Abstract P300: Differences in Characteristics and Care Among Stroke Patients With Documented Substance Use

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Leslie Corless ◽  
Alexandra C Lesko ◽  
Cameron Garvin ◽  
Tamela L Stuchiner ◽  
Elizabeth Baraban
Keyword(s):  
Substance Use ◽  
Patient Characteristics ◽  
Care Needs ◽  
Chi Square ◽  
Stroke Treatment ◽  
Discharge Disposition ◽  
Care Processes ◽  
Increased Risk ◽  
Stroke Diagnosis ◽  
Specific Care

Background: Despite the known increased risk of stroke occurrence due to substance use (SU), few studies focus on understanding this vulnerable population beyond incidence. The objective of this study was to examine patient characteristics and clinical outcomes among those admitted for stroke with documented substance use. Methods: Data included patients 18 years or older, discharged from two Portland, Oregon hospitals between October 2017 - May 2019 with a stroke diagnosis and documented abuse of alcohol (EtOH), cannabis (CB), methamphetamine (MA), opiates, cocaine, benzodiazepines, or Methylenedioxymethamphetamine (MDMA). Patients with SU of the three most common substances in this population, EtOH, MA and CB, were each compared to patients with any other type of SU with regard to demographics, risk factors, stroke subtypes, stroke treatment, discharge disposition and length of stay (LOS). Non parametric median tests and Pearson’s chi square tests were used. Results: Among 280 patients included, 79.3% (n=222) used EtOH, 26.8% (n=75) CB, and 24.6% (n=69) MA, with 38.7% (n=108) using more than one. Compared to patients with other SU, a greater percentage of patients with EtOH SU had dyslipidemia (56.8% vs. 31%, p=0.044). Fewer patients with EtOH SU smoked (50.0% vs 70.7%, p=0.008), were female (31.8% vs 50%, p=0.014) and received EVT (3.6% vs 12.7%. p=0.026). Patients with MA SU were younger (55 vs 63, p<.001), had a longer LOS (6 vs 4 days, p=0.022), more smoked (72.5% vs 48.3%, p=.001) and fewer had dyslipidemia (30.4% vs 47.9%, p=0.017) or depression (17.4% vs 31.8%, p=0.032). Fewer also arrived by EMS (28.8% vs. 43.1%) but more arrived by transfer (54.6% vs 33.2%) (p=0.008). Additionally, fewer patients with MA SU were admitted with ischemic stroke (66.7% vs 78.7%), but more with subarachnoid hemorrhage (14.5% vs 4.7%) (p=0.018). Only smoking (66.7% vs 49.8%, p=0.017) was significantly different between patients with CB SU and other SU groups. Conclusion: The findings of this study indicate care processes and stroke diagnosis differ among patients by specific type of SU. Strategies to address the specific care needs of patients with stroke and substance use should be explored.

Abstract P293: Disparate Outcomes for Stroke Patients With Documented Substance Use Compared to Those Without Substance Use

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Leslie Corless ◽  
Tamela L Stuchiner ◽  
Cameron Garvin ◽  
Alexandra C Lesko ◽  
Elizabeth Baraban
Keyword(s):  
Substance Use ◽  
Patient Characteristics ◽  
Stroke Care ◽  
Stroke Patients ◽  
Chi Square ◽  
Stroke Treatment ◽  
Discharge Disposition ◽  
Healthcare Settings ◽  
Medical Histories ◽  
The Impact

