed for dapagliflozin (HR 0.70; 95% CI 0.58-0.85; P < 0.001), canagliflozin (HR 0.48; 95% CI 0.36-0.63; P < 0.001), and ertugliflozin (HR 0.45; 95% CI 0.30-0.68; P < 0.001), but were attenuated for empagliflozin (HR 0.79; 95% CI 0.59-1.05; P = 0.100) after adjusting for potential confounders. The subgroup analyses suggested that, compared with DPP4i, SGLT2i was associated with a significantly decreased risk of incident syncope among T2DM patients, regardless of gender, age, glucose control status, Charlson comorbidity index, and the association remained constant amongst those with common cardiovascular drugs and most antidiabetic drugs at baseline. CONCLUSION Compared with DPP4i, SGLT2i was associated with a significantly lower risk of new-onset syncope in patients with T2DM, regardless of gender, age, degree of glycaemic control, and comorbidity burden.
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Affiliation(s)
- Xinyi Gao
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Nan Zhang
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Lei Lu
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Tianyu Gao
- School of Physical Education, Jinan University, Guangzhou, China
| | - Oscar Hou In Chou
- Department of Medicine, Division of Clinical Pharmacology and Therapeutics, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
- Diabetes Research Unit, Cardiovascular Analytics Group, PowerHealth Limited, Hong Kong, China
| | - Wing Tak Wong
- School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Carlin Chang
- Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Abraham Ka Chung Wai
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Qingpeng Zhang
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, and the Musketeers Foundation Institute of Data Science, University of Hong Kong, Hong Kong, China
| | - Gary Tse
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Tong Liu
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Jiandong Zhou
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Division of Health Science, Warwick Medical School, University of Warwick, Coventry, UK
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Staples JA, Erdelyi S, Merchant K, Yip C, Khan M, Redelmeier DA, Chan H, Brubacher JR. Syncope While Driving and the Risk of a Subsequent Motor Vehicle Crash. Ann Emerg Med 2024; 83:147-157. [PMID: 37943207 DOI: 10.1016/j.annemergmed.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 11/10/2023]
Abstract
STUDY OBJECTIVE Syncope that occurs while driving can result in a motor vehicle crash. Whether individuals with a prior syncope-related crash exhibit an exceptional risk of subsequent crash remains uncertain. METHODS We performed a population-based retrospective observational study of patients diagnosed with 'syncope and collapse' at any of 6 emergency departments in British Columbia, Canada (2010 to 2015). Data were obtained from chart abstraction, administrative health records, insurance claims and police crash reports. We compared crash-free survival among individuals with crash-associated syncope (a crash and an emergency visit for syncope on the same date) to that among controls with syncope alone (no crash on date of emergency visit for syncope). RESULTS In the year following their index emergency visit, 13 of 63 drivers with crash-associated syncope and 852 of 9,160 controls with syncope alone experienced a subsequent crash as a driver (crash risk 21% versus 9%). After accounting for censoring and potential confounders, crash-associated syncope was not associated with a significant increase in the risk of subsequent crash (adjusted hazard ratio [aHR] 1.38, 95% confidence interval [CI] 0.78 to 2.47). Individuals with crash-associated syncope were 31-fold more likely to have physician driving advice documented during their index visit (prevalence ratio 31.0, 95% CI, 21.3 to 45.1). In the subgroup without documented driving advice, crash-associated syncope was associated with a significant increase in subsequent crash risk (aHR 1.88, 95% CI 1.06 to 3.36). CONCLUSIONS Crash risk after crash-associated syncope appears similar to crash risk after syncope alone.
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Affiliation(s)
- John A Staples
- Department of Medicine, University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, Canada.
| | - Shannon Erdelyi
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Ketki Merchant
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Candace Yip
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Mayesha Khan
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Donald A Redelmeier
- Sunnybrook Research Institute, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada
| | - Herbert Chan
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Jeffrey R Brubacher
- Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
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5
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Corvino AR, Russo V, Monaco MGL, Garzillo EM, Guida D, Comune A, Parente E, Lamberti M, Miraglia N. Vasovagal Syncope at Work: A Narrative Review for an Occupational Management Proposal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5460. [PMID: 37107742 PMCID: PMC10138125 DOI: 10.3390/ijerph20085460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/29/2023] [Accepted: 04/07/2023] [Indexed: 05/11/2023]
Abstract
Syncope is a complex clinical manifestation that presents considerable diagnostic difficulties and, consequently, numerous critical issues regarding fitness for work, especially for high-risk tasks. To date, it is impossible to quantify the exact impact of syncope on work and public safety since it is highly improbable to identify loss of consciousness as the fundamental cause of work or driving-related accidents, especially fatal injuries. Working at high-risk jobs such as public transport operators, in high elevations, or with exposure to moving parts, construction equipment, fireworks, or explosives demand attention and total awareness. Currently, no validated criteria or indicators are available for occupational risk stratification of a patient with reflex syncope to return to work. By drawing inspiration from the updated literature, this narrative review intends to summarise the leading knowledge required regarding the return to work for subjects affected by syncope. According to the available data, the authors highlighted some key findings, summarised in macro-items, such as defined risk stratification for vasovagal accidents, return to work after a critical event, and a focus on pacemaker (PM) implementation. Lastly, the authors proposed a flowchart for occupational physicians to help them manage the cases of workers affected by syncope and exposed to levels of risk that could represent a danger to the workers' health.
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Affiliation(s)
- Anna Rita Corvino
- Experimental Medicine Department-Hygiene, Occupational, and Forensic Medicine Division-Occupational Forensic Area, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.R.C.); (D.G.); (M.L.); (N.M.)
| | - Vincenzo Russo
- Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, 80131 Naples, Italy; (V.R.); (A.C.); (E.P.)
| | | | | | - Daniele Guida
- Experimental Medicine Department-Hygiene, Occupational, and Forensic Medicine Division-Occupational Forensic Area, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.R.C.); (D.G.); (M.L.); (N.M.)
| | - Angelo Comune
- Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, 80131 Naples, Italy; (V.R.); (A.C.); (E.P.)
| | - Erika Parente
- Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, 80131 Naples, Italy; (V.R.); (A.C.); (E.P.)
| | - Monica Lamberti
- Experimental Medicine Department-Hygiene, Occupational, and Forensic Medicine Division-Occupational Forensic Area, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.R.C.); (D.G.); (M.L.); (N.M.)
| | - Nadia Miraglia
- Experimental Medicine Department-Hygiene, Occupational, and Forensic Medicine Division-Occupational Forensic Area, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.R.C.); (D.G.); (M.L.); (N.M.)
