To determine the incidence of patients presenting to a major metropolitan hospital after experiencing syncope at church, and to compare their outcomes with those of patients experiencing syncope at other locations. Design, setting and participants: A retrospective matched cohort study in which patients presenting with church syncope between July 2009 and June 2013 were compared with controls (patients presenting after syncope experienced elsewhere) matched by 5-year age group and San Francisco Syncope Score. Main outcome measures: Admission to hospital was the primary outcome measure. Mortality, intensive care unit or coronary care unit admission, and length of stay in hospital were secondary outcome measures. Results: There were 31 cases of church syncope during the study period, which were matched to 62 controls. The hospital admission rate among patients who experienced syncope in church was significantly lower than among controls (22.6 v 46.8 ; P = 0.02). After adjusting for other variables significantly associated with admission to hospital, the church as a location for syncope was no longer significantly associated with hospital admission (odds ratio, 0.4; 95 CI, 0.1?1.1; P=0.06). Conclusions: The number of patients presenting to hospital after church syncope was low; most had benign diagnoses and were discharged home from the emergency department. While syncope at church was associated with a lower rate of hospital admission, the church did not appear to offer any additional sanctuary when clinical risk profiles were taken into consideration.