Performance of the American Heart Association/American College of Cardiology/Heart Rhythm Society versus European Society of Cardiology guideline criteria for hospital admission of patients with syncope.

Aged American Heart Association Cardiology Hospitalization Hospitals Humans Syncope / diagnosis United States / epidemiology

Admission Diagnosis Guidelines Safety Syncope

Journal

Heart rhythm

ISSN: 1556-3871

Titre abrégé: Heart Rhythm

Pays: United States

ID NLM: 101200317

Informations de publication

Date de publication:
10 2022

Historique:

received: 17 12 2021

revised: 28 04 2022

accepted: 23 05 2022

pubmed: 2 6 2022

medline: 5 10 2022

entrez: 1 6 2022

Statut: ppublish

Résumé

Current American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) and European Society of Cardiology (ESC) guidelines recommend different strategies to avoid low-yield admissions in patients with syncope. The purpose of this study was to directly compare the safety and efficacy of applying admission criteria of both guidelines to patients presenting with syncope to the emergency department in 2 multicenter studies. The international BASEL IX (BAsel Syncope EvaLuation) study (median age 71 years) and the U.S. SRS (Improving Syncope Risk Stratification in Older Adults) study (median age 72 years) were investigated. Primary endpoints were sensitivity/specificity for the adjudicated diagnosis of cardiac syncope (BASEL IX only) and 30-day major adverse cardiovascular events (30d-MACE). Among 2560 patients in the BASEL IX and 2085 in SRS studies, ACC/AHA/HRS and ESC criteria recommended admission for a comparable number of patients in BASEL IX (27% vs 28%), but ACC/AHA/HRS criteria less often in SRS (19% vs 32%; P <.01). Recommendations were discordant in ∼25% of patients. In BASEL IX, sensitivity for cardiac syncope and 30d-MACE among patients without admission criteria was comparable for ACC/AHA/HRS and ESC criteria (64% vs 65%, P = .86; and 67% vs 71%, P = .15, respectively). In SRS, sensitivity for 30d-MACE was lower with ACC/AHA/HRS (54%) vs ESC criteria (88%; P <.001). Similarly, specificity for cardiac syncope and 30d-MACE in BASEL IX was comparable for both guidelines, but in SRS the ACC/AHA/HRS guidelines showed a higher specificity for 30d-MACE than the ESC guidelines. ACC/AHA/HRS and ESC guidelines showed disagreement regarding admission for 1 in 4 patients and had only modest sensitivity, all indicating possible opportunities for improvements.

Sections du résumé

BACKGROUND

OBJECTIVE

The purpose of this study was to directly compare the safety and efficacy of applying admission criteria of both guidelines to patients presenting with syncope to the emergency department in 2 multicenter studies.

METHODS

The international BASEL IX (BAsel Syncope EvaLuation) study (median age 71 years) and the U.S. SRS (Improving Syncope Risk Stratification in Older Adults) study (median age 72 years) were investigated. Primary endpoints were sensitivity/specificity for the adjudicated diagnosis of cardiac syncope (BASEL IX only) and 30-day major adverse cardiovascular events (30d-MACE).

RESULTS

Among 2560 patients in the BASEL IX and 2085 in SRS studies, ACC/AHA/HRS and ESC criteria recommended admission for a comparable number of patients in BASEL IX (27% vs 28%), but ACC/AHA/HRS criteria less often in SRS (19% vs 32%; P <.01). Recommendations were discordant in ∼25% of patients. In BASEL IX, sensitivity for cardiac syncope and 30d-MACE among patients without admission criteria was comparable for ACC/AHA/HRS and ESC criteria (64% vs 65%, P = .86; and 67% vs 71%, P = .15, respectively). In SRS, sensitivity for 30d-MACE was lower with ACC/AHA/HRS (54%) vs ESC criteria (88%; P <.001). Similarly, specificity for cardiac syncope and 30d-MACE in BASEL IX was comparable for both guidelines, but in SRS the ACC/AHA/HRS guidelines showed a higher specificity for 30d-MACE than the ESC guidelines.

CONCLUSION

ACC/AHA/HRS and ESC guidelines showed disagreement regarding admission for 1 in 4 patients and had only modest sensitivity, all indicating possible opportunities for improvements.

Identifiants

DOI: 10.1016/j.hrthm.2022.05.024 PMID: 35644354

pubmed: 35644354

pii: S1547-5271(22)02038-0

doi: 10.1016/j.hrthm.2022.05.024

pii:

doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't Research Support, N.I.H., Extramural

Langues

eng

Sous-ensembles de citation

Pagination

1712-1722

Investigateurs

Velina Widmer (V)

Kathrin Leu (K)

Tobias Reichlin (T)

Samyut Shrestha (S)

Michael Freese (M)

Philipp Krisai (P)

Maria Belkin (M)

Damian Kawecki (D)

Beata Morawiec (B)

Piotr Muzyk (P)

Ewa Nowalany-Kozielska (E)

Nicolas Geigy (N)

Gemma Martinez-Nadal (G)

Carolina Isabel Fuenzalida Inostroza (CI)

José Bustamante Mandrión (JB)

Imke Poepping (I)

Jaimi Greenslade (J)

Tracey Hawkins (T)

Katharina Rentsch (K)

Sandra Mitrovic (S)

Arnold von Eckardstein (A)

Andreas Buser (A)

Stefan Osswald (S)

Joan Walter (J)

David H Adler (DH)

Aveh Bastani (A)

Christopher W Baugh (CW)

Jeffrey M Caterino (JM)

Deborah B Diercks (DB)

Judd E Hollander (JE)

Bret A Nicks (BA)

Daniel K Nishijima (DK)

Manish N Shah (MN)

Kirk A Stiffler (KA)

Scott T Wilber (ST)

Alan B Storrow (AB)

Commentaires et corrections

Type : CommentIn