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Staples JA, Erdelyi S, Merchant K, Yip C, Khan M, Redelmeier DA, Chan H, Brubacher JR. Syncope and subsequent traffic crash: A responsibility analysis. PLoS One 2023; 18:e0279710. [PMID: 36656813 PMCID: PMC9851499 DOI: 10.1371/journal.pone.0279710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/12/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Physicians are often asked to counsel patients about driving safety after syncope, yet little empirical data guides such advice. METHODS We identified a population-based retrospective cohort of 9,507 individuals with a driver license who were discharged from any of six urban emergency departments (EDs) with a diagnosis of 'syncope and collapse'. We examined all police-reported crashes that involved a cohort member as a driver and occurred between 1 January 2010 and 31 December 2016. We categorized crash-involved drivers as 'responsible' or 'non-responsible' for their crash using detailed police-reported crash data and a validated responsibility scoring tool. We then used logistic regression to test the hypothesis that recent syncope was associated with driver responsibility for crash. RESULTS Over the 7-year study interval, cohort members were involved in 475 police-reported crashes: 210 drivers were deemed responsible and 133 drivers were deemed non-responsible for their crash; the 132 drivers deemed to have indeterminate responsibility were excluded from further analysis. An ED visit for syncope occurred in the three months leading up to crash in 11 crash-responsible drivers and in 5 crash-non-responsible drivers, suggesting that recent syncope was not associated with driver responsibility for crash (adjusted odds ratio, 1.31; 95%CI, 0.40-4.74; p = 0.67). However, all drivers with cardiac syncope were deemed responsible, precluding calculation of an odds ratio for this important subgroup. CONCLUSIONS Recent syncope was not significantly associated with driver responsibility for traffic crash. Clinicians and policymakers should consider these results when making fitness-to-drive recommendations after syncope.
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Affiliation(s)
- John A. Staples
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology & Evaluation, Vancouver, Canada
- * E-mail:
| | - Shannon Erdelyi
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Ketki Merchant
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Candace Yip
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Mayesha Khan
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Donald A. Redelmeier
- Sunnybrook Research Institute, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Herbert Chan
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Jeffrey R. Brubacher
- Centre for Clinical Epidemiology & Evaluation, Vancouver, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
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7
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Gross CP, Rosekind MR. Driving Safety After an Acute Illness-This Is Our Lane. JAMA Intern Med 2022; 182:942. [PMID: 35913724 DOI: 10.1001/jamainternmed.2022.2874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Cary P Gross
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Associate Editor, JAMA Internal Medicine
| | - Mark R Rosekind
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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8
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Staples JA, Erdelyi S, Merchant K, Yip C, Khan M, Redelmeier DA, Chan H, Brubacher JR. Syncope and the Risk of Subsequent Motor Vehicle Crash: A Population-Based Retrospective Cohort Study. JAMA Intern Med 2022; 182:934-942. [PMID: 35913711 PMCID: PMC9344386 DOI: 10.1001/jamainternmed.2022.2865] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Medical driving restrictions are burdensome, yet syncope recurrence while driving can cause a motor vehicle crash (MVC). Few empirical data inform current driving restrictions after syncope. OBJECTIVE To examine MVC risk among patients visiting the emergency department (ED) after first-episode syncope. DESIGN, SETTING, AND PARTICIPANTS A population-based, retrospective observational cohort study of MVC risk after first-episode syncope was performed in British Columbia, Canada. Patients visiting any of 6 urban EDs for syncope and collapse were age- and sex-matched to 4 control patients visiting the same ED in the same month for a condition other than syncope. Patients' ED medical records were linked to administrative health records, driving history, and detailed crash reports. Crash-free survival among individuals with syncope was then compared with that among matched control patients. Data analyses were performed from May 2020 to March 2022. EXPOSURES Initial ED visit for syncope. MAIN OUTCOMES AND MEASURES Involvement as a driver in an MVC in the year following the index ED visit. Crashes were identified using insurance claim data and police crash reports. RESULTS The study cohort included 43 589 patients (9223 patients with syncope and 34 366 controls; median [IQR] age, 54 [35-72] years; 22 360 [51.3%] women; 5033 [11.5%] rural residents). At baseline, crude MVC incidence rates among both the syncope and control groups were higher than among the general population (12.2, 13.2, and 8.2 crashes per 100 driver-years, respectively). In the year following index ED visit, 846 first crashes occurred in the syncope group and 3457 first crashes occurred in the control group, indicating no significant difference in subsequent MVC risk (9.2% vs 10.1%; adjusted hazard ratio [aHR], 0.93; 95% CI, 0.87-1.01; P = .07). Subsequent crash risk among patients with syncope was not significantly increased in the first 30 days after index ED visit (aHR, 1.07; 95% CI, 0.84-1.36; P = .56) or among subgroups at higher risk of adverse events after syncope (eg, age >65 years; cardiogenic syncope; Canadian Syncope Risk Score ≥1). CONCLUSIONS AND RELEVANCE The findings of this population-based retrospective cohort study suggest that patients visiting the ED with first-episode syncope exhibit a subsequent crash risk no different than the average ED patient. More stringent driving restrictions after syncope may not be warranted.
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Affiliation(s)
- John A Staples
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Clinical Epidemiology & Evaluation, Vancouver, British Columbia, Canada
| | - Shannon Erdelyi
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ketki Merchant
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Candace Yip
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mayesha Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald A Redelmeier
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Herbert Chan
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey R Brubacher
- Centre for Clinical Epidemiology & Evaluation, Vancouver, British Columbia, Canada.,Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
This article deals with the treatment and application of cardiac biosignals, an excited accelerometer, and a gyroscope in the prevention of accidents on the road. Previously conducted studies say that the seismocardiogram is a measure of cardiac microvibration signals that allows for detecting rhythms, heart valve opening and closing disorders, and monitoring of patients' breathing. This article refers to the seismocardiogram hypothesis that the measurements of a seismocardiogram could be used to identify drivers' heart problems before they reach a critical condition and safely stop the vehicle by informing the relevant departments in a nonclinical manner. The proposed system works without an electrocardiogram, which helps to detect heart rhythms more easily. The estimation of the heart rate (HR) is calculated through automatically detected aortic valve opening (AO) peaks. The system is composed of two micro-electromechanical systems (MEMSs) to evaluate physiological parameters and eliminate the effects of external interference on the entire system. The few digital filtering methods are discussed and benchmarked to increase seismocardiogram efficiency. As a result, the fourth adaptive filter obtains the estimated HR = 65 beats per min (bmp) in a still noisy signal (SNR = −11.32 dB). In contrast with the low processing benefit (3.39 dB), 27 AO peaks were detected with a 917.56-ms peak interval mean over 1.11 s, and the calculated root mean square error (RMSE) was 0.1942 m/s2 when the adaptive filter order is 50 and the adaptation step is equal to 0.933.
