Mortality outcomes of various causes of syncope.

Syncope, especially in older-age applicants, presents a risk selection quandary. When the etiology is established, risk classification is based on the causative impairment. However, often no diagnosis is ascertained. The lack of diagnosis presents a dilemma for the medical director. Underwriting decisions must be based on sound actuarial principles or related to actual and reasonable anticipated experience. The mortality outcome of various causes of syncope from participants of the Framingham Heart Study is presented in this abstract. The primary value to the medical director is the mortality outcome of those applicants without a specific etiologic diagnosis; those belonging to the unknown, the vasovagal or other causes groups. Over a 24-year observation period, patients whose syncope was attributed to vasovagal or other causes had a mortality ratio of 14% and an excess death rate of 20. Neurogenic syncope had a mortality ratio of 168% and an excess death rate of 34. No excess mortality was observed when those with seizures were excluded from analysis. Those whose cause of syncope was unknown had a mortality ratio of 192% and an excess death rate of 46. Individuals whose syncope was deemed to be cardiac exhibited a mortality ratio of 270% and an excess death rate of 82.