Complex non-drug therapies in patients with vasovagal syncope, adherence to treatment and quality of life

Objective. To study the effectiveness of combined non-drug treatments in patients with vasovagal syncope (VVS) in long-term period, adherence to treatment and quality of life. Material and methods. The study included 46 patients with VVS (≥2 recurrences in the past year). Mean age was 29.5 years; there were 20 (43.5%) women. All patients were advised with non-pharmacological methods (avoiding situations triggering VVS, fluid intake 2.5-3 liters daily, salt intake 6-9 g daily (except for patients with arterial hypertension), orthostatic training, and special maneuvers for pre-syncope symptoms). Patients completed questionnaires to assess their quality of life (EQ-5D-5L) and anxiety / depression (HADS). Adherence to lifestyle modifications was assessed using the KOP-25 questionnaire. Results. Throughout long-term period (Me=533 days), recurrent syncope occurred in 30 (65%) patients. Twenty-four (52%) patients experienced less number of relapses, and 6 (13%) patients had the same incidence of syncope. The median value of “health status” in VAS scale was 70% [60; 85]. According to HADS scale, signs of subclinical and significant anxiety were detected in 27% of cases, depression — in 23%. In long-term period, patients with VVS demonstrated better QOL indicators (median VAS 80%, 70—85% (Q1—Q3), p=0.006). Proportion of patients with depression decreased significantly. Ninety-six percent of patients with VVS demonstrated low (<50%) adherence to lifestyle modification, one patient (2.2%) had moderate (51%), and one patient (2.2%) had high (87%) adherence. Conclusion. Combined non-pharmacological treatments aimed at lifestyle modification are effective in 87% of patients with VVS in long-term period. This resulted in either absence of syncope (35%) or less number of syncope recurrences and better QoL (52%). Reduced QoL scores (EQ-5D-5L) are observed across all items, but these declines are mild. According to HADS scale, signs of subclinical and clinical anxiety are observed in 27% of VVS patients, while depression is observed in 23% of cases. Proportion of patients with depressive symptoms decreases significantly in long-term period. The KOP-25 questionnaire reveals low adherence to lifestyle modification in 95.6% of patients with VVS.