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10
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Leon SJ, Trachtenberg A, Briscoe D, Ahmed M, Hougen I, Askin N, Whitlock R, Ferguson T, Tangri N, Rigatto C, Komenda P. Opioids and the Risk of Motor Vehicle Collision: A Systematic Review. J Pharm Technol 2022; 38:54-62. [PMID: 35141728 PMCID: PMC8820048 DOI: 10.1177/87551225211059926] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Background: Opioid analgesics are among the most commonly prescribed medications, but questions remain regarding their impact on the day-to-day functioning of patients including driving. We set out to perform a systematic review on the risk of motor vehicle collision (MVC) associated with prescription opioid exposure. Method: We searched Medline, PubMed, EMBASE, Scopus, and TRID from January 1990 to August 31, 2021 for primary studies assessing prescribed opioid use and MVCs. Results: We identified 14 observational studies that met inclusion criteria. Among those, 8 studies found an increased risk of MVC among those participants who had a concomitant opioid prescription at the time of the MVC and 3 found no significant increase of culpability of fatal MVC. The 3 studies that evaluated the presence of a dose-response relationship between the dose of opioids taken and the effects on MVC risk reported the existence of a dose-response relationship. Due to the heterogeneity of the different studies, a quantitative meta-analysis to sum evidence was deemed unfeasible. Our review supports increasing evidence on the association between motor vehicle collisions and prescribed opioids. This research would guide policies regarding driving legislation worldwide. Conclusion: Our review indicates that opioid prescriptions are likely associated with an increased risk of MVCs. Further studies are warranted to strengthen this finding, and investigate additional factors such as individual opioid medications, opioid doses and dose adjustments, and opioid tolerance for their effect on MVC risk.
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Affiliation(s)
- Silvia J. Leon
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Aaron Trachtenberg
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
| | - Derek Briscoe
- Max Rady College of Medicine,
University of Manitoba, Winnipeg, MB, Canada
| | | | - Ingrid Hougen
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
- Max Rady College of Medicine,
University of Manitoba, Winnipeg, MB, Canada
| | - Nicole Askin
- Neil John Mclean Library, University of
Manitoba, Winnipeg, MB, Canada
| | - Reid Whitlock
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Thomas Ferguson
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Navdeep Tangri
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Claudio Rigatto
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Paul Komenda
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
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11
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Chee JN, Simpson C, Sheldon RS, Dorian P, Dow J, Guzman J, Raj SR, Sandhu RK, Thiruganasambandamoorthy V, Green MS, Krahn AD, Plonka S, Rapoport MJ. A Systematic Review of the Risk of Motor Vehicle Collision in Patients With Syncope. Can J Cardiol 2021; 37:151-161. [DOI: 10.1016/j.cjca.2020.02.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 01/28/2020] [Accepted: 02/10/2020] [Indexed: 11/30/2022] Open
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12
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Ma T, Chee JN, Hanna J, Al Jenabi N, Ilari F, Redelmeier DA, Elzohairy Y. Impact of medical fitness to drive policies in preventing property damage, injury, and death from motor vehicle collisions in Ontario, Canada. JOURNAL OF SAFETY RESEARCH 2020; 75:251-261. [PMID: 33334484 DOI: 10.1016/j.jsr.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 11/12/2019] [Accepted: 09/03/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Drivers with medical conditions and functional impairments are at increased collision risk. A challenge lies in identifying the point at which such risk becomes unacceptable to society and requires mitigating measures. This study models the road safety impact of medical fitness-to-drive policy in Ontario. METHOD Using data from 2005 to 2014, we estimated the losses to road safety incurred during the time medically-at-risk drivers were under review, as well as the savings to road safety accrued as a result of licensing decisions made after the review process. RESULTS While under review, drivers with medical conditions had an age- and sex-standardized collision rate no different from the general driver population, suggesting no road safety losses occurred (RR = 1.02; 95% CI: 0.93-1.12). Licensing decisions were estimated to have subsequently prevented 1,211 (95% CI: 780-1,730) collisions, indicating net road safety savings resulting from medical fitness to drive policies. However, more collisions occurred than were prevented for drivers with musculoskeletal disorders, sleep apnea, and diabetes. We theorize on these findings and discuss its multiple implications. CONCLUSIONS Minimizing the impact of medical conditions on collision occurrence requires robust policies that balance fairness and safety. It is dependent on efforts by academic researchers (who study fitness to drive); policymakers (who set driver medical standards); licensing authorities (who make licensing decisions under such standards); and clinicians (who counsel patients on their driving risk and liaise with licensing authorities). Practical Applications: Further efforts are needed to improve understanding of the effects of medical conditions on collision risk, especially for the identified conditions and combinations of conditions. Results reinforce the value of optimizing the processes by which information is solicited from physicians in order to better assess the functional impact of drivers' medical conditions on driving and to take suitable licensing action.
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Affiliation(s)
- Tracey Ma
- Ontario Ministry of Transportation, Safety Program Development Branch, Research and Evaluation Office, Toronto, Canada; The University of New South Wales, School of Population Health, Sydney, Australia; The George Institute for Global Health, Sydney, Australia
| | - Justin N Chee
- Ontario Ministry of Transportation, Safety Program Development Branch, Research and Evaluation Office, Toronto, Canada.
