{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:42:12Z","timestamp":1753875732442,"version":"3.41.2"},"reference-count":78,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T00:00:00Z","timestamp":1744243200000},"content-version":"vor","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In older syncope patients, medical histories are often less reliable due to retrograde amnesia and cognitive impairment. Therefore, additional tests may be needed to reach a diagnosis. We conducted a systematic review to evaluate positivity rates and safety of head-up tilt testing (HUTT) in these patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We searched Medline and Embase for HUTT positivity rates and diagnoses in older syncope patients (mean age\u2009\u2265\u200965\u00a0years) vs. younger patients. Secondary outcomes were time to syncope (TtS) and adverse events (AEs). Risk of bias was assessed with a modified version of the QUADAS-2.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In total, 42 studies were included, with 12\u00a0378 older participants in total. Positivity rates varied widely [passive HUTT 0.0%\u201390.0%; isoproterenol (IPR)-HUTT 18.3%\u201364.0%; nitroglycerin-HUTT 30.1%\u201390.5%]. The majority of studies found no differences between older and younger patients. Specificity was high for all HUTT-protocols (85.5%\u2013100%). TtS did not differ between older and younger patients, but was significantly longer in control subjects. Nitroglycerin-HUTT yielded the most diagnoses (median 64.2% vs. 23.7% for passive, P\u2009=\u2009.007, and 44.8% for IPR-HUTT, n.s.). Vasodepressive responses were more common than cardioinhibitory responses (median 54.9% vs. 9.1%) in older patients. AEs occurred in &amp;lt;6% of patients with passive\/nitroglycerin-HUTT.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion\/conclusion<\/jats:title>\n                  <jats:p>There is no consistent evidence that HUTT results differ between older and younger syncope patients. Nitroglycerin-HUTT yields the most diagnoses, whilst retaining a high specificity, and is safe to perform in older patients. Future studies should focus on the additional value of HUTT on top of the initial evaluation in these patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ageing\/afaf086","type":"journal-article","created":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T08:00:10Z","timestamp":1744272010000},"source":"Crossref","is-referenced-by-count":0,"title":["Head-up tilt testing in older syncope patients: a systematic review"],"prefix":"10.1093","volume":"54","author":[{"given":"Susanne C","family":"de Ruiter","sequence":"first","affiliation":[{"name":"Geriatric Medicine, North West Hospital Group , Alkmaar ,","place":["Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rob J","family":"van Marum","sequence":"additional","affiliation":[{"name":"General Medicine and Geriatric Medicine, Amsterdam University Medical Center De Boelelaan Site , Amsterdam ,","place":["Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaap H","family":"Ruiter","sequence":"additional","affiliation":[{"name":"Cardiology, North West Hospital Group , Alkmaar ,","place":["Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin E W","family":"Hemels","sequence":"additional","affiliation":[{"name":"Cardiology, Hospital Rijnstate Arnhem , Arnhem ,","place":["Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joris R","family":"de Groot","sequence":"additional","affiliation":[{"name":"Cardiology, Amsterdam University Medical Center , Amsterdam ,","place":["Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ren\u00e9 W M M","family":"Jansen","sequence":"additional","affiliation":[{"name":"Geriatric Medicine, North West Hospital Group , Alkmaar ,","place":["Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,4,10]]},"reference":[{"key":"2025041007595785900_ref1","doi-asserted-by":"publisher","first-page":"1883","DOI":"10.1093\/eurheartj\/ehy037","article-title":"2018 ESC guidelines for the diagnosis and management of syncope","volume":"39","author":"Brignole","year":"2018","journal-title":"Eur Heart J"},{"key":"2025041007595785900_ref2","doi-asserted-by":"publisher","first-page":"1506","DOI":"10.1093\/europace\/eus154","article-title":"The relation between age, sex, comorbidity, and pharmacotherapy and the risk of syncope: a Danish nationwide study","volume":"14","author":"Ruwald","year":"2012","journal-title":"Europace"},{"key":"2025041007595785900_ref3","doi-asserted-by":"publisher","first-page":"1870","DOI":"10.1093\/eurheartj\/ehy210","article-title":"Practical instructions for the 2018 ESC guidelines for the diagnosis and management of syncope","volume":"39","author":"Brignole","year":"2018","journal-title":"Eur Heart J"},{"key":"2025041007595785900_ref4","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1053\/eupc.1999.0064","article-title":"New classification of haemodynamics of vasovagal syncope: beyond the VASIS classification. 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