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Head-Up Tilt Test in Elderly Patients: A Retrospective Analysis in a Tertiary Center
Session:
Sessão de Posters 45 - Populações especiais, riscos especiais
Speaker:
Raquel França Moreira
Congress:
CPC 2026
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.5 Cardiovascular Disease in the Elderly
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Raquel França Moreira; Helena Fonseca; Sara Laginha; Pedro Silva Cunha (Phd); Bruno Valente; Guilherme Portugal; Paulo Osório; Sofia Jacinto; Ana Lousinha (Phd); Rui Ferreira; Sérgio Laranjo (Phd); Mário Oliveira (Phd)
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background</strong>: The Portuguese population is aging, leading to a higher prevalence of syncope and unexplained falls among older adults. Understanding causes such as polypharmacy, comorbidities, autonomic dysfunction, or hypotension is essential. The Head-Up Tilt Test (HUTT) is a simple and safe tool for assessing syncope in older patients. This study compared HUTT outcomes and therapeutic approaches between elderly and non-elderly patients.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: A retrospective single-centre analysis was performed on 271 consecutive HUTTs and 7 were excluded. Patients aged 70 years or older were considered elderly. Clinical, haemodynamic and autonomic data were reviewed. The statistical analysis comprised chi-square tests and comparisons of proportions and means, with a significance level set at p<0.05.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: Among 264 HUTT patients, 37.9% were 70 years or older and 62.1% were younger. Protocol selection differed significantly (p < 0.001): the Fast Italian protocol was used more frequently in the elderly (67% vs. 31.7%) – <strong>Table 1</strong>. As expected, the elderly showed a lower peak (median 87, IQR 22 vs. 105, IQR 32; p < 0.001) and average heart rates (72, IQR 16 vs. 81, IQR 22; p < 0.001), confirming the chronotropic reserve decrease with age, although chronotropic incompetence rates did not differ significantly (p = 1) – <strong>Table 2</strong>. Overall positivity rates were similar (p = 0.189), but response type differed (p = 0.001): elderly had more Type 3 (30% vs. 14.6%), and fewer Type 1 (26% vs. 41.5%) and Type 2B (4% vs. 12.2%) responses – <strong>Table 3 and 4</strong>. Classical orthostatic hypotension (OH) was more common in older patients and psychogenic pseudosyncope, postural orthostatic tachycardia syndrome, and dysautonomia only occurred in younger patients (p < 0.001) – <strong>Table 5</strong>. No significant differences were seen in therapeutic decisions such as device implantation (p = 0.3), eletrophisiology study (p = 0.458), pharmacological therapy (p = 1), and tilt training referral (p = 0.498), or syncope recurrence at one year follow up (0.318).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong>: HUTT protocol choice and test results differed significantly between age groups. Elderly patients more often underwent the Fast Italian protocol and showed vasodepressive patterns and classic OH, highlighting the role of age in autonomic changes and hemodynamic response to orthostasis. Interestingly, therapeutic decisions did not differ between the groups, which may suggest that syncope at this age is still undervalued by clinicians.</span></span></p>
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