| | - Joshua Hanna
- Ontario Ministry of Transportation, Safety Program Development Branch, Research and Evaluation Office, Toronto, Canada
| | - Nadia Al Jenabi
- Ontario Ministry of Transportation, Safety Program Development Branch, Research and Evaluation Office, Toronto, Canada
| | - Frances Ilari
- Ontario Ministry of Transportation, Safety Program Development Branch, Research and Evaluation Office, Toronto, Canada
| | - Donald A Redelmeier
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Yoassry Elzohairy
- Ontario Ministry of Transportation, Safety Program Development Branch, Research and Evaluation Office, Toronto, Canada
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13
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Furtan S, Pochciał P, Timler D, Ricci F, Sutton R, Fedorowski A, Zyśko D. Prognosis of Syncope With Head Injury: a Tertiary Center Perspective. Front Cardiovasc Med 2020; 7:125. [PMID: 32793639 PMCID: PMC7390840 DOI: 10.3389/fcvm.2020.00125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 06/15/2020] [Indexed: 12/02/2022] Open
Abstract
Aim: Head injury is the most common trauma occurring in syncope. We aimed to assess whether syncope as cause of head-trauma affects short-and long-term prognosis. Methods: From a database retrospective analysis of 97,014 individuals attending Emergency Department (ED), we selected data of patients with traumatic head injury including age, gender, injury mechanism, brain imaging, multiple traumas, bone fracture, intracranial bleeding, and mortality. Mean follow-up was 6.4 ± 1.8 years. Outcome data were obtained from a digital national population register. The study population included 3,470 ED head injury patients: 117 of them (50.0 ± 23.6 years, 42.7% men) reported syncope as cause of head trauma and 3,315 (32.2 ± 21.1 years, 68.5% men) without syncope preceding head trauma. Results: Thirty-day mortality was low and similar in traumatic head injury with or without syncope. One year and long-term all-cause mortality were both significantly higher in syncopal vs. non-syncopal traumatic head injury (11.1 vs. 2.8% and 32 vs. 10.2%, respectively; both p < 0.001). In adjusted logistic regression analysis, death between 121st-day and 1 year in patients with head-trauma was associated with male gender [odds ratio (OR): 6.48; 95% CI: 2.59–16.25], advancing age (per year) (OR 1.09; 95% CI 1.07–1.11), Glasgow Coma Scale < 13 (OR: 6.18; 95% CI:1.68–22.8), bone fracture (OR 4.72; 95% CI 2.13–10.5), and syncope (OR 3.70; 95% CI: 1;48–9.31). In multivariable Cox regression analysis, syncope was one of the strongest independent predictors of long-term all-cause death (hazard ratio: 1.95; 95% CI 1.37–2.78). Conclusion: In patients with head trauma, history of syncope preceding injury does not increase 30-day all-cause mortality but portends increased 1 year and long-term mortality.
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Affiliation(s)
- Stanisław Furtan
- Department of Emergency Medicine, Wrocław Medical University, Wroclaw, Poland
| | - Paweł Pochciał
- Department of Emergency Medicine, Wrocław Medical University, Wroclaw, Poland
| | - Dariusz Timler
- Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Łódz, Poland
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, G. D'Annunzio University, Chieti, Italy.,Department of Clinical Sciences, Faculty of Medicine, Clinical Research Center, Lund University, Malmö, Sweden
| | - Richard Sutton
- Department of Clinical Sciences, Faculty of Medicine, Clinical Research Center, Lund University, Malmö, Sweden.,National Heart and Lung Institute, Imperial College, Hammersmith Hospital Campus, London, United Kingdom
| | - Artur Fedorowski
- Department of Clinical Sciences, Faculty of Medicine, Clinical Research Center, Lund University, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Dorota Zyśko
- Department of Emergency Medicine, Wrocław Medical University, Wroclaw, Poland
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14
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Pezawas T. Fitness to Drive After Syncope and/or in Cardiovascular Disease - An Overview and Practical Advice. Curr Probl Cardiol 2020; 46:100677. [PMID: 32888697 DOI: 10.1016/j.cpcardiol.2020.100677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/26/2020] [Indexed: 10/23/2022]
Abstract
The risk of syncope occurring while driving has implications for personal and public safety. Little is thought about the medical considerations related to the driving of motor vehicles. Physicians treating patients with cardiovascular disease need to acquire basic competences to be able to advise them about their fitness to drive. Current knowledge, governmental regulations, and recommendations concerning fitness to drive in patients with syncope and/or cardiovascular disease are presented. Narrative review with educational and clinical advice. Cardiovascular disease can make a driver lose control of a vehicle without warning and thereby lead to an accident. The main pathophysiological mechanisms of sudden loss of control are disturbances of brain perfusion (eg, syncope with or without cardiac arrhythmia, sudden cardiac death due to ventricular fibrillation or asystole, stroke, etc.) and marked general weakness (eg, after major surgery or in heart failure). Patients with syncope and/or cardiovascular disease should be properly advised by their physicians about their fitness to drive, and restrictions should be documented.
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15
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Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, Fedorowski A, Furlan R, Kenny RA, Martín A, Probst V, Reed MJ, Rice CP, Sutton R, Ungar A, van Dijk JG. Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2019; 39:e43-e80. [PMID: 29562291 DOI: 10.1093/eurheartj/ehy071] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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16
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Long-term outcomes in syncope patients presenting to the emergency department: A systematic review. CAN J EMERG MED 2019; 22:45-55. [PMID: 31571558 DOI: 10.1017/cem.2019.393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Long-term outcomes among syncope patients are not well studied to guide physicians regarding outpatient testing and follow-up. The objective of this study was to conduct a systematic review for outcomes at 1-year or later among ED syncope patients. METHODS We searched Cochrane Central, Medline, Medline in Process, PubMed, Embase, and the Cumulative Index to Nursing databases from inception to December 2018. We included studies that reported long-term outcomes among ED syncope patients. We excluded studies on patients <16 years old, studies that included syncope mimickers (pre-syncope, seizure, intoxication, loss of consciousness after head trauma), case reports, letters to the editor, non-English and review articles. Outcomes included death, syncope recurrence requiring hospitalization, arrhythmias and procedural interventions for arrhythmias. Meta-analysis was performed by pooling the outcomes using random effects model. RESULTS Initial literature search generated 2,094 articles duplicate removal. Of the 50 articles selected for full-text review, 19 articles with 98,211 patients were included in this review: of which 12 were included in the 1-year outcome meta-analysis. Pooled analysis showed : 7.0% mortality; 16.0% syncope recurrence requiring hospitalization; 6.0% with device insertion. 1-year arrhythmias reported in two studies were 1.1 and 26.4%. Pooled analysis for outcome at 31 to 365 days showed: 5.0% mortality and 1% device insertion. Two studies reported 4.9% and 21% mortality at 30 months and 4.2 years follow-up. CONCLUSIONS An important proportion of ED syncope patients suffer long-term morbidity and mortality. Appropriate follow-up is needed and future research to identify patients at risk is needed.
