is much more sophisticated than that of vasovagal syncope and may involve pacemakers and implantable cardioverter-defibrillators depending on the precise cardiac cause. risk tools the san francisco syncope rule was developed to isolate people who have higher risk for a serious cause of syncope. high risk is anyone who has: congestive heart failure, hematocrit <30%, electrocardiograph abnormality, shortness of breath, or systolic blood pressure <90 mmhg. the san francisco syncope rule however was not validated by subsequent studies. the canadian syncope risk score was developed to help select low-risk people that may be viable for discharge home. a score of <0 on the canadian syncope risk score is associated with <2% risk of serious adverse event within 30 days. it has been shown to be more effective than older syncope risk scores even combined with cardiac biomarkers at predicting adverse events. epidemiology there are 18.1–39.7 syncope episodes per 1000 people in the general population. rates are highest between the ages of 10–30 years old. this is likely because of the high rates of vasovagal syncope in the young adult population. older adults are more likely to have orthostatic or cardiac syncope. syncope affects about three to six out of every thousand people each year. it is more common in older people and females. it is the reason for 2–5% of visits to emergency departments and admissions to hospital. up to half of women over the age of 80 and a third of medical students describe at least one event at some point in their lives. prognosis of those presenting with syncope to an emergency department, about 4% died in the next 30 days. the risk of a poor outcome, however, depends very much on the underlying cause. situational syncope is not at increased risk of death or adverse outcomes. cardiac syncope is associated with worse prognosis compared to noncardiac syncope. factors associated with poor outcomes include history of heart failure, history of myocardial infarction, ecg abnormalities, palpitations, signs of hemorrhage, syncope during exertion, and advanced age. society and culture fainting in women was a commonplace trope or stereotype in victorian england and in contemporary and modern depictions of the period. syncope and presyncope are common in young athletes. in 1990 the american college basketball player hank gathers suddenly collapsed and died during a televised intercollegiate basketball game. he had previously collapsed during a game a few months prior. he was diagnosed with exercise-induced ventricular tachycardia at the time. there was speculation that he had since stopped taking the prescribed medications on game days. falling-out is a culture-bound syndrome primarily reported in the southern united states and the caribbean. etymology the term is derived from the late latin syncope, from ancient greek συγκοπή (sunkopē) 'cutting up', 'sudden loss of strength', from σύν (sun, "together, thoroughly") and κόπτειν (koptein, "strike, cut off").