The DOI matches its Crossref record, with a small difference in title or year; 34 of the 34 references it cites were found in a registry or an index.
Cost implications of testing strategy in patients with syncope
Open accessAbstract
Objectives We sought to assess the cost implications of two investigation strategies in patients with unexplained syncope.Background Establishing a diagnosis in patients with unexplained syncope is complicated by infrequent and unpredictable events. The cost-effectiveness of immediate, prolonged monitoring as an alternative to conventional diagnostic strategies has not been studied.Methods Sixty patients (age 66 +/- 14 years; 33 males) with unexplained syncope and LV ejection fraction >35% were randomized to conventional testing with an external loop recorder, tilt and electrophysiologic (EP) testing, or prolonged monitoring with an implantable loop recorder with one-year monitoring. If patients remained undiagnosed after their assigned strategy, they were offered a crossover to the alternate strategy. Cost analysis of the two testing strategies was performed.Results Fourteen of 30 patients who were being monitored were diagnosed at a cost of 2,731 Canadian dollars +/- 285 Canadian dollars per patient and 5,852 Canadian dollars +/- 610 Canadian dollars per diagnosis. In contrast, only six of 30 conventional patients were diagnosed (20% vs. 47%, p = 0.029), at a cost of 1,683 Canadian dollars +/- 505 Canadian dollars per patient (p < 0.0001) and 8,414 Canadian dollars +/- 2,527 Canadian dollars per diagnosis (p < 0.0001). After crossover, a diagnosis was obtained in 1 of 5 patients undergoing conventional testing, compared with 8 of 21 patients who completed monitoring (20% vs. 38%, p = 0.44). Overall, a strategy of monitoring followed by tilt and EP testing was associated with a diagnostic yield of 50%, at a cost of 2,937 Canadian dollars +/- 579 Canadian dollars per patient and 5,875 Canadian dollars +/- 1,159 Canadian dollars per diagnosis. Conventional testing followed by monitoring was associated with a diagnostic yield of 47%, at a greater cost of 3,683 Canadian dollars +/- 1,490 Canadian dollars per patient (p = 0.013) and a greater cost per diagnosis (7,891 Canadian dollars +/- 3,193 Canadian dollars, p = 0.002).Conclusions A strategy of primary monitoring is more cost-effective than conventional testing in establishing a diagnosis in recurrent unexplained syncope.
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“It is important to note that there have been randomized controlled trials of the devices’ clinical effectiveness, and the results consistently show that for older patients with unexplained syncope, recorders should be used earlier in the investigation rather than later.102–104”
From 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope (2015) · cites this paper as [103]
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“Finally, mean costs per diagnostic result were also high in an outpatient ($19,900) specialty clinic for unexplained recurrent syncope (163).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [163]
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Cites
A Prospective Evaluation and Follow-up of Patients with Syncope
Kapoor, W. N., Karpf, M., Wieand, S., Peterson, J. R., & Levey, G. S. (1983) · New England Journal of Medicine · doi:10.1056/nejm198307283090401 · Cited by 779
Tilt table testing for assessing syncope
Benditt, D. G., Ferguson, D. W., Grubb, B. P., Kapoor, W. N., Kugler, J., Lerman, B. B., Maloney, J. D., Ravielle, A., Ross, B. A., Sutton, R., et al. (1996) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(96)00236-7 · Cited by 574
Krahn, A. D., Klein, G. J., Yee, R., & Skanes, A. C. (2001) · Circulation · doi:10.1161/01.cir.104.1.46 · Cited by 405
Self-citationUse of an Extended Monitoring Strategy in Patients With Problematic Syncope
Krahn, A. D., Klein, G. J., Yee, R., Takle-Newhouse, T., & Norris, C. (1999) · Circulation · doi:10.1161/01.cir.99.3.406 · Cited by 360
