4. Syncope Evaluation & Syncope Unit: 4.6 The Best Management of Syncope. Prospective Systematic Guideline-Based Evaluation of Patients Referred Urgently to General Hospitals Free

The guidelines of the European Society of Cardiology define the best current standard for the management of syncope

Prospective systematic evaluation on strict adherence to the guidelines of consecutive patients referred for syncope to the emergency departments of 11 general hospitals. In order to maximize the application, a decision making guideline-based software and the designation of trained core medical personnel – both locally in each hospital and centrally – who verified the adherence to the diagnostic pathway and eventually gave advices for its correction were utilized.

A diagnostic work-up consistent with guidelines was completed in 465/541 patients (86%). A definite diagnosis was established in 98% (unexplained in 2%): neurally-mediated syncope was found in 66%, orthostatic hypotension in 10%, primary cardiac arrhythmias in 11%, structural cardiac or cardiopulmonary disease in 5% and non-syncopal attacks in 6%. The initial evaluation (consisting in history, physical examination and standard electrocardiogram) established a diagnosis in 50% of cases. Hospitalization for the management of syncope was appropriate in 25% and was required for other reasons in a further 13% of cases. The median in-hospital stay was 5 days (interquartile range 3-9). Apart from the initial evaluation, a total of 358 appropriate tests were performed in 193 patients (mean 1.9±1.1 per patient).

Guidelines can be implemented in the clinical practice provided that they are carefully and systematically applied. The results of this study assess the current standard for the management of syncope.