Various existing models for syncope management from published data of comparison between systematic evaluation and conventional management in controlled studies
| . | The functional Syncope Unit in a cardiology department . | The Day-Care Syncope Evaluation Unit and Fall and Syncope Services . | The Rapid Access Blackouts Triage Clinic (T-LOC Triage Clinic) . | Tertiary referral SU . | The Syncope Observational Unit in the ED . | The web-based standardized care pathway for Faint and Fall patients (Faint and Fall Clinic) . |
|---|---|---|---|---|---|---|
| References | 13,17,20,25,36,39,41,43–45 | 12,35,46 | 47,48 | 49,50 | 15,26,51 | 5,25 |
| Location | Cardiology department/outpatient clinic | Outpatient clinic | Outpatient clinic | Outpatient clinic | ED | Outpatient clinic |
| Management | Cardiologist with rapid access to other specialists | Geriatrician/internist | Specialized nurses (arrhythmias, falls, epilepsy) Supervision: cardiologist/neurologist | One syncope specialist (neurologist, internist, cardiologist) | Experienced emergency physician | Cardiologist and geriatrician with rapid access to a neurologist |
| Support | Trained nurses | Other specialists and general practitioners, specialized nurses | Cardiologists | Technicians, specialized nurses | Specialized nurses, electrophysiologist's, other specialists | Nurse practitioner |
| Referral | Outpatients, fast track from ED, other departments | Community, ED, other departments | General practitioners, specialists (cardiology, neurology), ED | Most referrals from cardiologists and neurologists | ED (only intermediate risk patients were included in the SEEDS and EDOSP studies) | Outpatients and ED |
| Organization | Functional unit in the hospital | Day-care multidisciplinary medical approach, specialized nurses | Rapid assessment outpatient clinic | Outpatient clinic | 6–24 h of observation | Fixed unit with rapid access |
| Tools | Guidelines-based flowcharts, software | Specialist visits, non-invasive tests, occupational activities | Web-based questionnaire | History taking, reappraisal of the case | ECG and BP monitoring, non-invasive tests and electrophysiologist's consultations. Rapid FU appointment if discharged | Web-based decision-making software |
| Core laboratory tests | CSM, TT with beat-to-beat measurement, ILR and ELR, ambulatory BP monitoring | CSM, TT with beat-to-beat measurement, ILR, and ELR | History, physical examination, ECG, ILR | TT, CSM, autonomic tests, ambulatory BP and ECG monitoring, ILR | Laboratory tests, CSM, TT | Cardiac imaging, stress tests, TT, CSM, electrophysiological study, Holter, ELR, and ILR |
| Impact on outcomes: methodology | Lowering of hospital admissions and costs, improvement of the diagnostic yield | Lowering of costs driven by hospital admissions and readmissions, improvement of the diagnostic yield and access to tests | Rapid diagnosis and triage, lowering of readmissions for T-LOCs | Compared with other SUs low rates of unexplained syncope and of cardiac syncope, high rates of psychogenic pseudosyncope and complex reflex syncope | Higher and earlier number of suspected diagnosis, lower hospital admissions and patient-hospital days | Decrease in hospital admissions, higher rate of diagnosis at 45 days, less utilization of costly tests and consultations |
| . | The functional Syncope Unit in a cardiology department . | The Day-Care Syncope Evaluation Unit and Fall and Syncope Services . | The Rapid Access Blackouts Triage Clinic (T-LOC Triage Clinic) . | Tertiary referral SU . | The Syncope Observational Unit in the ED . | The web-based standardized care pathway for Faint and Fall patients (Faint and Fall Clinic) . |
|---|---|---|---|---|---|---|
| References | 13,17,20,25,36,39,41,43–45 | 12,35,46 | 47,48 | 49,50 | 15,26,51 | 5,25 |
| Location | Cardiology department/outpatient clinic | Outpatient clinic | Outpatient clinic | Outpatient clinic | ED | Outpatient clinic |
| Management | Cardiologist with rapid access to other specialists | Geriatrician/internist | Specialized nurses (arrhythmias, falls, epilepsy) Supervision: cardiologist/neurologist | One syncope specialist (neurologist, internist, cardiologist) | Experienced emergency physician | Cardiologist and geriatrician with rapid access to a neurologist |
| Support | Trained nurses | Other specialists and general practitioners, specialized nurses | Cardiologists | Technicians, specialized nurses | Specialized nurses, electrophysiologist's, other specialists | Nurse practitioner |
