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.
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.
Online ahead of print
du Fay de Lavallaz J, Zimmermann T, Badertscher P, Lopez-Ayala P, Nestelberger T, Miró Ò, Salgado E, Zaytseva X, Gafner MS, Christ M, Cullen L, Than M, Martin-Sanchez FJ, Di Somma S, Peacock WF, Keller DI, Costabel JP, Sigal A, Puelacher C, Wussler D, Koechlin L, Strebel I, Schuler S, Manka R, Bilici M, Lohrmann J, Kühne M, Breidthardt T, Clark CL, Probst M, Gibson TA, Weiss RE, Sun BC, Mueller C; BASEL IX and SRS Investigators. 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. Heart Rhythm. 2022 May 26:S1547-5271(22)02038-0. doi: 10.1016/j.hrthm.2022.05.024. Epub ahead of print. PMID: 35644354.