{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T02:21:09Z","timestamp":1793845269930,"version":"4.6.1"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"22","license":[{"start":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T00:00:00Z","timestamp":1644364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Sk\u00e5ne Sweden","award":["2020-0280"],"award-info":[{"award-number":["2020-0280"]}]},{"DOI":"10.13039\/501100003173","name":"Crafoord Foundation","doi-asserted-by":"crossref","award":["20190006"],"award-info":[{"award-number":["20190006"]}],"id":[{"id":"10.13039\/501100003173","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Swedish Heart and Lung Foundation","award":["20190383"],"award-info":[{"award-number":["20190383"]}]},{"name":"ALF","award":["46701"],"award-info":[{"award-number":["46701"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,6,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Unexplained syncope is an important clinical challenge. The influence of age at first syncope on the final syncope diagnosis is not well studied.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Consecutive head-up tilt patients (n\u2009=\u20091928) evaluated for unexplained syncope were stratified into age groups &amp;lt;30, 30\u201359, and \u226560 years based on age at first syncope. Clinical characteristics and final syncope diagnosis were analysed in relation to age at first syncope and age at investigation. The age at first syncope had a bimodal distribution with peaks at 15 and 70 years. Prodromes (64 vs. 26%, P\u2009&amp;lt;\u20090.001) and vasovagal syncope (VVS, 59 vs. 19%, P\u2009&amp;lt;\u20090.001) were more common in early-onset (&amp;lt;30 years) compared with late-onset (\u226560 years) syncope. Orthostatic hypotension (OH, 3 vs. 23%, P\u2009&amp;lt;\u20090.001), carotid sinus syndrome (CSS, 0.6 vs. 9%, P\u2009&amp;lt;\u20090.001), and complex syncope (&amp;gt;1 concurrent diagnosis; 14 vs. 26%, P\u2009&amp;lt;\u20090.001) were more common in late-onset syncope. In patients aged \u226560 years, 12% had early-onset and 70% had late-onset syncope; older age at first syncope was associated with higher odds of OH (+31% per 10-year increase, P\u2009&amp;lt;\u20090.001) and CSS (+26%, P\u2009=\u20090.004). Younger age at first syncope was associated with the presence of prodromes (+23%, P\u2009&amp;lt;\u20090.001) and the diagnoses of VVS (+22%, P\u2009&amp;lt;\u20090.001) and complex syncope (+9%, P\u2009=\u20090.018).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In patients with unexplained syncope, first-ever syncope incidence has a bimodal lifetime pattern with peaks at 15 and 70 years. The majority of older patients present only recent syncope; OH and CSS are more common in this group. In patients with early-onset syncope, prodromes, VVS, and complex syncope are more common.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehac017","type":"journal-article","created":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T20:12:01Z","timestamp":1642018321000},"page":"2116-2123","source":"Crossref","is-referenced-by-count":44,"title":["Early and late-onset syncope: insight into mechanisms"],"prefix":"10.1093","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4324-5844","authenticated-orcid":false,"given":"Parisa","family":"Torabi","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences, Lund University , Malm\u00f6 , Sweden"},{"name":"Department of Clinical Physiology, Sk\u00e5ne University Hospital , Malm\u00f6 , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2736-2242","authenticated-orcid":false,"given":"Giulia","family":"Rivasi","sequence":"additional","affiliation":[{"name":"Syncope Unit, Division of Geriatrics and Intensive Care Unit, University of Florence and Careggi Hospital , Florence , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8475-0866","authenticated-orcid":false,"given":"Viktor","family":"Hamrefors","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Lund University , Malm\u00f6 , Sweden"},{"name":"Department of Internal Medicine, Sk\u00e5ne University Hospital , Malm\u00f6 , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Ungar","sequence":"additional","affiliation":[{"name":"Syncope Unit, Division of Geriatrics and Intensive Care Unit, University of Florence and Careggi Hospital , Florence , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5710-1094","authenticated-orcid":false,"given":"Richard","family":"Sutton","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Lund University , Malm\u00f6 , Sweden"},{"name":"National Heart and Lung Institute, Imperial College, Hammersmith Hospital Campus , Du Cane Road, London W12 0HS , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1845-5607","authenticated-orcid":false,"given":"Michele","family":"Brignole","sequence":"additional","affiliation":[{"name":"IRCCS Istituto Auxologico Italiano, Faint & Fall Programme, Ospedale San Luca , Milano , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5352-6327","authenticated-orcid":false,"given":"Artur","family":"Fedorowski","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Lund University , Malm\u00f6 , Sweden"},{"name":"Department of Cardiology, Karolinska University Hospital , Stockholm , Sweden"},{"name":"Department of Medicine, Karolinska Institute , Stockholm , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,2,9]]},"reference":[{"key":"2022102517144649500_ehac017-B1","doi-asserted-by":"crossref","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":"2022102517144649500_ehac017-B2","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1016\/S0002-9149(03)00127-9","article-title":"Prevalence and triggers of syncope in medical students","volume":"91","author":"Ganzeboom","year":"2003","journal-title":"Am J Cardiol"},{"key":"2022102517144649500_ehac017-B3","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1111\/j.1540-8167.2006.00595.x","article-title":"Lifetime cumulative incidence of syncope in the general population: a study of 549 Dutch subjects aged 35\u201360 years","volume":"17","author":"Ganzeboom","year":"2006","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2022102517144649500_ehac017-B4","first-page":"45","article-title":"Syncope in an elderly, institutionalised population: prevalence, incidence, and associated risk","volume":"55","author":"Lipsitz","year":"1985","journal-title":"QJM"},{"key":"2022102517144649500_ehac017-B5","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1093\/ageing\/afq039","article-title":"Vasovagal syncope in the older person: differences in presentation between older and younger patients","volume":"39","author":"Duncan","year":"2010","journal-title":"Age Ageing"},{"key":"2022102517144649500_ehac017-B6","doi-asserted-by":"crossref","first-page":"i9","DOI":"10.1007\/s10286-004-1003-3","article-title":"Epidemiology of reflex syncope","volume":"14","author":"Colman","year":"2004","journal-title":"Clin Auton Res"},{"key":"2022102517144649500_ehac017-B7","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.pcad.2012.11.006","article-title":"Epidemiology of syncope\/collapse in younger and older Western patient populations","volume":"55","author":"Kenny","year":"2013","journal-title":"Prog Cardiovasc Dis"},{"key":"2022102517144649500_ehac017-B8","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1093\/qjmed\/hcr032","article-title":"The changing face of orthostatic and neurocardiogenic syncope with age","volume":"104","author":"Cooke","year":"2011","journal-title":"QJM"},{"key":"2022102517144649500_ehac017-B9","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1056\/NEJMoa012407","article-title":"Incidence and prognosis of syncope","volume":"347","author":"Soteriades","year":"2002","journal-title":"N Engl J Med"},{"key":"2022102517144649500_ehac017-B10","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/j.jamda.2019.01.149","article-title":"Increasing prevalence of orthostatic hypotension as a cause of syncope with advancing age and multimorbidity","volume":"20","author":"Ceccofiglio","year":"2019","journal-title":"J Am Med Dir Assoc"},{"key":"2022102517144649500_ehac017-B11","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/j.jacc.2007.11.025","article-title":"Vasovagal syncope in the older patient","volume":"51","author":"Tan","year":"2008","journal-title":"J Am Coll Cardiol"},{"key":"2022102517144649500_ehac017-B12","first-page":"757","article-title":"Vasovagal syncope masquerading as unexplained falls in an elderly patient","volume":"18","author":"Parry","year":"2002","journal-title":"Can J Cardiol"},{"key":"2022102517144649500_ehac017-B13","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1136\/heartjnl-2017-311857","article-title":"Cardiovascular risk after