| Referral | Outpatients, fast track from ED, other departments | Community, ED, other departments | General practitioners, specialists (cardiology, neurology), ED | Most referrals from cardiologists and neurologists | ED (only intermediate risk patients were included in the SEEDS and EDOSP studies) | Outpatients and ED |
| Organization | Functional unit in the hospital | Day-care multidisciplinary medical approach, specialized nurses | Rapid assessment outpatient clinic | Outpatient clinic | 6–24 h of observation | Fixed unit with rapid access |
| Tools | Guidelines-based flowcharts, software | Specialist visits, non-invasive tests, occupational activities | Web-based questionnaire | History taking, reappraisal of the case | ECG and BP monitoring, non-invasive tests and electrophysiologist's consultations. Rapid FU appointment if discharged | Web-based decision-making software |
| Core laboratory tests | CSM, TT with beat-to-beat measurement, ILR and ELR, ambulatory BP monitoring | CSM, TT with beat-to-beat measurement, ILR, and ELR | History, physical examination, ECG, ILR | TT, CSM, autonomic tests, ambulatory BP and ECG monitoring, ILR | Laboratory tests, CSM, TT | Cardiac imaging, stress tests, TT, CSM, electrophysiological study, Holter, ELR, and ILR |
| Impact on outcomes: methodology | Lowering of hospital admissions and costs, improvement of the diagnostic yield | Lowering of costs driven by hospital admissions and readmissions, improvement of the diagnostic yield and access to tests | Rapid diagnosis and triage, lowering of readmissions for T-LOCs | Compared with other SUs low rates of unexplained syncope and of cardiac syncope, high rates of psychogenic pseudosyncope and complex reflex syncope | Higher and earlier number of suspected diagnosis, lower hospital admissions and patient-hospital days | Decrease in hospital admissions, higher rate of diagnosis at 45 days, less utilization of costly tests and consultations |
BP, blood pressure; CSM, carotid sinus massage; TT, tilt table test; ILR, implantable loop recorder; ELR, external loop recorder; T-LOC, transient loss of consciousness; ED, emergency department; ECG, electrocardiogram.
Various existing models for syncope management from published data of comparison between systematic evaluation and conventional management in controlled studies
| . | The functional Syncope Unit in a cardiology department . | The Day-Care Syncope Evaluation Unit and Fall and Syncope Services . | The Rapid Access Blackouts Triage Clinic (T-LOC Triage Clinic) . | Tertiary referral SU . | The Syncope Observational Unit in the ED . | The web-based standardized care pathway for Faint and Fall patients (Faint and Fall Clinic) . |
|---|---|---|---|---|---|---|
| References | 13,17,20,25,36,39,41,43–45 | 12,35,46 | 47,48 | 49,50 | 15,26,51 | 5,25 |
| Location | Cardiology department/outpatient clinic | Outpatient clinic | Outpatient clinic | Outpatient clinic | ED | Outpatient clinic |
| Management | Cardiologist with rapid access to other specialists | Geriatrician/internist | Specialized nurses (arrhythmias, falls, epilepsy) Supervision: cardiologist/neurologist | One syncope specialist (neurologist, internist, cardiologist) | Experienced emergency physician | Cardiologist and geriatrician with rapid access to a neurologist |
| Support | Trained nurses | Other specialists and general practitioners, specialized nurses | Cardiologists | Technicians, specialized nurses | Specialized nurses, electrophysiologist's, other specialists | Nurse practitioner |
| Referral | Outpatients, fast track from ED, other departments | Community, ED, other departments | General practitioners, specialists (cardiology, neurology), ED | Most referrals from cardiologists and neurologists | ED (only intermediate risk patients were included in the SEEDS and EDOSP studies) | Outpatients and ED |
| Organization | Functional unit in the hospital | Day-care multidisciplinary medical approach, specialized nurses | Rapid assessment outpatient clinic | Outpatient clinic | 6–24 h of observation | Fixed unit with rapid access |
| Tools | Guidelines-based flowcharts, software | Specialist visits, non-invasive tests, occupational activities | Web-based questionnaire | History taking, reappraisal of the case | ECG and BP monitoring, non-invasive tests and electrophysiologist's consultations. Rapid FU appointment if discharged | Web-based decision-making software |