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Margulescu AD, Anderson MH. A Review of Driving Restrictions in Patients at Risk of Syncope and Cardiac Arrhythmias Associated with Sudden Incapacity: Differing Global Approaches to Regulation and Risk. Arrhythm Electrophysiol Rev 2019; 8:90-98. [PMID: 31114682 PMCID: PMC6528027 DOI: 10.15420/aer.2019.13.2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The ability to drive is a highly valued freedom in the developed world. Sudden incapacitation while driving can result in injury or death for the driver and passengers or bystanders. Cardiovascular conditions are a primary cause for sudden incapacitation and regulations have long existed to restrict driving for patients with cardiac conditions at high risk of sudden incapacitation. Significant variation occurs between these rules in different countries and legislatures. Quantification of the potential risk of harm associated with various categories of drivers has attempted to make these regulations more objective. The assumptions on which these calculations are based are now old and less likely to reflect the reality of modern driving. Ultimately, a more individual assessment of risk with a combined assessment of the medical condition and the patient's driving behaviour may be appropriate. The development of driverless technologies may also have an impact on decision making in this field.
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Affiliation(s)
- Andrei D Margulescu
- Morriston Cardiac Centre, Department of Cardiology, Morriston Hospital NHS Trust Swansea, UK
| | - Mark H Anderson
- Morriston Cardiac Centre, Department of Cardiology, Morriston Hospital NHS Trust Swansea, UK
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18
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Abazid RM, Almeman A, Sakr H, Eldesoky AF, Eissa HM, Alharbi TH, Altorbag AA, Smettei OA. Awareness of fitness to drive among cardiologists in Saudi Arabia. Saudi Med J 2019; 40:93-96. [PMID: 30617387 PMCID: PMC6452615 DOI: 10.15537/smj.2019.1.23595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives: To assess the perception and awareness of cardiologists in Saudi Arabia about medical fitness to drive in different cardiovascular diseases. Methods: The study is a cross-sectional survey-based study between June 2018 and July 2018. Cardiologists were asked to complete a self-administered questionnaire inquiring about awareness of driving fitness and educating patients regarding driving risks in specific cardiovascular conditions. Results: A total of 194 cardiologists completed the study survey; there were 30.4% consultants, 59.3% specialists, and 10.3% residents. Out of 195, 72% were aware of the existence of particular international driving regulations for cardiovascular diseases, whereas 28% were not aware. Although, no Saudi guidelines assessing fitness-to-drive are available, 11% of the participants claimed awareness of such regulations. Interestingly, we found that cardiologists had never or rarely educated their patients regarding the potential risks of driving: 49% in symptomatic angina, 47% when ejection fraction is ≤35%, 39% in symptomatic valvular diseases, 26% after cardioverter defibrillators implantation, and 23% after non-elective percutaneous coronary interventions. Conclusion: There is a lack of awareness among cardiologists in Saudi Arabia about international guidelines regarding medical driving fitness. This study highlights the necessity of formulating appropriate national driving regulations for cardiovascular diseases.
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Affiliation(s)
- Rami M Abazid
- Department of Cardiology, Prince Sultan Cardiac Center-Qassim, King Fahad Specialist Hospital, Qassim, Buraydah, Kingdom of Saudi Arabia. E-mail.
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Ricci F, Sutton R, Palermi S, Tana C, Renda G, Gallina S, Melander O, De Caterina R, Fedorowski A. Prognostic significance of noncardiac syncope in the general population: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2018; 29:1641-1647. [PMID: 30106212 DOI: 10.1111/jce.13715] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/04/2018] [Accepted: 08/07/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Cardiac syncope heralds significantly higher mortality compared with syncope due to noncardiac causes or unknown etiology, commonly considered a benign event. A few epidemiologic studies have examined the outcome of noncardiac/unexplained syncope comparing individuals with and without syncope, but with controversial results. We performed a systematic review and meta-analysis to clarify whether history of noncardiac/unexplained syncope is associated with increased all-cause mortality in the general population. METHODS AND RESULTS Our systematic review of the literature published between January 1, 1966, and March 31, 2018 sought prospective, observational, cohort studies reporting summary-level outcome data about all-cause mortality in subjects with history of noncardiac/unexplained syncope compared with syncope-free participants. Adjusted hazard ratios were pooled through inverse variance random-effect meta-analysis to compute the summary effect size. Meta-regression models were performed to explore the effect of age, cardiovascular risk factors, or other potential confounders on the measured effect size. We identified four studies including 287 382 individuals (51.6% men; age, 64 ± 12 years): 38 843 with history of noncardiac/unexplained syncope and 248 539 without history of syncope. The average follow-up was 4.4 years. History of noncardiac/unexplained syncope was associated with higher all-cause mortality (pooled adjusted hazard ratio = 1.13; 95% confidence interval, 1.05 to 1.23). Meta-regression analysis showed a stronger positive relationship proportional to aging and increasing prevalence of diabetes and hypertension. CONCLUSIONS This study-level meta-analysis showed that among older, diabetic and/or hypertensive individuals, history of noncardiac/unexplained syncope, even in the absence of an obvious cardiac etiology, is associated with higher all-cause mortality.
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Affiliation(s)
- Fabrizio Ricci
- Department of Neuroscience and Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, G. D'Annunzio University, Chieti, Italy.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Richard Sutton
- National Heart and Lung Institute, Imperial College, Hammersmith Hospital Campus, London, UK
| | - Stefano Palermi
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Cardiology, and Center of Excellence on Aging, CeSI-Met, G. D'Annunzio University, Chieti, Italy
| | - Claudio Tana
- Medicine Geriatric-Rehabilitation Department, Internal Medicine and Critical Subacute Care Unit, University Hospital of Parma, Parma, Italy
| | - Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Cardiology, and Center of Excellence on Aging, CeSI-Met, G. D'Annunzio University, Chieti, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Cardiology, and Center of Excellence on Aging, CeSI-Met, G. D'Annunzio University, Chieti, Italy
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Raffaele De Caterina
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Cardiology, and Center of Excellence on Aging, CeSI-Met, G. D'Annunzio University, Chieti, Italy
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden
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20
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Klein HH. [Syncope and fitness to drive]. Herzschrittmacherther Elektrophysiol 2018; 29:214-218. [PMID: 29766266 DOI: 10.1007/s00399-018-0565-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
Although medical students are rarely instructed in traffic medicine in Germany, they are obliged to inform their patients about their fitness to drive after having become a medical doctor. This article gives an overview on the fitness to drive for patients with syncope by referring to the driving license regulation and the current guidelines released by the department of traffic. The driving license regulation distinguishes between group 1 and group 2 drivers. Group 1 drivers drive vehicles with a total weight less than 3.5 t, whereas group 2 drivers drive vehicles with a total weight above 3.5 t or provide commercial passenger transport. Since patients with syncope may suffer from different serious illnesses, the first approach is to clarify the cause of syncope. If no treatable cause of syncope (e. g., pacemaker, aortic valve replacement) is found, drivers of group 1 are not fit to drive for 6 months after a second unexplained syncope, whereas in this situation, drivers of group 2 are not fit to drive permanently. If, however, syncopes occur in conditions which cannot be expected to occur while driving (e. g. venipuncture, defecation, micturition) fitness to drive will persist. Syncope due to ventricular tachycardia in ischemic heart disease and reduced left ventricular ejection fraction are in general treated with an implantable cardioverter-defibrillator (ICD). Group 2 drivers with an ICD are normally unfit to drive. Group 1 drivers with an ICD are fit to drive when no syncope or adequate shock occurred within the last three months.
