Serious Cardiac Outcomes and Physician Estimation of Risk in ED Patients With Presyncope vs Syncope
Suh et al., Annals of Emergency Medicine, September 23, 2025
📌 Conclusions
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Presyncope ≈ Syncope: Both groups have similar 30-day risks of serious cardiac outcomes (~5%).
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Clinician underestimation: Physicians perceive presyncope as lower risk, reflected in lower admission rates.
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Practice implication: Presyncope should be approached with the same caution as syncope in risk stratification and disposition planning.
👨⚕️ Key Takeaway for EM Physicians
Don’t dismiss presyncope—its 30-day serious cardiac outcome risk mirrors syncope. Clinical gestalt tends to underestimate presyncope risk, which may contribute to under-admission. Standard syncope risk tools and cautious follow-up should be applied equally to presyncope presentations.
🧪 Methods
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Design: Secondary analysis of a prospective, observational, multicenter study
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Population: Adults ≥40 years presenting with presyncope (n=542) or syncope (n=721)
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Exclusions: Patients with serious ED diagnoses at presentation
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Outcomes:
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Physician-estimated risk of serious cardiac outcomes
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Admission rates
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30-day incidence of serious cardiac events (MI, arrhythmia, cardiac death, etc.)
📊 Results
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30-day serious cardiac outcomes:
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Syncope: 34/721 (4.7%)
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Presyncope: 28/542 (5.2%)
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No significant difference (OR 1.13; 95% CI 0.66–1.79)
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Physician risk estimates:
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Syncope: 7.6%
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Presyncope: 5.3%
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Clinicians underestimated presyncope risk (statistically significant difference).
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Admission rates:
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Syncope: 49.5%
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Presyncope: 38.2%
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Presyncope patients were admitted less often (risk difference 11.3%, 95% CI 1.2–21.5).
Suh, E.H., Sacco, D.L., Winskill, C., DeAngelis, J., Nishijima, D., Schimmel, J., Storrow, A., Thiruganasambandamoorthy, V., Weiss, R.E., Wood, N. and Probst, M.A., 2025. Serious Cardiac Outcomes and Physician Estimation of Risk in Emergency Department Patients With Presyncope Versus Syncope. Annals of Emergency Medicine.