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Cited by 133Cardiovascular Syncope and Autonomic DisordersVestibular and auditory disordersHeart Rate Variability and Autonomic Control

Prospective multicentre systematic guideline-based management of patients referred to the Syncope Units of general hospitals

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Brignole, M., Ungar, A., Casagranda, I., Gulizia, M., Lunati, M., Ammirati, F., Del Rosso, A., Sasdelli, M. +8 more·2010·Europace
DOI 10.1093/europace/eup370
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Abstract

AIMS: Although an organizational model for syncope management facilities was proposed in the 2004 guidelines of the European Society of Cardiology (ESC), its implementation in clinical practice and its effectiveness are largely unknown. METHODS AND RESULTS: This prospective study enrolled 941 consecutive patients referred to the Syncope Units of nine general hospitals from 15 March 2008 to 15 September 2008. A median of 15 patients per month were examined in each unit, but the five older units had a two-fold higher volume of activity than the four newer ones (instituted <1 year before): 23 vs. 12, P = 0.02. These figures give an estimated volume of 163 and 60 patients per 100,000 inhabitants per year, respectively. Referrals: 60% from out-of-hospital services, 11% immediate and 13% delayed referrals from the Emergency Department, and 16% hospitalized patients. A diagnosis was established on initial evaluation in 191 (21%) patients and early by means of 2.9 +/- 1.6 tests in 541 (61%) patients. A likely reflex cause was established in 67%, orthostatic hypotension in 4%, cardiac in 6% and non-syncopal in 5% of the cases. The cause of syncope remained unexplained in 159 (18%) patients, despite a mean of 3.5 +/- 1.8 tests per patient. These latter patients were older, more frequently had structural heart disease or electrocardiographic abnormalities, unpredictable onset of syncope due to the lack of prodromes, and higher OESIL and EGSIS risk scores than the other groups of patients. The mean costs of diagnostic evaluation was 209 euro per outpatient and 1073 euro per inpatient. The median cost of hospital stay was 2990 euro per patient. CONCLUSION: We documented the current practice of syncope management in specialized facilities that have adopted the management model proposed by the ESC. The results are useful for those who wish to replicate this model in other hospitals. Syncope remains unexplained during in-hospital evaluation in more complex cases at higher risk.

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Crossref · 10.1093/europace/eup370

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  • In a multicentre study aimed at validation of the 2009 ESC Guidelines, carotid sinus massage was indicated after initial evaluation in 73% of 700 patients and was diagnostic in 12%.

    “In a multicentre study 94 aimed at validation of the 2009 ESC Guidelines, CSM was indicated after initial evaluation in 73% of 700 patients and was diagnostic in 12%.”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [94]

    Table 4 (Definitions; page unavailable) reports that carotid sinus massage was performed in 509 of 700 patients without a diagnosis after initial evaluation (73%) and was diagnostic in 62 of those tested (12%). It does not say the test was indicated in all 509. Patient recruitment took place in 2008, and the Diagnostic pathway section describes use of ESC guidelines without identifying the study as a validation of the 2009 guidelines. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • Specialized syncope evaluation units may lead to reduced health service use and increased diagnostic rates.

    “Specialized syncope evaluation units may lead to reduced health service use and increased diagnostic rates (114–119).”

    From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [118]

    The Discussion (page unavailable) reports that earlier syncope-care models improved diagnostic yield and cost-effectiveness compared with usual practice, and the study itself reports diagnoses for most patients. Its hospitalization and cost analysis (page unavailable) measures service use but does not show that the units reduced it; the Discussion presents reduced hospitalization as a potential source of savings, not an observed result. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • The rate of PPS varies from 1% of patients referred to general syncope clinics to 8% of patients referred to specialist neurological clinics.

    “The rate of PPS varies from 1% of patients referred to general syncope clinics 94 to 8% of patients referred to specialist neurological clinics, 116”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [94]

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Research works printed but not linked: 2

  1. Giada F, Ammirati F, Bartoletti A, Del Rosso A, Dinelli M, Foglia Manzillo G et al. Proposte organizzative per la gestione della sincope negli ospedali italiani. G Ital Aritmol Cardiostim 2007;10:117 -63.
  2. Brignole M, Ungar A, Bartoletti A, Lagi A, Mussi C, Ribani MA et al. Standardized care pathway versus usual management of syncope referred in emergency to general hospitals (EGSYS 2). Europace 2006;8:644 -50.

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Authors
Brignole, M., Ungar, A., Casagranda, I., Gulizia, M., Lunati, M., Ammirati, F., Del Rosso, A., Sasdelli, M., Santini, M., Maggi, R., Vitale, E., Morrione, A., Francese, G. M., Vecchi, M. R., Giada, F., & for the Syncope Unit Project (SUP) investigators
Affiliations
  • Presidio Ospedaliero (IT)
  • Azienda Ospedaliero-Universitaria Careggi (IT)
  • Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo (IT)
  • Ospedale Garibaldi (IT)
  • Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT)
  • Ospedale Sandro Pertini (IT)
  • Ospedale San Filippo Neri (IT)
  • Ospedale dell' Angelo (IT)
Corresponding author
Brignole, M.
ORCID
Venue
Europace
Publisher
Oxford University Press (OUP)
Published
2009-11-30
Volume
12
Issue
1
Pages
109-118
ISSN
  • 1099-5129 (ISSN-L)
  • 1532-2092
DOI
10.1093/europace/eup370
OpenAlex
W2037968100
Cited by
133
References
18
Citations by year
2026: 3 · 2025: 2 · 2024: 15 · 2023: 10 · 2022: 3 · 2021: 9 · 2020: 3 · 2019: 3 · 2018: 9 · 2017: 7 · 2016: 8 · 2015: 12 · 2014: 11 · 2013: 15 · 2012: 8
FWCI
7.77
Type
journal article
Language
en
Open access
Locations
  • EP Europace (publishedVersion)
  • PubMed (publishedVersion)
  • Florence Research (University of Florence) (submittedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Keywords
syncope, syncope unit, syncope management, diagnostic assessment, unexplained syncope, orthostatic hypotension, reflex syncope, cardiac syncope, referral patterns, diagnostic costs, hospital costs, risk score, general hospitals
MeSH terms
Adult, Aged, Aged, 80 and over, Female, Humans, Italy, Male, Middle Aged, Practice Patterns, Physicians', Prospective Studies, Syncope, Prevalence, Health Care Costs, Practice Guidelines as Topic, Guideline Adherence

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