title: Prospective multicentre systematic guideline-based management of patients referred to the Syncope Units of general hospitals.
abstract: OBJECTIVE
  Although an organizational model for syncope management facilities was proposed in the 2004 guidelines of the European Society of Cardiology (ESC), its implementation in clinical practice and its effectiveness are largely unknown.
  
  
  RESULTS
  This prospective study enrolled 941 consecutive patients referred to the Syncope Units of nine general hospitals from 15 March 2008 to 15 September 2008. A median of 15 patients per month were examined in each unit, but the five older units had a two-fold higher volume of activity than the four newer ones (instituted <1 year before): 23 vs. 12, P = 0.02. These figures give an estimated volume of 163 and 60 patients per 100,000 inhabitants per year, respectively. Referrals: 60% from out-of-hospital services, 11% immediate and 13% delayed referrals from the Emergency Department, and 16% hospitalized patients. A diagnosis was established on initial evaluation in 191 (21%) patients and early by means of 2.9 +/- 1.6 tests in 541 (61%) patients. A likely reflex cause was established in 67%, orthostatic hypotension in 4%, cardiac in 6% and non-syncopal in 5% of the cases. The cause of syncope remained unexplained in 159 (18%) patients, despite a mean of 3.5 +/- 1.8 tests per patient. These latter patients were older, more frequently had structural heart disease or electrocardiographic abnormalities, unpredictable onset of syncope due to the lack of prodromes, and higher OESIL and EGSIS risk scores than the other groups of patients. The mean costs of diagnostic evaluation was 209 euro per outpatient and 1073 euro per inpatient. The median cost of hospital stay was 2990 euro per patient.
  
  
  CONCLUSIONS
  We documented the current practice of syncope management in specialized facilities that have adopted the management model proposed by the ESC. The results are useful for those who wish to replicate this model in other hospitals. Syncope remains unexplained during in-hospital evaluation in more complex cases at higher risk.
authors: Department of Cardiology, Arrhythmologic Centre, Ospedali del Tigullio, Via don Bobbio 24, 16033 Lavagna, Italy. mbrignole@asl4.liguria.it
authors: Michele
authors: M
authors: Brignole
authors: Andrea
authors: A
authors: Ungar
authors: Ivo
authors: I
authors: Casagranda
authors: Michele
authors: M
authors: Gulizia
authors: Maurizio
authors: M
authors: Lunati
authors: Fabrizio
authors: F
authors: Ammirati
authors: Attilio
authors: A
authors: Del Rosso
authors: Massimo
authors: M
authors: Sasdelli
authors: Massimo
authors: M
authors: Santini
authors: Roberto
authors: R
authors: Maggi
authors: Elena
authors: E
authors: Vitale
authors: Alessandro
authors: A
authors: Morrione
authors: Giuseppina Maura
authors: GM
authors: Francese
authors: Maria Rita
authors: MR
authors: Vecchi
authors: Franco
authors: F
authors: Giada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019983:Guideline Adherence / Q000191:economics* / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000592:standards*; D015995:Prevalence; D011446:Prospective Studies; D013575:Syncope / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology