European Heart Journal Advance Access originally published online on November 4, 2005
European Heart Journal 2006 27(1):76-82; doi:10.1093/eurheartj/ehi647
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A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals
1Department of Cardiology, Arrhythmologic Centre, Ospedali del Tigullio, Via don Bobbio 24, 16033 Lavagna, Italy
2Department of Cardiology, Ospedale S Maria Nuova, Reggio Emilia, Italy
3Department of Cardiology, Nuovo Osp. S. Giovanni di Dio, Firenze, Italy
4Department of Cardiology, Ospedale Umberto I, Mestre, Italy
5Department of Emergency Medicine, Ospedale S. Maria Nuova, Firenze, Italy
6Department of Geriatrics, Ospedale Careggi and University of Firenze, Firenze, Italy
7Department of Emergency Medicine, Ospedale S Martino, Genova, Italy
8Department of Geriatrics, Ospedale Estense and University of Modena, Modena, Italy
9Department of Emergency Medicine, Policlinico S Orsola Malpighi and University of Bologna, Bologna, Italy
10Internal Medicine II, Ospedale L Sacco and University of Milan, Milan, Italy
11Department of Cardiology, Ospedale Salvini, Rho, Italy
12Fondazione Medtronic, Milano, Italy
Received 8 July 2005; revised 7 October 2005; accepted 20 October 2005; online publish-ahead-of-print 4 November 2005.
* Corresponding author. Tel: +39 0185 329569; fax: +39 0185 306506. E-mail address: mbrignole{at}asl4.liguria.it
See page 7 for the editorial comment on this article (doi:10.1093/eurheartj/ehi626)
Aims The guidelines of the European Society of Cardiology (ESC) define the current standard for the management of syncope, but are still incompletely applied in the clinical setting.
Methods and results Prospective systematic evaluation, on strict adherence to the guidelines, of consecutive patients referred for syncope to the emergency departments of 11 general hospitals. In order to maximize the application, a decision-making guideline-based software was used and trained core medical personnel were designated—both locally in each hospital and centrally—to verify adherence to the diagnostic pathway and give advice on its correction. A diagnostic work-up consistent with the guidelines was completed in 465/541 patients (86%). A definite diagnosis was established in 98% (unexplained in 2%): neurally mediated syncope accounted for 66% of diagnosis, orthostatic hypotension 10%, primary arrhythmias 11%, structural cardiac or cardiopulmonary disease 5%, and non-syncopal attacks 6%, respectively. The initial evaluation (consisting of history, physical examination, and standard electrocardiogram) established a diagnosis in 50% of cases. Hospitalization for the management of syncope was appropriate in 25% and was required for other reasons in a further 13% of cases. The median in-hospital stay was 5.5 days (interquartile range, 3–9). Apart from the initial evaluation, a mean of 1.9±1.1 appropriate tests per patient was performed in 193 patients and led to a final diagnosis in 182 of these (94%).
Conclusion The results of this study assess the current standard for the management of syncope on the basis of a rigorous adherence to guidelines of the ESC and provide a frame of reference for daily activity when dealing with syncope.
Key Words: Syncope • Diagnosis • Decision making system • Guidelines
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