The Impact of a Nurse-Led Syncope Clinic: Experience from a single UK tertiary center

Syncope is a leading cause of hospital admission and is associated with significant morbidity and mortality. Our Syncope Clinic commenced in 2014 and we sought to evaluate its impact on outcomes (1-yr mortality and syncope re-hospitalization) in patients discharged following syncope admission.

A single-center study of all consecutive patients discharged with syncope (ICD-10 R55) between April 2012 and 2017. Patient demographics, comorbidities, hospital stay, syncope re-hospitalization, and mortality at one-year were collected. Those subsequently referred and seen in Syncope Clinic were compared with those who were not and predictors of poor outcome were evaluated.

In total 2950 patients were discharged from hospital with syncope (median age: 73years, 51% male) with 1220 (41%) discharged same-day; after commencement of Syncope Clinic 231were subsequently reviewed here. Overall mortality was 11%, which was lower in the Syncope Clinic group (3% vs 12%, P < .001). Temporal analysis revealed reduced re-hospitalization following commencement of Syncope Clinic (2% vs 6%, P = .027). Independent predictors of mortality were increasing age (HR 1.03, 95% CI 1.03-1.04), AF (HR 1.6, 95% CI 1.2-2.1), HF (HR 2.2, 95% CI 1.6-3.0), COPD (HR 1.9, 95% CI 1.4-2.7), and CHADS₂ score ≥ 1 (HR 1.45, 95% CI 1,12-1.87). Syncope Clinic attendance was associated with reduced mortality (HR 0.3, 95% CI 0.1-0.6).

Syncope patients discharged from hospital had reduced 1yr mortality if seen in subsequent Syncope Clinic. Independent predictors of mortality were COPD, HF, AF, and CHADS₂ ≥1. Prospective randomized trials of Syncope Clinics are warranted.