Original articles
The relationship between health-related quality of life and frequency of spells in patients with syncope

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Abstract

Chronic syncope has a wide range of symptom burden, and anecdotal data suggest substantial but variable physical and psychosocial morbidity. We hypothesized that health-related quality of life (HRQL) is impaired in syncope patients and the degree of impairment is proportional to syncope frequency. The EuroQol EQ-5D was completed by 136 patients (79 female and 57 male) with mean age 40 (SD = 17) prior to assessment. HRQL was substantially impaired in syncope patients compared to population norms in all five dimensions of health measured by the EQ-5D. In patients with six or more lifetime syncopal spells there was a significant (P < 0.001) negative relationship between the frequency of spells and overall perception of health, which was not evident in those who had a history of less than six lifetime spells. These relationships were maintained after controlling for comorbid conditions.

Introduction

Recurrent syncope can have a substantial impact on a patient's life. Although previous studies have shown that patients with syncope have no increased risk of early mortality [1] or sudden death 2, 3, the severity of the impact of syncope ranges from inconvenience and embarrassment to restrictions on driving and the use of heavy machinery, which may in turn result in an inability to work. The measurement of health-related quality of life (HRQL) provides a vehicle with which we can systematically measure the impact of disease on day-to-day living. Results from an earlier study have suggested that physical and psychosocial impairment in patients with syncope is similar to that reported by patients with other chronic diseases 4, 5. We designed this study to measure HRQL in patients with syncope and to examine the relationship between HRQL and symptom burden. We hypothesized that HRQL is impaired in patients with syncope compared to general population norms, and that the degree of impairment is related to the frequency of syncopal spells. We also investigated which specific concepts of health contribute to overall perceptions of health and well-being in patients with syncope.

Section snippets

Patient population

We employed a cross-sectional study design of all patients presenting sequentially to the syncope clinic for initial assessment and tilt table testing who had no other identified cause of syncope (such as complete heart block or ventricular tachycardia). The sample consisted of 145 patients. Patients underwent tilt table testing if they had: 1) two or more lifetime syncopal episodes, or 2) one syncopal episode and four presyncopal episodes, or 3) one syncopal episode causing serious injury. No

Patient characteristics

The sample consisted of 136 (79 female and 57 male) patients with mean age of 40 years (SD = 17). Patient characteristics are presented in Table 2 for the group as a whole and stratified according to recurrent syncope risk group (high vs. low 1-year risk of recurrent syncope). The distribution of all three measures of symptom burden were highly skewed and therefore described using the geometric mean with 95% confidence interval. Patients in the high recurrent syncope risk group had a frequency

Discussion

The primary finding of this study is that HRQL is linearly associated with the log frequency of syncopal spells, but only in patients with six or more lifetime spells. Our initial analysis described a curvilinear relationship between the frequency of syncopal spells and HRQL. Subsequent analysis, however, indicated that the apparent curvilinear relationship was the result of a highly significant negative linear relationship between the frequency of syncopal spells and HRQL for patients in the

Acknowledgements

Supported in part by a grant from the Medical Research Council of Canada, Ottawa, Canada (PG11188) to R.S.

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