Background: Few studies have shown the impact of substance use (SU) on treatment and outcomes of stroke patients. Research suggests stigma related to SU impacts patient experience in healthcare settings. In this study we assessed whether there were differences in patient characteristics and outcomes for stroke patients with SU compared to those with no substance use (NSU). Methods: Retrospective data from two Oregon hospitals included patients admitted with stroke diagnosis, 18 years or older, who discharged between October 2017 and May 2019. Patients with documented SU and specific SU type were compared to patients with NSU with regard to demographics, medical history, stroke subtypes, treatment, discharge disposition and length of stay (LOS). SU was defined as any documented abuse of alcohol (ETOH), methamphetamine (MA), cannabis, opiates, cocaine, benzodiazepines, and Methyl-enedioxy-methamphetamine (MDMA). Non parametric median tests and Pearson’s chi square tests were used. Results: Among 2,030 patients included in the analysis, 13.8% (n=280) were SU and 86.2% (n=1,750) were NSU. Patients with SU were significantly younger, median age (61 vs. 73, p <.001) and less were female (35.4% vs. 53.6%, p <0.001). Those with SU had lower prevalence of dyslipidemia (43.6% vs. 59.5%, p <0.001), AFIB (12.5% vs. 22.2%, p <0.001), and previous TIA (6.1% vs 10.8%, p=0.02), and more smoked (54.3% vs 13.3% p <0.001). More patients with SU arrived via transfer (38.4% vs 27.4%, p=.001). Fewer patients with SU expired or were discharged to hospice (8.9% vs 13.7%) and a greater percent left against medical advice (AMA) (3.2% vs 0.6%) (p<.001). When comparing specific SU types to NSU, all SU groups were younger, had similar medical histories and a greater proportion left AMA. Only MA users had differentiating stroke diagnoses with a higher percent of SAH (14.5% vs 5.6%) (p=.003) in addition to longer LOS (6 vs 4 days, p=.006). No differences were found in acute stroke treatment rates. Conclusion: Patients with SU were demographically different from the NSU population and did differentiate on some stroke care outcomes and processes, potentially indicating opportunities to address stigma around substance use to meet the needs of patients with both stroke and substance use.

scholarly journals Incidence and risk factors for seizures associated with deep brain stimulation surgery

2020 ◽  
pp. 1-5
Author(s):  
Travis J. Atchley ◽  
Galal A. Elsayed ◽  
Blake Sowers ◽  
Harrison C. Walker ◽  
Gustavo Chagoya ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Patient Characteristics ◽  
Primary Diagnosis ◽  
Electrode Placement ◽  
Retrospective Case ◽  
Chi Square ◽  
Increased Risk ◽  
Continuous Outcomes ◽  
Deep Brain

OBJECTIVEThe objective of this study was to determine the incidence of seizures following deep brain stimulation (DBS) electrode implantation and to evaluate factors associated with postoperative seizures.METHODSThe authors performed a single-center retrospective case-control study. The outcome of interest was seizure associated with DBS implantation. Univariate analyses were performed using the Student t-test for parametric continuous outcomes. The authors used the Kruskal-Wallis test or Wilcoxon rank-sum test for nonparametric continuous outcomes, chi-square statistics for categorical outcomes, and multivariate logistic regression for binomial variables.RESULTSA total of 814 DBS electrode implantations were performed in 645 patients (478 [58.7%] in men and 520 [63.9%] in patients with Parkinson’s disease). In total, 22 (3.4%) patients who had undergone 23 (2.8%) placements experienced seizure. Of the 23 DBS implantation–related seizures, 21 were new-onset seizures (3.3% of 645 patients) and 2 were recurrence or worsening of a prior seizure disorder. Among the 23 cases with postimplantation-related seizure, epilepsy developed in 4 (17.4%) postoperatively; the risk of DBS-associated epilepsy was 0.50% per DBS electrode placement and 0.63% per patient. Nine (39.1%) implantation-related seizures had associated postoperative radiographic abnormalities. Multivariate analyses suggested that age at surgery conferred a modest increased risk for postoperative seizures (OR 1.06, 95% CI 1.02–1.10). Sex, primary diagnosis, electrode location and sidedness, and the number of trajectories were not significantly associated with seizures after DBS surgery.CONCLUSIONSSeizures associated with DBS electrode placement are uncommon, typically occur early within the postoperative period, and seldom lead to epilepsy. This study suggests that patient characteristics, such as age, may play a greater role than perioperative variables in determining seizure risk. Multiinstitutional studies may help better define and mitigate the risk of seizures after DBS surgery.

