Step-by-step guide to creating the best syncope units: From combined United States and European experiences

Syncope can be caused by many physiological and pathophysiological conditions. Causes of syncope encompass a wide range of conditions from benign vasovagal syncope to life-threatening arrhythmias. The lack of a standardized method of evaluation and management of this large patient population leads to a wide practice variation which results in broad-based testing, frequent hospital admission and high healthcare cost. The concept of a syncope observational unit was created for inpatients and outpatients in the United States and Europe. Studies have demonstrated that syncope units, staffed by trained health care providers with sufficient resources could expedite and improve diagnostic yield, reduce hospital admission, and result in decreased healthcare cost with favorable clinical outcomes. The implementation of a standardized syncope unit has been challenging because resources and health care systems are variable regionally, nationally, and internationally. In this review, we provide an overview of the evidences that support a standardized syncope unit practice. We provide step-by-step algorithms for the "best syncope units" in the inpatient and outpatient settings by combining the synergistic experiences from the United States and Europe.