Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In this cohort study, uptake of the 2018 European Society of Cardiology Syncope Guidelines by emergency departments was associated with greater diagnostic yield and accuracy.

Evidence rating level: 2 (Good)

Syncope is a common complaint in emergency departments (EDs), accounting for about 1% of all ED visits. Researchers aimed to assess whether the use of the 2018 European Society of Cardiology (ESC) Syncope Guidelines would have an impact on diagnostic accuracy, diagnostic yield, or healthcare costs. This study was conducted across 5 Dutch hospitals. 521 patients who presented to the ED following a syncopal episode were included in this study. The first cohort (October 2017 to September 2019, n = 275) received usual care. The second cohort (October 2017 to September 2019, n = 246) received care after the implementation of ESC Syncope Guidelines. Patients were then seen at a one-year follow-up appointment to evaluate diagnostic accuracy by applying ESC criteria or, if not possible, evaluation by an expert committee. Implementation of the ESC guidelines was associated with greater diagnostic accuracy compared to usual care (86% vs.69%; risk ratio 1.15; 95% CI 1.07 to 1.23) and greater diagnostic yield (89% vs. 76%, 95% CI of difference 6 to 19%). There was no associated change in healthcare costs. On an individual level, implementing ESC guidelines resulted in reduced syncope-related costs for patients (saving €908 per patient; 95% CI €34 to €1782). A limitation of this study is that while the use of ESC guidelines was encouraged in the emergency departments of the intervention group, their use was not enforced, likely resulting in inconsistent use. Overall, this study demonstrates that implementing the use of the ESC Syncope Guidelines in an emergency department is beneficial for improving diagnostic yield and accuracy, as well as reducing the financial burden on patients. Future research may assess whether greater use of these guidelines improves health outcomes for patients, such as reducing the incidence of subsequent syncopal episodes.

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