Self-citationCLINICAL GUIDELINE: Diagnosing Syncope: Part 2: Unexplained Syncope
Linzer, M., Yang, E. H., Estes, N. A. M., Wang, P., Vorperian, V. R., & Kapoor, W. N. (1997) · Annals of Internal Medicine · doi:10.7326/0003-4819-127-1-199707010-00014 · Cited by 313
Guidelines for clinical intracardiac electrophysiological and catheter ablation procedures
Zipes, D. P., Dimarco, J., Gillette, P. C., Jackman, W. M., Myerburg, R. J., Rahimtoola, S. H., Ritchie, J. L., Cheitlin, M. D., Garson, A., Gibbons, R. J., et al. (1995) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(95)80037-h · Cited by 279
Upright tilt testing in evaluating syncope: A comprehensive literature review
Kapoor, W. N., Smith, M. A., & Miller, N. L. (1994) · The American Journal of Medicine · doi:10.1016/0002-9343(94)90051-5 · Cited by 275
Incremental diagnostic yield of loop electrocardiographic recorders in unexplained syncope
Linzer, M., Pritchett, E. L. C., Pontinen, M., McCarthy, E., & Divine, G. W. (1990) · The American Journal of Cardiology · doi:10.1016/0002-9149(90)90591-n · Cited by 239
Unexplained Syncope Evaluated by Electrophysiologic Studies and Head-up Tilt Testing
SRA, J. S., Anderson, A. J., Sheikh, S. H., Avitall, B., TCHOU, P. J., Troup, P. J., Gilbert, C. J., Akhtar, M., & Jazayeri, M. R. (1991) · Annals of Internal Medicine · doi:10.7326/0003-4819-114-12-1013 · Cited by 220
The etiology of syncope in patients with negative tilt table and electrophysiological testing
Krahn, A. D., Klein, G. J., Norris, C., & Yee, R. (1995) · Circulation · doi:10.1161/01.cir.92.7.1819 · Cited by 215
Self-citation
Research works printed but not linked: 1
- Simpson, 1999, A cost effective approach to the investigation of syncope, Can J Cardiol, 15, 579
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Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), societies, E. B. T. F., European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp298 · Cited by 2,040
Self-citationSheldon, R. S., Grubb, B. P., Olshansky, B., Shen, W.-K., Calkins, H., Brignole, M., Raj, S. R., Krahn, A. D., Morillo, C. A., Stewart, J. M., et al. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.03.029 · Cited by 1,013
Self-citation2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.03.004 · Cited by 478
Self-citationShen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Circulation · doi:10.1161/cir.0000000000000499 · Cited by 463
Self-citationShen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Circulation · doi:10.1161/cir.0000000000000498 · Cited by 411
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Metadata
- Authors
- Krahn, A. D., Klein, G. J., Yee, R., Hoch, J. S., & Skanes, A. C.
- Affiliations
- Western University (CA)
- Corresponding author
- Krahn, Andrew D
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2003-08
- Volume
- 42
- Issue
- 3
- Pages
- 495-501
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2130890027
- Semantic Scholar
- fb515b0e264326bf89e06d61086adca7e71aabcd
- Cited by
- 170
- References
- 34
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 1 · 2023: 1 · 2022: 5 · 2021: 6 · 2020: 3 · 2019: 1 · 2018: 4 · 2017: 12 · 2016: 17 · 2015: 14 · 2014: 13 · 2013: 14 · 2012: 9
- FWCI
- 7.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Heart and Stroke Foundation of Canada
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Keywords
- unexplained syncope, cost-effectiveness, implantable loop recorder, prolonged cardiac monitoring, tilt table test, electrophysiologic testing, diagnostic yield, recurrent syncope, diagnostic approach, elderly patients, crossover design, United States comparison, United Kingdom comparison
- MeSH terms
- Aged, Costs and Cost Analysis, Electrodes, Implanted, Female, Humans, Male, Middle Aged, Prospective Studies, Recurrence, Syncope, Electrocardiography, Ambulatory
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