Abstract 11857: Polypharmacy is Associated With Increased Long Term Risk of Recurrent Syncope
Background Recurrent syncope is a public health problem, and the association with polypharmacy is not fully elucidated.
Objective To examine the relationship between the sum of medications and the subsequent risk of recurrent syncope in a nationwide cohort of patients with a first-time diagnosis of syncope Methods Patients hospitalized with syncope in Denmark from 1997-2009 and their medication and comorbidity were identified in nationwide administrative registers. The risk of recurrent syncope and association with polypharmacy were analyzed using multivariable Cox proportional-hazard regression and competing risk models. Medications known to cause orthostatic hypotension and potentially malignant cardiac arrhythmias were investigated.
Results We identified 127,508 patients with syncope; median age 64 years (IQR: 46-78) and 47% males. A total of 28,686 (22.5%) had at least one recurrent episode yielding an overall event rate of 51 per 1000 person-years. The multivariable Cox regression analysis demonstrated significantly increased risk of recurrent syncope according to the level of polypharmacy: Compared to zero medication, one medication (HR=1.16 [CI: 1.16-1.20]), two medications (HR=1.20 [CI: 1.14-1.26], and three or more medications (HR=1.32 [CI: 1.24-1.40]). Event rates were 58, 67 and 82 per 1000 person-years in the three groups, respectively compared to an event rate of 37 per 1000 person-years when no medications were taken. The 10-year cumulative incidence ranged from 24% to 36%.
Conclusion Recurrent syncope is a very frequent event and is significantly associated with the number of medications taken simultaneously. Medication revision strategies to reduce recurrent syncope might have long-term benefits in these patients.
- © 2012 by American Heart Association, Inc.