Now is the time to take syncope seriously

Syncope, as a symptom, remains poorly understood and handled in the UK. Personal involvement stemmed from successful abolition of syncope by cardiac pacing, initially in atrioventricular block then other bradycardias; UK facilities were sparse in the late 1970s. The aim was to broaden distribution and encourage understanding. To achieve this required abandoning the typical cardiology mindset and re-engaging with internal medicine. Syncope is poorly taught in medical schools, which implies that few physicians understand it and, therefore, cannot practise it to benefit patients. Syncope patients presenting in emergency departments (>1% of all) are frequently admitted to hospital to undergo numerous non-diagnostic tests, then discharged without diagnosis. Syncope has life-threatening causes in >1% of patients; given its prevalence, this represents a large number. Treatment is now possible. Syncope science has notably advanced, offering valuable diagnostic and therapeutic strategies. Ubiquitous delivery in the UK requires a new approach, which has been applied in the Netherlands. Now, more than ever, is the time to take syncope seriously, with action now to address this critical situation.