Title

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.

Document Type

Article

Publication Date

5-26-2022

Publication Title

Heart Rhythm

Abstract

BACKGROUND: Current ACC/AHA/HRS and ESC-guidelines recommend different strategies to avoid low-yield admissions in patients with syncope.

OBJECTIVE: Directly comparing safety and efficacy of applying admission criteria of both guidelines to patients presenting with syncope to the ED in two multicentre studies METHODS: The international BASEL-IX (median age 71 years) and the American SRS study (median age 72 years). 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 2'560 patients in BASEL-IX and 2'085 in SRS, 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% versus 32%, p=0.15, respectively). In SRS, sensitivity for 30d-MACE was lower with ACC/AHA/HRS (54%) versus ESC-criteria (88%, p<0.001). Similarly, the specificity for cardiac syncope and 30d-MACE in BASEL-IX was comparable for both guidelines, while in SRS, the ACC/AHA/HRS showed a higher specificity for 30d-MACE than the ESC-guidelines.

CONCLUSION: ACC/AHA/HRS and ESC-guideline showed disagreement regarding admission in one of four patients, and had only modest sensitivity, all indicating possible opportunities for improvements.

Volume

Online ahead of print

DOI

10.1016/j.hrthm.2022.05.024

ISSN

1556-3871

PubMed ID

35644354

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