Evidence map›Paper›PMID 38890128›Full record

SynthesisOpen heart2024

Therapeutic options for neurocardiogenic syncope: a meta-analysis of randomised trials with and without blinding.

Nandita Kaza, Michela Sorbini, Zhuang Liu, Monika Johal, Bradley Porter, Alexandra Nowbar, Shuli Levy, Melanie Dani, Patricia Taraborelli, Philip Eardley and 8 more

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Open heart, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Nandita KazaImperial College London, London, UK.
Michela SorbiniImperial College London, London, UK.ORCID 0000-0002-9539-0907
Zhuang LiuImperial College London, London, UK.
Monika JohalImperial College London, London, UK.
Bradley PorterImperial College Healthcare NHS Trust, London, UK.
Alexandra NowbarImperial College London, London, UK.
Shuli LevyImperial College Healthcare NHS Trust, London, UK.
Melanie DaniImperial College Healthcare NHS Trust, London, UK.
Patricia TaraborelliImperial College Healthcare NHS Trust, London, UK.
Philip EardleyImperial College Healthcare NHS Trust, London, UK.
Mohamed ZuhairImperial College Healthcare NHS Trust, London, UK.
Ahran ArnoldImperial College London, London, UK.
James HowardImperial College London, London, UK.
Zachary I WhinnettImperial College London, London, UK.
Darrel P FrancisImperial College London, London, UK.
Matthew J Shun-ShinImperial College London, London, UK m.shun-shin@imperial.ac.uk.
Phang Boon LimImperial College London, London, UK.
Daniel KeeneImperial College London, London, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundNeurocardiogenic syncope is a common condition with significant associated psychological and physical morbidity. The effectiveness of therapeutic options for neurocardiogenic syncope beyond placebo remains uncertain.

methodsThe primary endpoint was the risk ratio (RR) of spontaneously recurring syncope following any therapeutic intervention. We also examined the effect of blinding on treatment efficacy. We identified all randomised trials which evaluated the effect of any pharmacological, device-based or supportive intervention on patients with a history of syncope. A systematic search was conducted on Medline, Embase, PubMed databases and Cochrane Central Register for Controlled Trials from 1950 to 25 April 2023. Event rates, their RRs and 95% CIs were calculated, and a random-effects meta-analysis was conducted for each intervention. Data analysis was performed in R using RStudio.

resultsWe identified 47 eligible trials randomising 3518 patients. Blinded trials assessing syncope recurrence were neutral for beta blockers, fludrocortisone and conventional dual-chamber pacing but were favourable for selective serotonin reuptake inhibitors (SSRIs) (RR 0.40, 95% CI 0.26 to 0.63, p<0.001), midodrine (RR 0.70, 95% CI 0.53 to 0.94, p=0.016) and closed-loop stimulation (CLS) pacing (RR 0.15, 95% CI 0.07 to 0.35, p<0.001). Unblinded trials reported significant benefits for all therapy categories other than beta blockers and consistently showed larger benefits than blinded trials.

conclusionsUnder blinded conditions, SSRIs, midodrine and CLS pacing significantly reduced syncope recurrence. Future trials for syncope should be blinded to avoid overestimating treatment effects. PROSPERO REGISTRATION NUMBER: CRD42022330148.

Indexed as

Randomized Controlled Trials as TopicSyncope, VasovagalHumansRecurrenceTreatment OutcomeMeta-AnalysisPacemaker, ArtificialQuality of Health CareSYNCOPE

Identifiers

PMID38890128
PMCPMC11191821

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.