Abstract 18006: A Simple Novel SELF-Pathway Appropriately Identify High Risk Patients When Admitted with Unexplained Syncope
Background: We developed a novel SELF pathway to guide physicians in risk stratification of patients with unexplained syncope. According to our pathway patients are risk stratified twice using the acronyms SELF-A (Short period, Early-rapid onset, Loss of consciousness, Full recovery) and SELF-B (Structural heart disease, abnormal Ecg, and arrhythmia Fib/FL). We assessed the short-term outcome according to this approach.
Methods: 1462 patients presented to our ED for evaluation of unexplained syncope between September 2007 and September 2009 was prospectively followed. Patients were risk assessed according to the pathway to having SELF-A and SELF-B present (Group A: SELF +/+) or not present (Group B: SELF -/-).The primary endpoint was a composite endpoint of readmission for syncope (ROS), myocardial infarction (MI), stroke or death. Follow-up was 494 ± 120 days.
Results: 762 subjects were classified accordingly to the two groups. 534 (70%) patients in Group A and 228 (30%) patients in Group B. Group A were older (73 ± 15 years vs. 61 ± 21 years), with more hypertension (74% vs. 45%), diabetes (25% vs. 16%), heart failure (9% vs. 3%), and coronary disease (21% vs. 4%); p<0.001. During hospital stay group A had 58 (11%) procedures including 33 device implantation, 10 EP studies, 11 tilt tables and 4 cardioversions. At 7-days follow-up group A patients had 11 (2%) events comparing to 2 (0.01%) for group B; p <0.001. At 30-days follow-up group A patients had 46 (9%) events comparing to 11 (1.7%) for group B; p <0.0001 as seen in Figure.
Conclusions: Using a simple novel SELF pathway for patients presenting with unexplained syncope effectively identifies high risk patients who merit hospitalization for further work-up. This has important implications for the evaluation management of a common disease that poses a significant economic burden on healthcare utilization.
- © 2011 by American Heart Association, Inc.