Abstract TMP41: Early Mobility Initiated at 12 Hours Post Thrombolytic Therapy for Stroke Increases Likelihood for Discharge to Home

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
John Gwilliam ◽  
Mechelle McNicholas
Keyword(s):  
Thrombolytic Therapy ◽  
Positive Impact ◽  
Chi Square ◽  
Comfort Care ◽  
Early Mobility ◽  
Discharge Disposition ◽  
Increased Risk ◽  
Significant Difference ◽  
Discharge Outcomes ◽  
Stroke Center

Purpose: To assess patient safety and discharge outcomes of initiating early mobility after 12 hours of receiving thrombolytic therapy (tPA) for stroke at a Primary Stroke Center. Background: Patients receiving tPA are traditionally maintained on bedrest for 24 hours due to an alleged risk of increased complications or falls, however this standard is not supported by data. Prior data among patients receiving tPA supports the concept of providing early mobility before 24 hours without an increased risk of falls or other adverse response. There is also evidence that early mobility in other critical care populations has positive impact on discharge disposition and decreasing the length of stay (LOS). Methods: A validated Early Mobility Protocol was implemented within 24 hours for all patients receiving tPA for stroke with a focus to progress each patient through the stages of the mobility protocol based on clinical presentation. Data from pre-implementation (January – May 2018) and post implementation (June 2018-December 2018) were compared for outcomes, including discharge disposition, adverse responses and LOS. T-test and Chi-square were used to determine significant difference in outcomes between groups. Results: Between January to December 2018 44 patients received tPA (18 pre-implementation and 26 post implementation). For the post implementation group 18/26 early mobility was initiated with 24 hours, 4/26 were placed on comfort care and 4/26 were transferred to a comprehensive stroke center. Among the early mobility group, there were no falls or adverse physiological events. Patients that participated with early mobility were more likely to discharge home, 46.15% vs 33.33%, less likely to require post-acute services, 15.38% vs 27.78%, and less likely to require transfer to a higher level of care, 15.38% vs 33.78%. There was not a significant difference in LOS. Conclusion: Providing early mobility to patients post thrombolytic therapy between 12-24 hours does not cause an increase in adverse physiological events. Additionally, providing early mobility has a positive impact on patient discharges to home. Further study may include initiating mobility at an early timeframe to examine the correlation to LOS and discharge outcomes.

Abstract NS6: Early Mobility Initiated at 12 Hours Post Thrombolytic Therapy for Stroke Increases Likelihood for Discharge to Home

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
John Gwilliam ◽  
Mechelle McNicholas
Keyword(s):  
Thrombolytic Therapy ◽  
Positive Impact ◽  
Chi Square ◽  
Comfort Care ◽  
Early Mobility ◽  
Discharge Disposition ◽  
Increased Risk ◽  
Significant Difference ◽  
Discharge Outcomes ◽  
Stroke Center

Purpose: To assess patient safety and discharge outcomes of initiating early mobility after 12 hours of receiving thrombolytic therapy (tPA) for stroke at a Primary Stroke Center. Background: Patients receiving tPA are traditionally maintained on bedrest for 24 hours due to an alleged risk of increased complications or falls, however this standard is not supported by data. Prior data among patients receiving tPA supports the concept of providing early mobility before 24 hours without an increased risk of falls or other adverse response. There is also evidence that early mobility in other critical care populations has positive impact on discharge disposition and decreasing the length of stay (LOS). Methods: A validated Early Mobility Protocol was implemented within 24 hours for all patients receiving tPA for stroke with a focus to progress each patient through the stages of the mobility protocol based on clinical presentation. Data from pre-implementation (January – May 2018) and post implementation (June 2018-December 2018) were compared for outcomes, including discharge disposition, adverse responses and LOS. T-test and Chi-square were used to determine significant difference in outcomes between groups. Results: Between January to December 2018 44 patients received tPA (18 pre-implementation and 26 post implementation). For the post implementation group 18/26 early mobility was initiated with 24 hours, 4/26 were placed on comfort care and 4/26 were transferred to a comprehensive stroke center. Among the early mobility group, there were no falls or adverse physiological events. Patients that participated with early mobility were more likely to discharge home, 46.15% vs 33.33%, less likely to require post-acute services, 15.38% vs 27.78%, and less likely to require transfer to a higher level of care, 15.38% vs 33.78%. There was not a significant difference in LOS. Conclusion: Providing early mobility to patients post thrombolytic therapy between 12-24 hours does not cause an increase in adverse physiological events. Additionally, providing early mobility has a positive impact on patient discharges to home. Further study may include initiating mobility at an early timeframe to examine the correlation to LOS and discharge outcomes.

