Abstract 11207: The Application of New Practice Guidelines to Patients Hospitalized with Syncope: Impact on Management and Long-Term Outcomes
Background: Syncope is a common cause for hospital admission. Since pts with a cardiac etiology for syncope have high mortality, recent practice guidelines (ESC/EGYSYS, OESIL) emphasize the need to risk stratify pts with syncope as opposed to focusing on making a definitive diagnosis. There are no prospective data that examine outcomes following implementation of this strategy.
Methods: We enrolled consecutive pts admitted from the ER for further evaluation of syncope. All pts underwent a history and physical, ECG, echo, and ≥24 hrs of telemetry. Additional tests were performed as necessary. Pts with significant bradycardia received a PPM; pts with LV dysfunction received an ICD. An ILR was suggested to all pts with recurrent or traumatic syncope or syncope with an abnormal ECG (e.g. LBBB).
Results: We enrolled 200 pts (69 ± 17 yrs, 52% M), including 75 (28%) pts with prior syncope. Most (182 [91%] pts) were in sinus rhythm. Bundle branch block was present in 14 (7%) pts. LV function was assessed in 186 (93%) pts and was normal in 162 (87%). The median hospitalization was 3 days (IQR 2, 6); the major discharge diagnoses were vasovagal syncope (n=90 [45%] and unknown (n=46 [23%]). Devices were placed in 23 (12%) pts; this included an ILR (n=6), PPM (n=9), and an ICD (n=8). During follow-up, 6 pts died, which included 2 pts who died during index hospitalization and 1 pt with LV dysfunction who refused an ICD and later died of a cardiac arrest. Only 1 pt with an “unknown” cause for syncope died. The 1-year survival was 96.5% (Figure).
Conclusions: These prospective data demonstrate that implementation of recent practice guidelines that emphasize risk stratification over making a definitive diagnosis is associated with an excellent 1-year survival in pts being admitted for evaluation of syncope. A minority of pts require an implantable device for monitoring or therapy. Further efforts need to be directed towards reducing duration of hospitalization in these pts.
- © 2010 by American Heart Association, Inc.