SynthesisAge and ageing2025
Head-up tilt testing in older syncope patients: a systematic review.
Synthesis in Age and ageing, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
backgroundIn older syncope patients, medical histories are often less reliable due to retrograde amnesia and cognitive impairment. Therefore, additional tests may be needed to reach a diagnosis. We conducted a systematic review to evaluate positivity rates and safety of head-up tilt testing (HUTT) in these patients.
methodsWe searched Medline and Embase for HUTT positivity rates and diagnoses in older syncope patients (mean age ≥ 65 years) vs. younger patients. Secondary outcomes were time to syncope (TtS) and adverse events (AEs). Risk of bias was assessed with a modified version of the QUADAS-2.
resultsIn total, 42 studies were included, with 12 378 older participants in total. Positivity rates varied widely [passive HUTT 0.0%-90.0%; isoproterenol (IPR)-HUTT 18.3%-64.0%; nitroglycerin-HUTT 30.1%-90.5%]. The majority of studies found no differences between older and younger patients. Specificity was high for all HUTT-protocols (85.5%-100%). TtS did not differ between older and younger patients, but was significantly longer in control subjects. Nitroglycerin-HUTT yielded the most diagnoses (median 64.2% vs. 23.7% for passive, P = .007, and 44.8% for IPR-HUTT, n.s.). Vasodepressive responses were more common than cardioinhibitory responses (median 54.9% vs. 9.1%) in older patients. AEs occurred in <6% of patients with passive/nitroglycerin-HUTT. DISCUSSION/
conclusionThere is no consistent evidence that HUTT results differ between older and younger syncope patients. Nitroglycerin-HUTT yields the most diagnoses, whilst retaining a high specificity, and is safe to perform in older patients. Future studies should focus on the additional value of HUTT on top of the initial evaluation in these patients.
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