scholarly journals P089: Frequency of substance abuse in Albertan emergency departments: a retrospective NACRS analysis

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S108-S108
Author(s):  
J. Moe ◽  
C. Camargo ◽  
S. Jelinski ◽  
B.H. Rowe
Keyword(s):  
Substance Abuse ◽  
A Priori ◽  
Patient Characteristics ◽  
Fiscal Year ◽  
Strongly Correlated ◽  
Chi Square ◽  
Increased Risk ◽  
Icd 10 ◽  
Ed Visits ◽  
Visit Number

Introduction: Substance abuse is strongly correlated with frequent ED use, which is a known risk factor for mortality. This study aimed to examine epidemiologic trends in ED visit frequency, and visit and patient characteristics among all patients presenting to Albertan EDs with visits related to substance abuse over a five-year period. Methods: This is a retrospective analysis of National Ambulatory Care Reporting System (NACRS) administrative ED data for Alberta. All ED visits related to substance abuse made by adults from fiscal year 2010/11 to 2014/15 were included. Using a validated definition enhanced by expert consultation, ED visits were classified as visits related to substance abuse if a set of ICD-10 codes determined a priori were present within the primary or secondary diagnostic fields. Data are reported as means (with SD), medians (with IQR) and proportions. Visit and admission frequencies were compared using Chi square and Chi square trend tests. All analysis was performed using SAS 9.4. Results: Over the study period, 177,287 visits related to substance abuse were made to Alberta EDs. These visits were made by 77,291 unique patients, and annual patient numbers increased consistently from 17,660 in 2010/11 to 24,737 in 2014/15; 62% of patients were male and median age was 38 years (IQR 24, 49). Visits increased from 27,839 in 2010/11 to 42,965 in 2014/15 (p<0.001). 50% arrived by ambulance, and were mostly triaged as CTAS 3 to 5 (32% CTAS 1 or 2, 43% CTAS 3, and 23% CTAS 4 or 5). While most of the patients were discharged, 15.6% of visits resulted in admission; statistical but not clinically meaningful differences were detected in proportions of admitted visits across the study years. Compared to the overall population of patients with substance abuse presentations, frequent presenters (with a visit number greater than the 95th percentile) appeared to be older (median age 40 years [IQR 31, 49]) and had a higher proportion of males (69%). Conclusion: ED presentations for substance abuse increased from 2010 to 2015 in Alberta, and frequent presenters appear to have a different demographic profile. Future study is needed to determine whether patients who present frequently with substance abuse are at increased risk for mortality as this may justify targeted intervention.

scholarly journals Sexual Experience, Suicidal Behaviors and Depression Association, and Its Tendency to Lead to Smoking and Alcohol Consumption among Korean Adolescents

2021 ◽  
Vol 9 (4) ◽  
Author(s):  
Baby Doll Bana ◽  
Jinsoo Jason Kim ◽  
Jerre Mae Tamanal ◽  
Sun Hee Kim
Keyword(s):  
Risk Factors ◽  
Substance Use ◽  
Logistic Regression ◽  
Alcohol Drinking ◽  
Sexual Experience ◽  
P Value ◽  
Suicidal Behaviors ◽  
Chi Square ◽  
Korean Adolescents ◽  
Increased Risk

