Diagnostic and societal impact of implementing the syncope guidelines of the European Society of Cardiology (SYNERGY study)

Background Syncope management is fraught with unnecessary tests and frequent failure to establish a diagnosis. We evaluated the potential of implementing the 2018 European Society of Cardiology (ESC) Syncope Guidelines regarding diagnostic yield, accuracy and costs. Methods A multicentre pre-post st...

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Published in:	BMC medicine Vol. 21; no. 1; pp. 1 - 365
Main Authors:	Ghariq, M, van den Hout, W. B, Dekkers, O. M, Bootsma, M, de Groot, B, Groothuis, J. G. J, Harms, M. P. M, Hemels, M. E. W, Kaal, E. C. A, Koomen, E. M, de Lange, F. J, Peeters, S. Y. G, van Rossum, I. A, Rutten, J. H. W, van Zwet, E. W, van Dijk, J. G, Thijs, R. D, Tuinema, R. M, Voet, W, Boerman, D. B, Firouzi, M, Fokke, C
Format:	Journal Article
Language:	English
Published:	London BioMed Central Ltd 25-09-2023 BioMed Central BMC
Subjects:	Admission Analysis Blood pressure Cardiology Care and treatment Causes of Diagnosis Diagnostic systems Diseases Emergency medical care Emergency medical services Epilepsy Fainting Family physicians Guidelines Health aspects Health care Healthcare efficiency Hospitals Internal medicine Medical care, Cost of Medical diagnosis Medical referrals Patients Quality of life Regression analysis Relapse Syncope Tilt table testing Trade and professional associations Transient loss of consciousness Netherlands
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Summary:	Background Syncope management is fraught with unnecessary tests and frequent failure to establish a diagnosis. We evaluated the potential of implementing the 2018 European Society of Cardiology (ESC) Syncope Guidelines regarding diagnostic yield, accuracy and costs. Methods A multicentre pre-post study in five Dutch hospitals comparing two groups of syncope patients visiting the emergency department: one before intervention (usual care; from March 2017 to February 2019) and one afterwards (from October 2017 to September 2019). The intervention consisted of the simultaneous implementation of the ESC Syncope Guidelines with quick referral routes to a syncope unit when indicated. The primary objective was to compare diagnostic accuracy using logistic regression analysis accounting for the study site. Secondary outcome measures included diagnostic yield, syncope-related healthcare and societal costs. One-year follow-up data were used to define a gold standard reference diagnosis by applying ESC criteria or, if not possible, evaluation by an expert committee. We determined the accuracy by comparing the treating physician's diagnosis with the reference diagnosis. Results We included 521 patients (usual care, n = 275; syncope guidelines intervention, n = 246). The syncope guidelines intervention resulted in a higher diagnostic accuracy in the syncope guidelines group than in the usual care group (86% vs.69%; risk ratio 1.15; 95% CI 1.07 to 1.23) and a higher diagnostic yield (89% vs. 76%, 95% CI of the difference 6 to 19%). Syncope-related healthcare costs did not differ between the groups, yet the syncope guideline implementation resulted in lower total syncope-related societal costs compared to usual care (saving [euro]908 per patient; 95% CI [euro]34 to [euro]1782). Conclusions ESC Syncope Guidelines implementation in the emergency department with quick referral routes to a syncope unit improved diagnostic yield and accuracy and lowered societal costs. Trial registration Netherlands Trial Register, NTR6268 Keywords: Transient loss of consciousness, Healthcare efficiency, Syncope, Epilepsy, Admission, Tilt table testing, QALY
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1741-7015 1741-7015
DOI:	10.1186/s12916-023-03056-6