TY - JOUR
T1 - 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
AU - BASEL IX and SRS Investigators
AU - du Fay de Lavallaz, Jeanne
AU - Zimmermann, Tobias
AU - Badertscher, Patrick
AU - Lopez-Ayala, Pedro
AU - Nestelberger, Thomas
AU - Miró, Òscar
AU - Salgado, Emilio
AU - Zaytseva, Xenia
AU - Gafner, Michele Sara
AU - Christ, Michael
AU - Cullen, Louise
AU - Than, Martin
AU - Martin-Sanchez, F. Javier
AU - Di Somma, Salvatore
AU - Peacock, W. Frank
AU - Keller, Dagmar I.
AU - Costabel, Juan Pablo
AU - Sigal, Alan
AU - Puelacher, Christian
AU - Wussler, Desiree
AU - Koechlin, Luca
AU - Strebel, Ivo
AU - Schuler, Sereina
AU - Manka, Robert
AU - Bilici, Murat
AU - Lohrmann, Jens
AU - Kühne, Michael
AU - Breidthardt, Tobias
AU - Clark, Carol L.
AU - Probst, Marc
AU - Gibson, Thomas A.
AU - Weiss, Robert E.
AU - Sun, Benjamin C.
AU - Mueller, Christian
AU - Widmer, Velina
AU - Leu, Kathrin
AU - Reichlin, Tobias
AU - Shrestha, Samyut
AU - Freese, Michael
AU - Krisai, Philipp
AU - Belkin, Maria
AU - Kawecki, Damian
AU - Morawiec, Beata
AU - Muzyk, Piotr
AU - Nowalany-Kozielska, Ewa
AU - Geigy, Nicolas
AU - Martinez-Nadal, Gemma
AU - Fuenzalida Inostroza, Carolina Isabel
AU - Mandrión, José Bustamante
AU - Diercks, Deborah B.
N1 - Publisher Copyright:
© 2022 Heart Rhythm Society
PY - 2022/10
Y1 - 2022/10
N2 - Background: 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. 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.
AB - Background: 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. 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.
KW - Admission
KW - Diagnosis
KW - Guidelines
KW - Safety
KW - Syncope
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U2 - 10.1016/j.hrthm.2022.05.024
DO - 10.1016/j.hrthm.2022.05.024
M3 - Article
C2 - 35644354
AN - SCOPUS:85134723917
SN - 1547-5271
VL - 19
SP - 1712
EP - 1722
JO - Heart Rhythm
JF - Heart Rhythm
IS - 10
ER -