A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals

Eur Heart J. 2006 Jan;27(1):76-82. doi: 10.1093/eurheartj/ehi647. Epub 2005 Nov 4.


Aims: The guidelines of the European Society of Cardiology (ESC) define the current standard for the management of syncope, but are still incompletely applied in the clinical setting.

Methods and results: Prospective systematic evaluation, on strict adherence to the guidelines, of consecutive patients referred for syncope to the emergency departments of 11 general hospitals. In order to maximize the application, a decision-making guideline-based software was used and trained core medical personnel were designated-both locally in each hospital and centrally-to verify adherence to the diagnostic pathway and give advice on its correction. A diagnostic work-up consistent with the guidelines was completed in 465/541 patients (86%). A definite diagnosis was established in 98% (unexplained in 2%): neurally mediated syncope accounted for 66% of diagnosis, orthostatic hypotension 10%, primary arrhythmias 11%, structural cardiac or cardiopulmonary disease 5%, and non-syncopal attacks 6%, respectively. The initial evaluation (consisting of history, physical examination, and standard electrocardiogram) established a diagnosis in 50% of cases. Hospitalization for the management of syncope was appropriate in 25% and was required for other reasons in a further 13% of cases. The median in-hospital stay was 5.5 days (interquartile range, 3-9). Apart from the initial evaluation, a mean of 1.9+/-1.1 appropriate tests per patient was performed in 193 patients and led to a final diagnosis in 182 of these (94%).

Conclusion: The results of this study assess the current standard for the management of syncope on the basis of a rigorous adherence to guidelines of the ESC and provide a frame of reference for daily activity when dealing with syncope.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Emergencies
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Guideline Adherence*
  • Hospitalization / statistics & numerical data*
  • Hospitals, General / statistics & numerical data*
  • Humans
  • Italy
  • Male
  • Middle Aged
  • Practice Guidelines as Topic*
  • Prospective Studies
  • Referral and Consultation / statistics & numerical data*
  • Syncope / therapy*