hospitalisation for unexplained syncope and orthostatic hypotension","volume":"104","author":"Yasa","year":"2018","journal-title":"Heart"},{"key":"2022102517144649500_ehac017-B14","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1111\/j.1540-8167.2005.00267.x","article-title":"Age of first faint in patients with vasovagal syncope","volume":"17","author":"Sheldon","year":"2006","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2022102517144649500_ehac017-B15","doi-asserted-by":"crossref","first-page":"e0128962","DOI":"10.1371\/journal.pone.0128962","article-title":"Orthostatic changes in hemodynamics and cardiovascular biomarkers in dysautonomic patients","volume":"10","author":"Nilsson","year":"2015","journal-title":"PLoS One"},{"key":"2022102517144649500_ehac017-B16","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1111\/joim.12043","article-title":"Novel cardiovascular biomarkers in unexplained syncopal attacks: the SYSTEMA cohort","volume":"273","author":"Fedorowski","year":"2013","journal-title":"J Intern Med"},{"key":"2022102517144649500_ehac017-B17","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1053\/eupc.2000.0125","article-title":"\u2018The Italian Protocol\u2019: a simplified head-up tilt testing potentiated with oral nitroglycerin to assess patients with unexplained syncope","volume":"2","author":"Bartoletti","year":"2000","journal-title":"Europace"},{"key":"2022102517144649500_ehac017-B18","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1038\/ajh.2008.368","article-title":"Nexfin noninvasive continuous blood pressure validated against Riva-Rocci\/Korotkoff","volume":"22","author":"Schattenkerk","year":"2009","journal-title":"Am J Hypertens"},{"key":"2022102517144649500_ehac017-B19","doi-asserted-by":"crossref","first-page":"37","DOI":"10.3109\/03091909809009997","article-title":"Why use finapres or portapres rather than intra-arterial or intermittent non-invasive techniques of blood pressure measurement?","volume":"22","author":"Langewouters","year":"1998","journal-title":"J Med Eng Technol"},{"key":"2022102517144649500_ehac017-B20","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s10286-011-0119-5","article-title":"Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome","volume":"21","author":"Freeman","year":"2011","journal-title":"Clin Auton Res"},{"key":"2022102517144649500_ehac017-B21","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1007\/s10286-017-0424-8","article-title":"Delayed orthostatic hypotension and vasovagal syncope: a diagnostic dilemma","volume":"27","author":"Fedorowski","year":"2017","journal-title":"Clin Auton Res"},{"key":"2022102517144649500_ehac017-B22","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1212\/WNL.0b013e3182a1aa88","article-title":"The semiology of tilt-induced psychogenic pseudosyncope","volume":"81","author":"Tannemaat","year":"2013","journal-title":"Neurology"},{"key":"2022102517144649500_ehac017-B23","doi-asserted-by":"crossref","first-page":"28","DOI":"10.15420\/ecr.2014.9.1.28","article-title":"Syncope in the elderly","volume":"9","author":"O\u2019Brien","year":"2014","journal-title":"Eur Cardiol Rev"},{"key":"2022102517144649500_ehac017-B24","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.eupc.2003.09.003","article-title":"Clinical spectrum of neurally mediated reflex syncopes","volume":"6","author":"Alboni","year":"2004","journal-title":"Europace"},{"key":"2022102517144649500_ehac017-B25","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1053\/eupc.2001.0155","article-title":"Clinical characteristics of patients with vasovagal reactions presenting as unexplained syncope","volume":"3","author":"Graham","year":"2001","journal-title":"Europace"},{"key":"2022102517144649500_ehac017-B26","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1016\/j.amjcard.2005.07.047","article-title":"Relation of clinical presentation of syncope to the age of patients","volume":"96","author":"Del Rosso","year":"2005","journal-title":"Am J Cardiol"},{"key":"2022102517144649500_ehac017-B27","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1093\/europace\/eur069","article-title":"Amnesia for loss of consciousness is common in vasovagal syncope","volume":"13","author":"O\u2019Dwyer","year":"2011","journal-title":"Europace"},{"key":"2022102517144649500_ehac017-B28","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1016\/S0735-1097(97)00020-X","article-title":"Syncope