Search

Background: Most patients admitted to the hospital from the emergency department (ED) with syncope do not have a myocardial infarction (MI), yet a common practice is to draw serial cardiac enzymes.Methods: To assess the value of serial cardiac enzymes in elderly patients who present to the ED with syncope, a retrospective chart review was performed on consecutive patients aged 65 and older with syncope in an urban teaching hospital ED between July 1, 1998 and June 30, 1999. Charts were screened for presenting history, cardiac risk factors, testing, and outcomes including acute coronary syndromes, MI, death, and patients returning to the ED or admitted within 72 hours of discharge.Results: 319 patients met the study criteria of syncope with confirmed loss of consciousness in the absence of seizure or stroke. 141 of 228 admitted patients (62%) had creatine phosphokinase (CPK) drawn and 5% of these had Troponin I (TnI). 3 of 141 patients, or 2.1% (95% CI [confidence interval]: 0.04%-6.09%), had positive cardiac enzymes during their hospitalization. CPK was positive in all 3, and TnI, drawn in 1 patient, was also positive. Two of these patients had chest discomfort and ST segment and T-wave abnormalities on electrocardiogram (ECG) in addition to a syncopal event. The third patient had dementia and could not recall the details surrounding her syncopal event. In addition, her baseline ECG demonstrated a left bundle branch block, limiting ECG interpretation.Conclusions: Cardiac enzymes may be of little additional value if drawn routinely on elderly patients with syncope who are admitted to the hospital from the ED, unless they have other signs or symptoms suggestive of myocardial ischemia. [ABSTRACT FROM AUTHOR]

COVID‐19 has caused enormous economic and social disruptions that may have lasting effects on employment, income, and working conditions. Critically, these disruptions often have a negative impact on mental health. While significant research has examined the relationship between COVID‐19 and mental health, most of these studies focus on urban centres. This paper presents results from a pilot study conducted in two rural counties in Ontario, Canada on the experiences of residents from small and rural communities related to COVID‐19. Based on 3496 survey results, this study quantifies the negative impact of COVID‐19 on overall mental health and the confounding role of gender, income, and age. Results must be used to expand the dialogue around rural mental health and to ensure appropriate programs and policies are developed. Key messages: COVID‐19 has had variable and significant impacts on residents in rural communities.Gender is a key characteristic, as self‐identifying females have experienced a greater decrease in self‐assessed mental health since the start of the pandemic.Governments must consider the "lived reality" that residents experience when they design and implement response plans; a one‐size‐fits‐all response to disruption is not sufficient. [ABSTRACT FROM AUTHOR]

Background. Current data suggest that 30%-50% of patients with syncope leave the hospital without a defined etiology of their syncopal event. Recent studies have shown significant differences in both presentation and therapy in women with coronary disease and congestive heart failure. Methods. To assess the impact of sex on the frequency of syncope and the rate of identifying a specific etiology among elderly patients who present to the emergency department (ED), a retrospective chart review was performed during a 1-year period. Consecutive patients older than 65 years presenting with syncope to a large urban teaching hospital were enrolled. Inclusion criterion was documented loss of consciousness with no other obvious etiology of loss of consciousness such as stroke or seizure. Charts were screened for presenting history, ethnicity, sex, comorbid conditions, living circumstances, outpatient medication, and cardiac risk factors and outcomes including acute coronary syndromes, myocardial infarction, and death. Results. During 1 year of observation, 7496 women (60%) of 12,401 patients over the age of 65 presented to our ED, and 219 (2.9%) of these met inclusion criteria for syncope. In comparison, 4905 (40%) men presented to the ED, 104 (2.1%) of whom had syncope (relative risk of syncope for women vs men, 1.38; 95% confidence interval, 1.09-1.74). Men were more likely to have comorbid conditions including coronary artery disease (p ≤ .01), prior myocardial infarction (p ≤ .03), and diabetes mellitus (p ≤ .03) than were women. No sex differences were noted in living circumstances, such as living alone, with assistance, or in an institution. Forty-two percent of patients received no diagnosis on discharge from the hospital. Sixty-nine of 147 women admitted (47%) had no etiology of their syncope as compared to 27 (32%) of men. The relative risk for no diagnosis in women versus men was 1.67 (95% confidence interval, 1.07-2.61). Conclusions. Considerable numbers of patients presenting to EDs with syncope remain without a diagnosis. Women, despite being less likely to have concomitant coronary artery disease or diabetes, are significantly more likely to present to an ED with syncope, yet less likely to be discharged with a defined etiology. [ABSTRACT FROM AUTHOR]