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(Circulation. 2004;110:3621-3623.)
© 2004 American Heart Association, Inc.

Editorial

Specialized Syncope Evaluation

William H. Maisel, MD, MPH

From Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass.

Reprint requests to William H. Maisel, MD, MPH, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail wmaisel@partners.org

Key Words: Editorials • syncope • death, sudden

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The concept of specialized cardiovascular care is not new. Nearly 4 decades ago, Killip and Kimball¹ reported the results of their study of the treatment of 250 patients with myocardial infarction in a coronary care unit. With continuous ECG monitoring at a centralized nursing station, defibrillators at each bedside, and nurses authorized to deliver precordial shocks if physicians did not respond fast enough, the mortality rate was reduced from 26% to 7%.¹ A classification scheme for heart failure severity was developed, and the authors ultimately concluded that the coronary care unit was critical to the timely recognition and treatment of potentially lethal arrhythmias.

See p 3636

During the ensuing decades, expert coronary care has been extended to the emergency department, where specialized units or critical pathways are used to provide expedited, high-quality care for a variety of cardiovascular symptoms and diagnoses, including chest pain, unstable angina, myocardial infarction, heart failure, and stroke. The goals of this specialized care are to provide more efficient, higher-quality health care for less money by reducing unnecessary hospital admissions, hastening diagnosis, increasing diagnostic yield, and decreasing adverse outcomes. For a specialized plan of care to be realistic, the diagnosis should be relatively common, require immediate evaluation, and have significant associated morbidity, mortality, or both if left untreated or misdiagnosed.

As an example, critical pathways for the management of acute chest pain have succeeded at improving care for patients at low or intermediate risk for myocardial ischemia. A strategy of early diagnostic testing including the measurement . . . [Full Text of this Article]

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