In numerous published findings, the cohesion was they have treated sexual experience, suicidal behaviors and depression, as the outcome variables and regard substance use as the core factors. In this study, we aim to do the opposite. We seek to make sense of the linkage by inversing the analytical direction. We intend to examine the association and the likelihood, and observe the levels to which sexual experience, suicidal behaviors, and depression may play a part in the odds of smoking and alcohol drinking among middle school and high school Korean students. The data obtained were cross-sectional from the 2019 Korean Youth Risk Behavior Web-Based Survey, participated by 57, 303 Korean adolescents. Among which are male 52.1%, female 47.9%, ages 15 below 59.2 % and 15 above 40.4%. This study utilized descriptive, Chi-square, and logistic regression analyses. Our basic findings signified that sexual experience and mental health problems doubled the odds of motivation. Chi-square analyses asserted that the association was statistically significant. All variables were notably correlated to substance use at 0.01 level, that is, when sexual experience, suicidal behaviors, and depression tend to increase, there was a high risk of using substances. The results for logistic regression on alcohol drinking, the -2LL statistic is 73157.25, the Cox & Snell R2 is 0.057, and Nagelkerke R2 is 0.078 having the df of 1, with the p value of 0.000l, and the -2LL statistic is 39022.46, the Cox & Snell R2 is 0.064, and Nagelkerke R2 is 0.122 having the df of 1, with the p value of 0.000 for smoking, predicted the maximum likelihood and considerably identified as positive significant indicators in the onset of substance initiation. This study also found that sexual experience had remained robustly substantial with the odds of smoking and drinking, that is, participants with higher sexual experience had the strongest likelihood of substance use motivation. Our overall results contribute to the debate by treating sexual experience, suicidal behaviors, and depression as precedent significant risk factors for developing substance use behaviors among Korean adolescents. For efficient and effective management of sexual experience, suicidal behaviors and depression on teenagers, findings underscore the need for early detection on adolescents at risk. A comprehensive prevention and protective efforts is required along with continuous parental guidance. Intervention programs with coping skills to handle emotional and behavioral problems is essential to help reduce the probability of an increased risk factors and subsequently lessen the threat for developing cigarette smoking and alcohol drinking behaviors among teenagers. School-based programs that can create synergy by embedding teenagers in an academic environment that is equally supportive, beneficial and can help promote a positive mindset is recommended.

Circulating Stem/Progenitor Cells as Prognostic Biomarkers in Macro- and Microvascular Disease: A Narrative Review of Prospective Observational Studies

2018 ◽  
Vol 25 (35) ◽  
pp. 4507-4517 ◽  
Author(s):  
Mauro Rigato ◽  
Gian Paolo Fadini
Keyword(s):  
Cardiovascular Disease ◽  
Progenitor Cells ◽  
Cardiovascular Events ◽  
Observational Studies ◽  
English Language ◽  
Microvascular Disease ◽  
Patient Characteristics ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Cell Phenotypes

Background: Circulating progenitor cells (CPCs) and endothelial progenitor cells (EPCs) are immature cells involved in vascular repair and related to many aspects of macro and microvascular disease. <p> Objective: We aimed to review studies reporting the prognostic role of CPCs/EPCs measurement on development of cardiovascular disease and microangiopathy. <p> Methods and Results: We reviewed the English language literature for prospective observational studies reporting the future development of cardiovascular disease or microangiopathy in patients having a baseline determination of CPCs/EPCs. We retrieved 34 studied reporting on cardiovascular outcomes and 2 studies reporting on microvascular outcomes. Overall, a reduced baseline level of CPCs/EPCs was associated with a significant increased risk of cardiovascular events, all-cause death, and onset/progression of microangiopathy. The most predictive phenotypes were CD34+ and CD34+CD133+. The main limitation was related to the high heterogeneity among studies in terms of patient characteristics and cell phenotypes. <p> Conclusion: The present review shows that a reduced level of circulating progenitor cells is a risk factor for the development of future cardiovascular events and death. In addition, low CPCs/EPCs levels predict the onset or worsening of microalbuminuria and retinopathy in diabetic patients.

scholarly journals Predictors of Chronic Opioid Use: A Population-level Analysis of North Carolina Cancer Survivors Using Multi-Payer Claims

2021 ◽  
Author(s):  
Devon K Check ◽  
Christopher D Bagett ◽  
KyungSu Kim ◽  
Andrew W Roberts ◽  
Megan C Roberts ◽  
...  
Keyword(s):  
North Carolina ◽  
Substance Use ◽  
Cancer Survivors ◽  
Low Income ◽  
Opioid Therapy ◽  
Adjusted Relative Risk ◽  
Opioid Use ◽  
Chronic Opioid Therapy ◽  
Increased Risk ◽  
Chronic Opioid Use

