ACC/AHA/HRS Versus ESC Guidelines for the Diagnosis and Management of Syncope: JACC Guideline Comparison
Zachary D Goldberger1, Bradley J Petek2, Michele Brignole3
1Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Insights
This review compares the 2017 American and 2018 European syncope guidelines, identifying key differences and similarities in diagnosing and managing syncope patients. It aims to clarify clinical practice and guide future research in this challenging area.
Area of Science:
- Cardiology
- Clinical Practice Guidelines
Background:
- Syncope presents variably, making diagnosis challenging even after extensive evaluation.
- Clinical practice guidelines are essential for managing patients with syncope.
- Two major guideline sets exist: the American College of Cardiology/American Heart Association (ACC/AHA) in 2017 and the European Society of Cardiology (ESC) in 2018.
Purpose of the Study:
- To compare and contrast the ACC/AHA and ESC syncope guidelines.
- To analyze the congruencies and discrepancies between the two guideline sets.
- To discuss implications for clinical practice and identify future research directions.
Main Methods:
- Comparative analysis of the 2017 ACC/AHA and 2018 ESC syncope guidelines.
- Review of recommendations for diagnosis and management of syncope.
- Identification of similarities and differences in clinical approaches.
Main Results:
- The review highlights both shared recommendations and notable divergences between the American and European guidelines.
- Specific areas of agreement and disagreement in diagnostic strategies and management protocols are identified.
- The study underscores the need for a unified approach where possible, while acknowledging regional differences.
Conclusions:
- Understanding the nuances between the ACC/AHA and ESC syncope guidelines is crucial for clinicians.
- The review identifies areas where guidelines align and diverge, impacting patient care.
- Further research is needed to address remaining knowledge gaps and refine syncope management strategies.
Abstract:
Syncope is a commonly encountered and challenging problem in medical practice. Presentations are variable, and the causal mechanism often remains elusive even after extensive (and often expensive) evaluation. Clinical practice guidelines have been developed to help guide the multidisciplinary approach necessary to diagnose and manage the broad spectrum of patients presenting with syncope. The American College of Cardiology/American Heart Association, in collaboration with the Heart Rhythm Society, published its first syncope guidelines in 2017. The European Society of Cardiology released the fourth iteration of its syncope guidelines in 2018. This review highlights the differences and congruencies between the 2 sets of recommendations, their implications for clinical practice, the remaining gaps in understanding, and areas of future research.
