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

BMC Medicine

Research Article

W. B. van den Hout¹  E. W. van Zwet¹  F. J. de Lange²  J. G. J. Groothuis³  E. M. Koomen⁴  M. Bootsma⁵  M. E. W. Hemels⁶  O. M. Dekkers⁷  S. Y. G. Peeters⁸  B. de Groot⁹  J. H. W. Rutten^1,10  M. P. M. Harms^1,11  J. G. van Dijk^1,12  M. Ghariq^1,12  I. A. van Rossum^1,12  R. D. Thijs^1,13  E. C. A. Kaal^1,14 

[1] Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands;Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands;Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands;Department of Cardiology, Gelre Hospital, Apeldoorn, The Netherlands;Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands;Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands;Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands;Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands;Department of Emergency Medicine, Flevo Hospital, Almere, The Netherlands;Department of Emergency Medicine, Leiden University Medical Centre, Leiden, The Netherlands;Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands;Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands;Department of Neurology, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands;Department of Neurology, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands;Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands;Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands;

关键词: Transient loss of consciousness;    Healthcare efficiency;    Syncope;    Epilepsy;    Admission;    Tilt table testing;    QALY;   

DOI  :  10.1186/s12916-023-03056-6

 received in 2023-02-04, accepted in 2023-08-29,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundSyncope 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.MethodsA 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.ResultsWe 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 €908 per patient; 95% CI €34 to €1782).ConclusionsESC 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 registrationNetherlands Trial Register, NTR6268

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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