Do Medications Increase the Risk in Elderly Patients for Hospitalizations Due to Syncope? A Case Controlled Study.

Abstract

Abstract INTRODUCTION In the elderly, syncope, a form of temporary loss of consciousness with no focal neurologic deficits is common. The association with drug therapy however is uncertain. In fact, we are unaware of previous studies demonstrating such a relationship, except to show that potentially inappropriate drug use is common in patients with syncope and falls. METHODS: In the following study, we selected elderly patients (65–85 years old) hospitalized because of a syncopal episode. They will be matched according to hospitalization date to other elderly hospitalized patients with other admission diagnoses. The major predictor variable is admission drug therapy, focusing on benzodiazepines and diuretics, but will consider other drug groups such as other hypertensive drugs, antipsychotics, and antihypertensives. Secondary predictors will include age, gender, presence of dementia, ability to walk freely, hypotensive blood pressure (SBP ≤ 100 mmHg) on admission, and laboratory tests that determine if the patient had a hemoglobin < 10 g/L, a BUN ≥ 30 mg/dL, a serum potassium < 3.5 meq/L or a serum sodium < 135 meq/L. RESULTS: Both on univariate and multivariate analysis (odds ratio, 95% confidence intervals) only psychiatric drugs (1.91, 1.31–2.77) were associated with syncope. Walking freely was a risk factor and polypharmacy and an elevated blood urea nitrogen were negatively associated with syncope. The model was poor with a c-statistic of only 0.645(0.606–0.682). The results were the same if we included only those with vasovagal and orthostatic syncope. CONCLUSIONS: Our findings support the association between psychiatric drugs and the risk of syncope.