| Core laboratory tests | CSM, TT with beat-to-beat measurement, ILR and ELR, ambulatory BP monitoring | CSM, TT with beat-to-beat measurement, ILR, and ELR | History, physical examination, ECG, ILR | TT, CSM, autonomic tests, ambulatory BP and ECG monitoring, ILR | Laboratory tests, CSM, TT | Cardiac imaging, stress tests, TT, CSM, electrophysiological study, Holter, ELR, and ILR |
| Impact on outcomes: methodology | Lowering of hospital admissions and costs, improvement of the diagnostic yield | Lowering of costs driven by hospital admissions and readmissions, improvement of the diagnostic yield and access to tests | Rapid diagnosis and triage, lowering of readmissions for T-LOCs | Compared with other SUs low rates of unexplained syncope and of cardiac syncope, high rates of psychogenic pseudosyncope and complex reflex syncope | Higher and earlier number of suspected diagnosis, lower hospital admissions and patient-hospital days | Decrease in hospital admissions, higher rate of diagnosis at 45 days, less utilization of costly tests and consultations |
| . | The functional Syncope Unit in a cardiology department . | The Day-Care Syncope Evaluation Unit and Fall and Syncope Services . | The Rapid Access Blackouts Triage Clinic (T-LOC Triage Clinic) . | Tertiary referral SU . | The Syncope Observational Unit in the ED . | The web-based standardized care pathway for Faint and Fall patients (Faint and Fall Clinic) . |
|---|---|---|---|---|---|---|
| References | 13,17,20,25,36,39,41,43–45 | 12,35,46 | 47,48 | 49,50 | 15,26,51 | 5,25 |
| Location | Cardiology department/outpatient clinic | Outpatient clinic | Outpatient clinic | Outpatient clinic | ED | Outpatient clinic |
| Management | Cardiologist with rapid access to other specialists | Geriatrician/internist | Specialized nurses (arrhythmias, falls, epilepsy) Supervision: cardiologist/neurologist | One syncope specialist (neurologist, internist, cardiologist) | Experienced emergency physician | Cardiologist and geriatrician with rapid access to a neurologist |
| Support | Trained nurses | Other specialists and general practitioners, specialized nurses | Cardiologists | Technicians, specialized nurses | Specialized nurses, electrophysiologist's, other specialists | Nurse practitioner |
| Referral | Outpatients, fast track from ED, other departments | Community, ED, other departments | General practitioners, specialists (cardiology, neurology), ED | Most referrals from cardiologists and neurologists | ED (only intermediate risk patients were included in the SEEDS and EDOSP studies) | Outpatients and ED |
| Organization | Functional unit in the hospital | Day-care multidisciplinary medical approach, specialized nurses | Rapid assessment outpatient clinic | Outpatient clinic | 6–24 h of observation | Fixed unit with rapid access |
| Tools | Guidelines-based flowcharts, software | Specialist visits, non-invasive tests, occupational activities | Web-based questionnaire | History taking, reappraisal of the case | ECG and BP monitoring, non-invasive tests and electrophysiologist's consultations. Rapid FU appointment if discharged | Web-based decision-making software |
| Core laboratory tests | CSM, TT with beat-to-beat measurement, ILR and ELR, ambulatory BP monitoring | CSM, TT with beat-to-beat measurement, ILR, and ELR | History, physical examination, ECG, ILR | TT, CSM, autonomic tests, ambulatory BP and ECG monitoring, ILR | Laboratory tests, CSM, TT | Cardiac imaging, stress tests, TT, CSM, electrophysiological study, Holter, ELR, and ILR |
| Impact on outcomes: methodology | Lowering of hospital admissions and costs, improvement of the diagnostic yield | Lowering of costs driven by hospital admissions and readmissions, improvement of the diagnostic yield and access to tests | Rapid diagnosis and triage, lowering of readmissions for T-LOCs | Compared with other SUs low rates of unexplained syncope and of cardiac syncope, high rates of psychogenic pseudosyncope and complex reflex syncope | Higher and earlier number of suspected diagnosis, lower hospital admissions and patient-hospital days | Decrease in hospital admissions, higher rate of diagnosis at 45 days, less utilization of costly tests and consultations |
BP, blood pressure; CSM, carotid sinus massage; TT, tilt table test; ILR, implantable loop recorder; ELR, external loop recorder; T-LOC, transient loss of consciousness; ED, emergency department; ECG, electrocardiogram.
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