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Affiliation(s)
- Hermann H Klein
- Helios Klinikum Warburg, Langwiesenstr. 13, 55743, Idar-Oberstein, Deutschland.
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Sado J, Kiyohara K, Hayashida S, Matsuyama T, Katayama Y, Hirose T, Kiguchi T, Nishiyama C, Iwami T, Kitamura Y, Sobue T, Kitamura T. Characteristics and Outcomes of Out-of-Hospital Cardiac Arrest Occurring While in a Motor Vehicle. Am J Cardiol 2018; 121:1387-1392. [PMID: 29605079 DOI: 10.1016/j.amjcard.2018.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/01/2018] [Accepted: 02/08/2018] [Indexed: 11/28/2022]
Abstract
This study aimed to investigate the incidence, patient characteristics, and outcomes of out-of-hospital cardiac arrest (OHCA) occurring while in a motor vehicle in Osaka City, Japan (with a population of 2.6 million), from 2009 to 2015. The OHCA data used in this study were obtained from the population-based Utstein-style registry in Osaka City. Patients who had OHCA occurring while in a motor vehicle were included. The primary end point was 1-month survival with favorable neurologic outcome after OHCA. During the study period, 18,458 OHCAs were observed, and 264 of them (1.4%) occurred while on or in a motor vehicle (drivers, n = 179; nondrivers, n = 85). The overall incidence rate of OHCAs occurring while in a motor vehicle was 14.0 per million population per year (drivers, 9.5; nondrivers, 4.5). In the drivers with OHCAs, 78 (43.6%) and 101 (56.4%) cases were of medical origin and traffic injuries, respectively. Approximately half of OHCAs with a medical origin in drivers presumably occurred while driving (46.2%, 36 of 78). The overall proportion of 1-month survival with favorable neurologic outcome after OHCA was 6.4% (17 of 264). In the drivers, the proportion of OHCAs with a medical origin and because of traffic injuries were 11.5% (9 of 78) and 2.0% (2 of 101) (p = 0.008), respectively. In conclusion, although OHCAs occurring while in a motor vehicle represented a small subset of the overall OHCA burden, a relatively large number of cardiac arrests with a medical origin occurred in drivers.
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Affiliation(s)
- Junya Sado
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kosuke Kiyohara
- Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan; Emergency and Critical Medical Center, Osaka Police Hospital, Osaka, Japan
| | | | - Chika Nishiyama
- Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science, Kyoto, Japan
| | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
| | - Yuri Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.
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Sumiyoshi M. Driving restrictions for patients with reflex syncope. J Arrhythm 2017; 33:590-593. [PMID: 29255506 PMCID: PMC5728707 DOI: 10.1016/j.joa.2017.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/17/2017] [Accepted: 03/30/2017] [Indexed: 11/17/2022] Open
Abstract
Reflex syncope is the most common form of syncope that occurs while driving. The 2014 revision of Japanese Road Traffic Laws placed stricter driving restrictions, along with some associated legal penalties, on individuals with recurrent syncope. "Recurrent syncope" is defined as the occurrence of more than two episodes of syncope over a period of 5 years. No restrictions are recommended for private drivers unless they experience syncope without a reliable prodrome while driving or sitting. For commercial drivers, a driving restriction is recommended unless the efficacy of treatment can be confirmed. The "risk of harm" (RH) to other road users appears to be particularly high when commercial driving is involved. The RH formula is calculated using the time of driving, the type of vehicle driven, the risk of sudden cardiac incapacitation, and the probability of a fatal or injury-producing accident. Reducing the driving time or driving a lighter vehicle can reduce the RH. Physicians should talk to their patients about driving and advise their high-risk patients to refrain from driving.
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Affiliation(s)
- Masataka Sumiyoshi
- Department of Cardiology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-9521, Japan
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H. Klein H, Sechtem U, Trappe HJ. Fitness to Drive in Cardiovascular Disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:692-702. [PMID: 29082864 PMCID: PMC5672600 DOI: 10.3238/arztebl.2017.0692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 02/22/2017] [Accepted: 08/02/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Medical students are taught little or nothing about the medical considerations related to the driving of motor vehicles. Physicians treating patients with cardiovascular disease need to acquire competence in traffic medicine in order to be able to advise them about their fitness to drive. METHODS We present the current governmental regulations and recommendations concerning fitness to drive in patients with cardiovascular disease. We also review pertinent publications that were retrieved by a selective search in PubMed with the search terms "cardiovascular disease and traffic accidents" and "cardiovascular disease and traffic deaths" for the decade 2007-2016, as well as further publications collected by us individually. RESULTS Cardiovascular disease can make a driver lose control of a vehicle without warning and thereby lead to an accident. The main pathophysiological mechanisms of sudden loss of control are disturbances of brain perfusion (e.g., syncope with or without cardiac arrhythmia, sudden cardiac death due to ventricular fibrillation or asystole, stroke, aneurysm rupture) and marked general weakness (e.g., after major surgery or in cardiac insufficiency). CONCLUSION Patients with cardiovascular disease should be advised by their physicians about their fitness to drive, and the discussion should be documented in writing. Because of the German law on the confidentiality of medical data, only the affected patient should receive this information, with very few exceptions.
