Internal Medicine Resident University of Calgary Calgary, Alberta, Canada
Background: Vasovagal syncope (VVS) is the most common cause of fainting. Although medically benign, it is frequently associated with reduced quality of life (QoL), psychological distress, and recurrent healthcare utilization. Despite decades of investigation, no treatments for recurrent VVS have demonstrated efficacy in prospective, randomized, placebo-controlled trials. Notably, meta-analyses have shown that enrollment in clinical trials—without active intervention—is associated with high remission rates and improved QoL, suggesting that patient perception and psychological factors may significantly influence outcomes. This study aimed to identify psychological, cognitive, and clinical predictors of both syncope-specific and general health-related QoL in patients with VVS.
METHODS AND RESULTS: We conducted a cross-sectional analysis of 108 adult patients with clinically diagnosed VVS recruited from two Calgary syncope clinics. Prior to specialist consultation, participants completed standardized self-report assessments including the Hospital Anxiety and Depression Scale (HADS), Revised Life Orientation Test (LOT-R), EQ-5D-3L, EuroQol Visual Analogue Scale (EQ-VAS), and the Impact of Syncope on Quality of Life (ISQL). Syncope frequency over the previous 12 months and lifetime was also recorded.
Two multiple linear regression models were constructed using standardized predictors to identify independent associations with ISQL and EQ-VAS scores. All assumptions for linear regression were met. Multicollinearity was assessed using variance inflation factor (VIF), with all predictors showing VIF < 3.4.
Significant predictors of worse ISQL scores included anxiety (β = 4.08, p = 0.003), depression (β = 3.16, p = 0.022), EQ-5D activity limitations (β = 3.32, p = 0.005), and EQ-5D anxiety/depression (β = 2.27, p = 0.049). Lower EQ-VAS scores were predicted by depression (β = –6.79, p = 0.006) and EQ-5D pain/discomfort (β = –5.84, p = 0.005). Syncope frequency (both 12-month and lifetime) was not significantly associated with QoL in either model. R² was 0.499 for ISQL and 0.325 for EQ-VAS.
Conclusion: Anxiety and depression are the strongest predictors of QoL in adults with VVS. Anxiety was independently associated with worse syncope-specific QoL (ISQL), while depression predicted lower general health ratings (EQ-VAS). EQ-5D domains—particularly pain/discomfort, activity limitations, and anxiety/depression—also contributed significantly to QoL outcomes. Syncope frequency, whether over the past year or lifetime, was not significantly associated with QoL. These findings suggest that the psychological and functional impact of VVS—not the number of episodes—more strongly influences patient outcomes, challenging the traditional emphasis on episode reduction as the primary therapeutic goal.