in children and adolescents","volume":"29","author":"Driscoll","year":"1997","journal-title":"J Am Coll Cardiol"},{"key":"2022102517144649500_ehac017-B29","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1111\/jgs.15236","article-title":"Syncope, hypotension, and falls in the treatment of hypertension: results from the randomized clinical systolic blood pressure intervention trial","volume":"66","author":"Sink","year":"2018","journal-title":"J Am Geriatr Soc"},{"key":"2022102517144649500_ehac017-B30","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1001\/archinte.166.5.515","article-title":"Carotid sinus hypersensitivity in asymptomatic older persons: implications for diagnosis of syncope and falls","volume":"166","author":"Kerr","year":"2006","journal-title":"Arch Intern Med"},{"key":"2022102517144649500_ehac017-B31","first-page":"333","article-title":"Neuroautonomic evaluation of patients with unexplained syncope: incidence of complex neurally mediated diagnoses in the elderly","volume":"9","author":"Rafanelli","year":"2014","journal-title":"Clin Interv Aging"},{"key":"2022102517144649500_ehac017-B32","doi-asserted-by":"crossref","first-page":"414","DOI":"10.4065\/78.4.414","article-title":"Prevalence and clinical outcomes of patients with multiple potential causes of syncope","volume":"78","author":"Chen","year":"2003","journal-title":"Mayo Clin Proc"},{"key":"2022102517144649500_ehac017-B33","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1111\/j.1540-8159.2000.tb06757.x","article-title":"Frequency-domain analysis of heart rate variability during positive and negative head-up tilt test: importance of age","volume":"23","author":"Ruiz","year":"2000","journal-title":"Pacing Clin Electrophysiol"},{"key":"2022102517144649500_ehac017-B34","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1016\/S0002-9149(97)00613-9","article-title":"Effects of chronic vasodilator therapy to enhance susceptibility to vasovagal syncope during upright tilt testing","volume":"80","author":"Gaggioli","year":"1997","journal-title":"Am J Cardiol"},{"key":"2022102517144649500_ehac017-B35","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1093\/europace\/eux099","article-title":"Multiple causes of syncope in the elderly: diagnostic outcomes of a Dutch multidisciplinary syncope pathway","volume":"20","author":"de Ruiter","year":"2018","journal-title":"Europace"},{"key":"2022102517144649500_ehac017-B36","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1093\/europace\/euaa345","article-title":"Diagnostic yield and accuracy in a tertiary referral syncope unit validating the ESC guideline on syncope: a prospective cohort study","volume":"23","author":"de Jong","year":"2021","journal-title":"Europace"},{"key":"2022102517144649500_ehac017-B37","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/S0002-9343(01)00797-5","article-title":"Prospective evaluation of patients with syncope: a population-based study","volume":"111","author":"Sarasin","year":"2001","journal-title":"Am J Med"},{"key":"2022102517144649500_ehac017-B38","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1053\/euhj.1999.1910","article-title":"Diagnosing syncope in clinical practice. Implementation of a simplified diagnostic algorithm in a multicentre prospective trial\u2014the OESIL 2 Study (Osservatorio Epidemiologico della Sincope nel Lazio)","volume":"21","author":"Ammirati","year":"2000","journal-title":"Eur Heart J"}],"container-title":["European Heart Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurheartj\/article-pdf\/43\/22\/2116\/46629675\/ehac017.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurheartj\/article-pdf\/43\/22\/2116\/46629675\/ehac017.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T18:21:30Z","timestamp":1666722090000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurheartj\/article\/43\/22\/2116\/6525339"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,9]]},"references-count":38,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2022,2,9]]},"published-print":{"date-parts":[[2022,6,6]]}},"URL":"https:\/\/doi.org\/10.1093\/eurheartj\/ehac017","relation":{},"ISSN":["0195-668X","1522-9645"],"issn-type":[{"value":"0195-668X","type":"print"},{"value":"1522-9645","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,6,7]]},"published":{"date-parts":[[2022,2,9]]}}}