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Affiliation(s)
| | - Udo Sechtem
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart
| | - Hans-Joachim Trappe
- Medical Clinic II—Cardiology and Angiology, Marienhospital Herne, Ruhr University Bochum
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Juraschek SP, Daya N, Rawlings AM, Appel LJ, Miller ER, Windham BG, Griswold ME, Heiss G, Selvin E. Association of History of Dizziness and Long-term Adverse Outcomes With Early vs Later Orthostatic Hypotension Assessment Times in Middle-aged Adults. JAMA Intern Med 2017; 177:1316-1323. [PMID: 28738139 PMCID: PMC5661881 DOI: 10.1001/jamainternmed.2017.2937] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Guidelines recommend assessing orthostatic hypotension (OH) 3 minutes after rising from supine to standing positions. It is not known whether measurements performed immediately after standing predict adverse events as strongly as measurements performed closer to 3 minutes. OBJECTIVE To compare early vs later OH measurements and their association with history of dizziness and longitudinal adverse outcomes. DESIGN, SETTING, AND PARTICIPANTS This was a prospective cohort study of middle-aged (range, 44-66 years) participants in the Atherosclerosis Risk in Communities Study (1987-1989). EXPOSURES Orthostatic hypotension, defined as a drop in blood pressure (BP) (systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg) from the supine to standing position, was measured up to 5 times at 25-second intervals. MAIN OUTCOMES AND MEASURES We determined the association of each of the 5 OH measurements with history of dizziness on standing (logistic regression) and risk of fall, fracture, syncope, motor vehicle crashes, and all-cause mortality (Cox regression) over a median of 23 years of follow-up (through December 31, 2013). RESULTS In 11 429 participants (mean age, 54 years; 6220 [54%] were women; 2934 [26%] were black) with at least 4 OH measurements after standing, after adjustment OH assessed at measurement 1 (mean [SD], 28 [5.4] seconds; range, 21-62 seconds) was the only measurement associated with higher odds of dizziness (odds ratio [OR], 1.49; 95% CI, 1.18-1.89). Measurement 1 was associated with the highest rates of fracture, syncope, and death at 18.9, 17.0, and 31.4 per 1000 person-years. Measurement 2 was associated with the highest rate of falls and motor vehicle crashes at 13.2 and 2.5 per 1000 person-years. Furthermore, after adjustment measurement 1 was significantly associated with risk of fall (hazard ratio [HR], 1.22; 95% CI, 1.03-1.44), fracture (HR, 1.16; 95% CI, 1.01-1.34), syncope (HR, 1.40; 95% CI, 1.20-1.63), and mortality (HR, 1.36; 95% CI, 1.23-1.51). Measurement 2 (mean [SD], 53 [7.5] seconds; range, 43-83 seconds) was associated with all long-term outcomes, including motor vehicle crashes (HR, 1.43; 95% CI, 1.04-1.96). Measurements obtained after 1 minute were not associated with dizziness and were inconsistently associated with individual long-term outcomes. CONCLUSIONS AND RELEVANCE In contrast with prevailing recommendations, OH measurements performed within 1 minute of standing were the most strongly related to dizziness and individual adverse outcomes, suggesting that OH be assessed within 1 minute of standing.
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Affiliation(s)
- Stephen P Juraschek
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,The Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Natalie Daya
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,The Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Andreea M Rawlings
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,The Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Lawrence J Appel
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,The Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Edgar R Miller
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,The Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - B Gwen Windham
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Michael E Griswold
- Department of Medicine, University of Mississippi Medical Center, Jackson.,Center of Biostatistics, University of Mississippi Medical Center, Jackson
| | - Gerardo Heiss
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Elizabeth Selvin
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,The Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Johns Hopkins Medical Institutions, Baltimore, Maryland
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Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2017; 136:e60-e122. [DOI: 10.1161/cir.0000000000000499] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Win-Kuang Shen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | | | - David G. Benditt
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Mitchell I. Cohen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Daniel E. Forman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Zachary D. Goldberger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Blair P. Grubb
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Mohamed H. Hamdan
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Andrew D. Krahn
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Mark S. Link
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Brian Olshansky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Satish R. Raj
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Roopinder Kaur Sandhu
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Dan Sorajja
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Benjamin C. Sun
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Clyde W. Yancy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
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Numé AK, Kragholm K, Carlson N, Kristensen SL, Bøggild H, Hlatky MA, Torp-Pedersen C, Gislason G, Ruwald MH. Syncope and Its Impact on Occupational Accidents and Employment. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003202. [DOI: 10.1161/circoutcomes.116.003202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 03/07/2017] [Indexed: 11/16/2022]
Abstract
Background—
First-time syncopal episodes usually occur in adults of working age, but their impact on occupational safety and employment remains unknown. We examined the associations of syncope with occupational accidents and termination of employment.
Methods and Results—
Through linkage of Danish population-based registers, we included all residents 18 to 64 years from 2008 to 2012. Among 3 410 148 eligible individuals, 21 729 with a first-time diagnosis of syncope were identified, with a median age 48.4 years (first to third quartiles, 33.0–59.5), and 10 757 (49.5%) employed at time of the syncope event. Over a median follow-up of 3.2 years (first to third quartiles, 2.0–4.5), 622 people with syncope had an occupational accident requiring hospitalization (2.1/100 person-years). In multiple Poisson regression analysis, the incidence rate ratio in the employed syncope population was higher than in the employed general population (1.44; 95% confidence interval [CI], 1.33–1.55) and more pronounced in people with recurrences (2.02; 95% CI, 1.47–2.78). The 2-year risk of termination of employment was 31.3% (95% CI, 30.4%–32.3%), which was twice the risk of the reference population (15.2%; 95% CI, 14.7%–15.7%), using the Aalen–Johansen estimator. Factors associated with termination of employment were age <40 years (incidence rate ratio, 1.48; 95% CI, 1.37–1.59), cardiovascular disease (1.20; 95% CI, 1.06–1.36), depression (1.72; 95% CI, 1.55–1.90), and low educational level (2.61; 95% CI, 2.34–2.91).
Conclusions—
In this nationwide cohort, syncope was associated with a 1.4-fold higher risk of occupational accidents and a 2-fold higher risk of termination of employment compared with the employed general population.
