Performance of the American Heart Association/American College of Cardiology/Heart Rhythm Society versus European Society of Cardiology Guideline Criteria for Hospital Admission of Patients with Syncope

Current ACC/AHA/HRS and ESC-guidelines recommend different strategies to avoid low-yield admissions in patients with syncope. Directly comparing safety and efficacy of applying admission criteria of both guidelines to patients presenting with syncope to the ED in two multicentre studies The internat...

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Published in:	Heart rhythm Vol. 19; no. 10; pp. 1712 - 1722
Main Authors:	du Fay de Lavallaz, Jeanne, Zimmermann, Tobias, Badertscher, Patrick, Lopez-Ayala, Pedro, Nestelberger, Thomas, Miró, Òscar, Salgado, Emilio, Zaytseva, Xenia, Gafner, Michele Sara, Christ, Michael, Cullen, Louise, Than, Martin, Martin-Sanchez, F. Javier, Di Somma, Salvatore, Peacock, W. Frank, Keller, Dagmar I., Costabel, Juan Pablo, Sigal, Alan, Puelacher, Christian, Wussler, Desiree, Koechlin, Luca, Strebel, Ivo, Schuler, Sereina, Manka, Robert, Bilici, Murat, Lohrmann, Jens, Kühne, Michael, Breidthardt, Tobias, Clark, Carol L., Probst, Marc, Gibson, Thomas A., Weiss, Robert E., Sun, Benjamin C., Mueller, Christian, Widmer, Velina, Leu, Kathrin, Reichlin, Tobias, Shrestha, Samyut, Freese, Michael, Krisai, Philipp, Belkin, Maria, Kawecki, Damian, Morawiec, Beata, Muzyk, Piotr, Nowalany-Kozielska, Ewa, Geigy, Nicolas, Martinez-Nadal, Gemma, Fuenzalida Inostroza, Carolina Isabel, Mandrión, José Bustamante, Poepping, Imke, Greenslade, Jaimi, Hawkins, Tracey, Rentsch, Katharina, Mitrovic, Sandra, von Eckardstein, Arnold, Buser, Andreas, Osswald, Stefan, Walter, Joan, Adler, David H., Bastani, Aveh, Baugh, Christopher W., Caterino, Jeffrey M., Diercks, Deborah B., Hollander, Judd E., Nicks, Bret A., Nishijima, Daniel K., Shah, Manish N., Stiffler, Kirk A., Wilber, Scott T., Storrow, Alan B.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-10-2022
Subjects:	admission diagnosis guidelines safety Syncope diagnosis guidelines admission Syncope safety
Online Access:	Get full text
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Summary:	Current ACC/AHA/HRS and ESC-guidelines recommend different strategies to avoid low-yield admissions in patients with syncope. Directly comparing safety and efficacy of applying admission criteria of both guidelines to patients presenting with syncope to the ED in two multicentre studies The international BASEL-IX (median age 71 years) and the American SRS study (median age 72 years). Primary endpoints were sensitivity/specificity for the adjudicated diagnosis of cardiac syncope (BASEL-IX only) and 30-day major adverse cardiovascular events (30d-MACE). Among 2’560 patients in BASEL-IX and 2’085 in SRS, ACC/AHA/HRS and ESC-criteria recommended admission for a comparable number of patients in Basel-IX (27% vs 28%), but ACC/AHA/HRS-criteria less often in SRS (19% versus 32%, p<0.01). Recommendations were discordant in ∼25% of patients. In BASEL-IX, the sensitivity for cardiac syncope and for 30d-MACE among patients without admission criteria was comparable for ACC/AHA/HRS and ESC-criteria (64% versus 65%, p=0.86 and 67% versus 71%, p=0.15, respectively). In SRS, sensitivity for 30d-MACE was lower with ACC/AHA/HRS (54%) versus ESC-criteria (88%, p<0.001). Similarly, the specificity for cardiac syncope and 30d-MACE in BASEL-IX was comparable for both guidelines, while in SRS, the ACC/AHA/HRS showed a higher specificity for 30d-MACE than the ESC-guidelines. ACC/AHA/HRS and ESC-guideline showed disagreement regarding admission in one of four patients, and had only modest sensitivity, all indicating possible opportunities for improvements.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1547-5271 1556-3871
DOI:	10.1016/j.hrthm.2022.05.024