Abstract Background No population-based studies have examined chronic opioid use among cancer survivors who are diverse with respect to diagnosis, age group, and insurance status. Methods We conducted a retrospective cohort study using North Carolina (NC) cancer registry data linked with claims from public and private insurance (2006–2016). We included adults with non-metastatic cancer who had no prior chronic opioid use (N = 38,366). We used modified Poisson regression to assess the adjusted relative risk of chronic opioid use in survivorship (&gt;90-day continuous supply of opioids in the 13–24 months following diagnosis) associated with patient characteristics. Results Only 3.0% of cancer survivors in our cohort used opioids chronically in survivorship. Predictors included younger age (adjusted risk ratio [aRR], 50–59 vs 60–69 = 1.23, 95% confidence interval [CI] = 1.05–1.43), baseline depression (aRR = 1.22, 95% CI = 1.06–1.41) or substance use (aRR = 1.43, 95% CI = 1.15–1.78) and Medicaid (aRR vs Private = 1.93, 95% CI = 1.56–2.40). Survivors who used opioids intermittently (vs not at all) before diagnosis were twice as likely to use opioids chronically in early survivorship (aRR = 2.62, 95% CI = 2.28–3.02). Those who used opioids chronically (vs intermittently or not at all) during active treatment had a nearly 17-fold increased likelihood of chronic use in survivorship (aRR = 16.65, 95 CI = 14.30–19.40). Conclusions Younger and low-income survivors, those with baseline depression or substance use, and those who require chronic opioid therapy during treatment are at increased risk for chronic opioid use in survivorship. Our findings point to opportunities improve assessment of psychosocial histories and to engage patients in shared decision-making around long-term pain management, when chronic opioid therapy is required during treatment.

scholarly journals Incidence, characteristics, determinants and prognostic impact of recurrent syncope

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Zimmermann ◽  
J Du Fay De Lavallaz ◽  
T Nestelberger ◽  
D Gualandro ◽  
P Badertscher ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Coronary Intervention ◽  
Final Diagnosis ◽  
Major Adverse Cardiovascular Events ◽  
Unknown Etiology ◽  
Funding Source ◽  
Prognostic Impact ◽  
Lasso Regression ◽  
Recurrence Rates ◽  
Increased Risk

Abstract Background The incidence, characteristics, determinants, and prognostic impact of recurrent syncope are largely unknown, causing uncertainty for both patients and physicians. Methods We characterized recurrent syncope including sex-specific aspects and its impact on death and major adverse cardiovascular events (MACE) in a large prospective international multicenter study enrolling patients ≥40 years presenting with syncope to the emergency department (ED). Syncope etiology was centrally adjudicated by two independent and blinded cardiologists using all information becoming available during syncope work-up and 12-month follow-up. MACE were defined as a composite of all-cause death, acute myocardial infarction, surgical or percutaneous coronary intervention, life-threatening arrhythmia including cardiac arrest, pacemaker or implantable cardioverter defibrillator implantation, valve intervention, heart-failure, gastrointestinal bleeding or other bleeding requiring transfusion, intracranial hemorrhage, ischemic stroke or transient ischemic attack, sepsis and pulmonary embolism. Results Incidence of recurrent syncope among 1790 patients was 20% (95%-confidence interval (CI) 18% to 22%) within 24 months. Patients with an adjudicated final diagnosis of cardiac syncope (hazard ratio (HR) 1.50, 95%-CI 1.11 to 2.01) or syncope of unknown etiology even after central adjudication (HR 2.11, 95%-CI 1.54 to 2.89) had an increased risk for syncope recurrence (Figure). LASSO regression fit on all patient information available early in the ED identified more than three previous episodes of syncope as the only independent predictor for recurrent syncope (HR 2.13, 95%-CI 1.64 to 2.75). Recurrent syncope within the first 12 months after the index event carried an increased risk for all-cause death (HR 1.59, 95%-CI 1.06 to 2.38) and MACE (HR 2.24, 95%-CI 1.67 to 3.01), whereas recurrences after 12 months did not have a significant impact on outcome measures. Conclusion Recurrence rates of syncope are substantial and vary depending on syncope etiology. There seem to be no reliable patient characteristics available early on the ED that allow for the prediction of recurrent syncope with only a history of more than three previous syncope being associated with a higher risk for future recurrences. Importantly, recurrent syncope within the first 12 months carries an increased risk for death and MACE. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation

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