Adults with syncope may have increased risk of occupational accidents, job termination

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 - Anna Karin Numé

Adults in Denmark who were diagnosed with a first-time syncope had a 1.4-fold higher risk of occupational accidents and a two-fold higher risk of getting terminated from their job within two years when compared to the general employed population, according to a nationwide cohort study.

The researchers found that 91.6 percent of adults who were employed at the time of syncope maintained or returned to employment within a month after hospital discharge. However, the two-year risk of termination of employment was 31.3 percent.

Lead researcher Anna-Karin Numé, MD, of Copenhagen University Herlev Gentofte Hospital in Hellerup, Denmark, and colleagues published their results online in Circulation: Cardiovascular Quality and Outcomes on April 18.

“We believe that our findings shed light on a hidden consequence of syncope,” Numé said in a news release. “The ability to feel safe at work and maintain a full-time job addresses an indirect effect and cost of syncope beyond the usual clinical parameters such as mortality and hospitalization. Employment is more than a measure of performance status; besides its financial importance, it is crucial for self-esteem and quality of life.”

The researchers noted that the lifetime prevalence of syncope is 35 percent, while one-third of patients have a recurrent syncope within a few years. Meanwhile, approximately 3.4 million workers are treated in emergency departments for occupational injuries in the U.S. each year.

This study examined 21,729 residents of Denmark who were 18 to 64 years old from 2008 to 2012. All of the adults were diagnosed with a first-time syncope and discharged from a hospital or emergency department.

The median age of patients with syncope was 48.4 years old, while 49.7 percent were men and 49.5 percent were employed at the time of syncope.

After a median follow-up period of 3.2 years, the incidence rates of an occupational accident were 2.1 per 100 patient-years for people with syncope and 1.6 per 100 patient-years for the employed general population.

Adults with a recurrent syncope had an additional 1.4-fold increased risk of occupational accidents compared with patients who were hospitalized for syncope. The risk was particularly increased for adults with a low educational level and those who were younger than 40 years old. The risk was similar for people with syncope who had cardiovascular disease and people who did not have cardiovascular disease.

In addition, the researchers mentioned that adults younger than 40 years old and those with cardiovascular disease, depression or low educational level had a significantly increased risk of employment termination.

“Our study suggests that working-age patients with syncope could benefit from further attention to work-related implications,” the researchers wrote. “In particular, the association of excess risk of termination of employment among patients with syncope of young age supports the need for intervention because it might have broader implications for individual physical and mental health, and signicant public health and socioeconomic con- sequences. We urge for more focused and appropriate assessment of patients with syncope in clinical practice.”

The researchers noted that the study had a few limitations, including its observational design, which precluded them from making causal observations. They also did not have information on adults’ medical history, blood pressure, electrocardiographic and echocardiographic measures. In addition, they did not have data on circumstances of the occupational accidents, physical and psychosocial work environment factors and employer characteristics. Further, the results apply to adults from Denmark who were evaluated in emergency departments and hospitals, but the findings might not be generalizable to other populations.

“We hope that our findings will stimulate more research to examine why syncope is associated with adverse employment outcomes and to identify and test preventive strategies,” Numé said in a news release. “Until then, we urge physicians to ask patients with syncope about their work to reduce any adverse consequences of syncope and educate them about underlying mechanisms and coping strategies.”