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Affiliation(s)
- Anna-Karin Numé
- From the Department of Cardiology (A.N., N.C., S.L.K., G.G., M.H.R.) and Department of Nephrology (N.C.), Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark; the Departments of Cardiology and Clinical Epidemiology, Aalborg University Hospital, Denmark (K.K., H.B., C.T.-P.); the Department of Health Research and Policy (M.A.H.) and Department of Medicine (M.A.H.), Stanford University School of Medicine, CA; The National Institute of Public Health, University of Southern Denmark,
| | - Kristian Kragholm
- From the Department of Cardiology (A.N., N.C., S.L.K., G.G., M.H.R.) and Department of Nephrology (N.C.), Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark; the Departments of Cardiology and Clinical Epidemiology, Aalborg University Hospital, Denmark (K.K., H.B., C.T.-P.); the Department of Health Research and Policy (M.A.H.) and Department of Medicine (M.A.H.), Stanford University School of Medicine, CA; The National Institute of Public Health, University of Southern Denmark,
| | - Nicolas Carlson
- From the Department of Cardiology (A.N., N.C., S.L.K., G.G., M.H.R.) and Department of Nephrology (N.C.), Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark; the Departments of Cardiology and Clinical Epidemiology, Aalborg University Hospital, Denmark (K.K., H.B., C.T.-P.); the Department of Health Research and Policy (M.A.H.) and Department of Medicine (M.A.H.), Stanford University School of Medicine, CA; The National Institute of Public Health, University of Southern Denmark,
| | - Søren L. Kristensen
- From the Department of Cardiology (A.N., N.C., S.L.K., G.G., M.H.R.) and Department of Nephrology (N.C.), Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark; the Departments of Cardiology and Clinical Epidemiology, Aalborg University Hospital, Denmark (K.K., H.B., C.T.-P.); the Department of Health Research and Policy (M.A.H.) and Department of Medicine (M.A.H.), Stanford University School of Medicine, CA; The National Institute of Public Health, University of Southern Denmark,
| | - Henrik Bøggild
- From the Department of Cardiology (A.N., N.C., S.L.K., G.G., M.H.R.) and Department of Nephrology (N.C.), Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark; the Departments of Cardiology and Clinical Epidemiology, Aalborg University Hospital, Denmark (K.K., H.B., C.T.-P.); the Department of Health Research and Policy (M.A.H.) and Department of Medicine (M.A.H.), Stanford University School of Medicine, CA; The National Institute of Public Health, University of Southern Denmark,
| | - Mark A. Hlatky
- From the Department of Cardiology (A.N., N.C., S.L.K., G.G., M.H.R.) and Department of Nephrology (N.C.), Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark; the Departments of Cardiology and Clinical Epidemiology, Aalborg University Hospital, Denmark (K.K., H.B., C.T.-P.); the Department of Health Research and Policy (M.A.H.) and Department of Medicine (M.A.H.), Stanford University School of Medicine, CA; The National Institute of Public Health, University of Southern Denmark,
| | - Christian Torp-Pedersen
- From the Department of Cardiology (A.N., N.C., S.L.K., G.G., M.H.R.) and Department of Nephrology (N.C.), Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark; the Departments of Cardiology and Clinical Epidemiology, Aalborg University Hospital, Denmark (K.K., H.B., C.T.-P.); the Department of Health Research and Policy (M.A.H.) and Department of Medicine (M.A.H.), Stanford University School of Medicine, CA; The National Institute of Public Health, University of Southern Denmark,
| | - Gunnar Gislason
- From the Department of Cardiology (A.N., N.C., S.L.K., G.G., M.H.R.) and Department of Nephrology (N.C.), Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark; the Departments of Cardiology and Clinical Epidemiology, Aalborg University Hospital, Denmark (K.K., H.B., C.T.-P.); the Department of Health Research and Policy (M.A.H.) and Department of Medicine (M.A.H.), Stanford University School of Medicine, CA; The National Institute of Public Health, University of Southern Denmark,
| | - Martin H. Ruwald
- From the Department of Cardiology (A.N., N.C., S.L.K., G.G., M.H.R.) and Department of Nephrology (N.C.), Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark; the Departments of Cardiology and Clinical Epidemiology, Aalborg University Hospital, Denmark (K.K., H.B., C.T.-P.); the Department of Health Research and Policy (M.A.H.) and Department of Medicine (M.A.H.), Stanford University School of Medicine, CA; The National Institute of Public Health, University of Southern Denmark,
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Ali NJ, Grossman SA. Geriatric Syncope and Cardiovascular Risk in the Emergency Department. J Emerg Med 2017; 52:438-448.e3. [DOI: 10.1016/j.jemermed.2016.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/27/2016] [Accepted: 12/02/2016] [Indexed: 11/16/2022]
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Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 2017; 14:e155-e217. [PMID: 28286247 DOI: 10.1016/j.hrthm.2017.03.004] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Indexed: 12/26/2022]
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Silva M, Godinho A, Freitas J. Transient loss of consciousness assessment in a University Hospital: From diagnosis to prognosis. Porto Biomed J 2016; 1:118-123. [PMID: 32258560 DOI: 10.1016/j.pbj.2016.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 07/01/2016] [Indexed: 12/18/2022] Open
Abstract
Background Transient loss of consciousness (TLoC) is a symptom that has several differential etiologic diagnosis, causes significant morbidity and mortality with impact on quality of life. Objective The purpose of this study was to access the diagnosis and prognosis of these patients admitted in a Portuguese University Hospital. Methods The study included 125 patients with TLoC admitted in the emergency room and then admitted to the hospital during the year 2013. Patients were contacted by phone for follow-up evaluations, during the 18 months from the date of admission. Results Cardiogenic syncope was the most common etiology of TLoC (39.2%). The 18-month overall mortality was 11.2%, however this was higher in patients with unexplained TLoC, with an 18-month mortality of 27.8% (p = 0.031); It was found that half of patients who died, did so in the first month from admission date; 20% of patients had recurrent episodes of TLoC (mean number of 5.6 episodes), with a higher percentage of recurrence occurring in patients with reflex syncope (35.3%; p = 0.023). 60% of patients with recurrent episodes suffered accidents and/or injuries, and 20% of recurrence patients gave up driving (p = 0.019). Conclusion The results obtained highlight the burden of TLoC in terms of morbidity and mortality, similar results to those previously published, except for the prevalence of the etiology, cause of death and recurrence's etiology of TLoC. This study emphasizes the significant implications that TLoC leads on morbidity and mortality being essential its accurate diagnosis.
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Affiliation(s)
- Mariana Silva
- Universidade do Porto, Faculdade de Medicina, Porto, Portugal
| | - Ana Godinho
- Centro Hospitalar São João, Cardiologia, Porto, Portugal
| | - João Freitas
- Universidade do Porto, Faculdade de Medicina, Porto, Portugal.,Centro Hospitalar São João, Cardiologia, Porto, Portugal
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[Not Available]. MMW Fortschr Med 2016; 158:3. [PMID: 28924825 DOI: 10.1007/s15006-016-7895-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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