Evaluation of the effectiveness of tilt training and education in prevention of reflex syncope in patients with vasovagal syndrome hospitalized in the Department of Coronary Heart Disease and Heart Failure in 2010–2015
Abstract
Introduction. Tilt training (TT) is a form of therapy usually proposed to patients with malignant or recurrent form of reflex syncope syndrome, which causes deterioration of quality of life and carries the risk of injuries. Traditionally, TT involves maintaining an upright posture against the wall for the extending period of time. The use of TT in the therapy of reflex syncope has been mentioned in the guidelines of the European Society of Cardiology only as a possible method of treatment in a selected group of patients (IIb, B). The aim of the study was to assess the effectiveness of the therapy including intensified in-hospital tilt training and simultaneous patient education in prevention of reflex syncope.
Materials and methods. The study included 33 patients (19 women) aged 17–69 (average 40) with vasovagal syncope syndrome who were hospitalized in 2010–2015 in the Department of Coronary Heart Disease and Heart Failure in order to undergo TT therapy and syncope prevention education. The average number of TT sessions was 4 (1–9). Treatment effects were assessed using telephone survey and the medical records analysis. The effectiveness of the applied therapy in reflex syncope prevention and adherence to the therapy have been established, including the level of anxiety due to syncope recurrence, quality of life after treatment and subjective effectiveness of the applied therapy.
Results. The mean follow-up period was 1.6 years. During the follow-up 22 patients (66.7%) continued TT, 30 (91%) applied anti-syncope maneuvers, 29 (88%) increased the liquids consumption, 17 (51.5%) were trying to avoid high-risk for syncope situations. Twenty-four patients (72.7%) had no recurrence of syncope during the follow-up period. Twenty- -nine patients (88%) reported improvement in the quality of life. Thirty-one patients (94%) experienced reduction in the anxiety level associated with the possibility of recurrent syncope. Average rating of usefulness of the undergone therapy, assessed by the patients, in the prevention of reflex syncope was 9.3 out of 10.
Conclusions. 1. High adherence to the syncope prevention recommendations is an important cause of the low recurrence rates of syncope in the study group of patients with vasovagal syncope. 2. The use of the non-pharmacological therapies such as tilt training and patient education has an important role for improving the quality of life and for reduction of the anxiety in patients with vasovagal syncope. 3. Needs to be highlighted a very high subjective assessment of patients with vasovagal syncope regarding the relevance and effectiveness of the applied therapy.
Keywords: tilt trainingreflex syncopevasovagal syncopehead-up tilt test
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