• Bishoy Deif, Sally Kang, Abid Ismail, Thuva Vanniyasingam, Juan C Guzman, and Carlos A Morillo.
• Department of Medicine, Division of Cardiology, Western University, London, Ontario, Canada.
• Can J Cardiol. 2018 Sep 1; 34 (9): 1158-1164.

BackgroundLow-risk syncope accounts for a large proportion of hospital admissions; however, inpatient investigations are often not necessary and are rarely diagnostic. Reducing the number of low-risk syncope admissions can likely lower health care resource consumption and overall expenditure. Application of syncope guidelines by physicians in the emergency department provides a standardized approach that may potentially reduce admissions and lead to health care resource utilization savings.MethodsA retrospective chart review of 1229 syncope presentations was conducted at 2 major academic centres spanning 1 year. Three major society guidelines and position statements were applied to determine the effect on admission rates.ResultsA total of 1031 true syncope charts were included in the analysis; 407 (39%) were admitted and 624 (61%) were discharged by the treating physician (MD). There was a significant difference in the mean [standard deviation] age (75 [14] vs 55 [22]) and baseline cardiovascular disease, including congestive heart failure 51/407 (13%) vs 28/624 (5%), coronary artery disease 125/407 (31%) vs 91/624 (15%), and structural heart disease 36/407 (9%) vs 26/624 (4%), between admitted and not admitted patients, respectively (P < 0.01). All guidelines warranted more low-risk admissions when compared with 19% by the MD: Canadian Cardiovascular Society 34% (P < 0.01), American College of Emergency Physicians 22% (P = 0.03), and European Society of Cardiology 26% (P < 0.01).ConclusionIn conclusion, application of the current syncope guidelines to an emergency department population is unlikely to reduce low-risk hospital admissions.Copyright © 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

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