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Cost-effectiveness of in-hospital evaluation of patients with syncope
B Mozes1, R Confino-Cohen, H Halkin
1Department of Internal Medicine A, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Insights
In-hospital syncope evaluation can be streamlined. Initial history, physical exam, and ECG are sufficient, reducing costs with minimal impact on prognosis.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Syncope evaluation in hospitals is common but costly.
- The diagnostic yield of extensive in-hospital workups for syncope is debated.
Purpose of the Study:
- To assess the utility of comprehensive in-hospital evaluation for syncope.
- To determine if initial diagnostic measures are sufficient for patient management.
Main Methods:
- Retrospective review of 134 patients admitted within 6 hours of syncope.
- Follow-up data collected on 130 patients after 3 years.
- Analysis of ECG, prolonged monitoring, and other diagnostic tests.
Main Results:
- Initial ECG detected all cardiac rhythm and conduction disturbances.
- Prolonged monitoring and further tests confirmed initial findings without new diagnoses.
- Therapeutic intervention was required in only 24% of patients, guided by initial evaluation.
- No sudden deaths or associations between syncope causes and mortality were found.
Conclusions:
- A focused initial evaluation (history, physical, ECG) is adequate for most syncope patients.
- Extensive in-hospital testing offers limited additional diagnostic value.
- Streamlining syncope evaluation can reduce costs by an estimated 85% with minimal adverse prognostic effects.
Abstract:
In order to assess the utility of in-hospital evaluation of syncope we reviewed the records of 134 consecutive patients admitted within 6 h of a true syncopal episode, and obtained follow-up information on 130 of them 3 years later. All threatened cardiac rhythm and conduction disturbances were detected on the initial ECG recording. Prolonged ECG monitoring did not contribute additional diagnoses. Other diagnostic tests and procedures performed during the mean 7.5-day hospital stay only confirmed the findings of the initial history, physical and ECG examinations. Diagnostic evaluation was followed by therapeutic intervention in only 33 patients (24%); all interventions were clearly mandated by the initial admission evaluation. There were no cases of sudden death and no association between causes of death, the index syncope episode or prior history of syncope. We therefore propose that the evaluation of patients presenting within hours of a syncopal episode include only history taking, physical examination and the initial ECG recording. Further in-hospital evaluation should be limited to confirming initial positive findings. This approach may allow an estimated 85% reduction in costs involved in the management of similar patients, with probable negligible adverse effects on prognosis.