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Research Article

8 July 2020

Burden of recurrent syncope and injuries and the usefulness of implantable cardiac monitors: insights from a nationwide longitudinal cohort analysis

Authors: Claudia Wolff https://orcid.org/0000-0002-5570-6137 [email protected] and Sanjiv Petkar https://orcid.org/0000-0002-1699-7963Author Info & Affiliations

Publication: Journal of Comparative Effectiveness Research

Volume 9, Number 10

https://doi.org/10.2217/cer-2020-0059

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Abstract

Aim: The study assesses the burden and costs of recurring unexplained syncope and injuries and the effectiveness of implantable loop recorders. Methods: The English national hospital database (Hospital Episode Statistics) was retrospectively analyzed. Results: 12,002 patients were identified with repeated syncope hospitalizations. 25% of patients were hospitalized at least once again for syncope, 9% of the patients were hospitalized at least once for an injury, causing substantial costs. In the second analysis: 10,902 patients implanted with an implantable cardiac monitor were tracked. By year 3, hospitalizations due to syncope had dropped by 60% versus pre-implantable cardiac monitor (ICM) levels. Conclusion: This study shows a high rate of recurrent syncope admissions and a parallel burden of hospitalizations for injuries. Use of an ICM appears to reduce syncope hospitalizations.

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References

Papers of special note have been highlighted as: •• of considerable interest

1.

Soteriades ES, Evans JC, Larson MG et al. Incidence and prognosis of syncope. N. Engl. J. Med. 347(12), 878–885 (2002).

2.

Brignole M, Moya A, de Lange FJ et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur. H. J. 39(21), 1883–1948 (2018).

•• The ESC Syncope Guidelines present evidence and recommendations regarding which investigations are most relevant and likely to lead to a diagnosis in syncope patients. They include a meta-analysis showing that implantable loop recorder are 3.6 times more likely to reach a diagnosis than conventional testing.

3.

Sutton R, Benditt DG. Epidemiology and economic impact of cardiac syncope in western countries. Future Cardiol. 8(3), 467–472 (2012).

4.

van Dijk N, Sprangers MA, Colman N, Boer KR, Wieling W, Linzer M. Clinical factors associated with quality of life in patients with transient loss of consciousness. J. Cardiovasc. Electrophysiol. 17, 998–1003 (2006).

5.

Linzer M, Gold DT, Pontinen M, Divine GW, Felder A, Brooks WB. Recurrent syncope as a chronic disease: preliminary validation of a disease-specific measure of functional impairment. J. Gen. Intern. Med. 9(4), 181–186 (1994).

6.

Numé AK, Kragholm K, Carlson N et al. Syncope and its impact on occupational accidents and employment. Circ. Cardiovasc. Qual. Outcomes 10(4), e003202 (2017).

7.

Yasa E, Ricci F, Magnusson M, Sutton R, Gallina S, De Caterina R. Cardiovascular risk after hospitalization for unexplained syncope and orthostatic hypotension. Heart 104(6), 487–493 (2018).

•• Shows that a hospitalization for unexplained syncope is associated with a higher risk of cardiovascular death and all-cause mortality. Patients have a higher risk of coronary events, strokes, heart failure and aortic stenosis.

8.

Ricci F, Sutton R, Palermi S et al. Prognostic significance of noncardiac syncope in the general population: a systematic review and meta-analysis. J. Cardiovasc. Electrophysiol. 29(12), 1641–1647 (2018).

•• Shows a higher all-cause mortality in patients with a previous hospitalization for unexplained syncope.

9.

Bartoletti A, Fabiani P, Bagnoli L et al. Physical injuries caused by a transient loss of consciousness: main clinical characteristics of patients and diagnostic contribution of carotid sinus massage. Eur. Heart J. 29(5), 618–624 (2017).

10.

Edvardsson N, Frykman V, van Mechelen R et al. Use of an implantable loop recorder to increase the diagnostic yield in unexplained syncope: results from the PICTURE registry. Europace 13(2), 262–269 (2011).

•• This observational registry showed that syncope evaluations are unstructured which results in low diagnostic yield. Some tests are repeated many times, patients undergo various expensive diagnostic tests with low diagnostic yield and see three specialists without receiving a diagnosis.

11.

Edvardsson N, Wolff C, Tsintzos S, Rieger G, Linker NJ. Costs of unstructured investigation of unexplained syncope: insights from a micro-costing analysis of the observational PICTURE registry. Europace 17(7), 1141–1148 (2015).

12.

Rogers G, O'Flynn N. NICE guideline: transient loss of consciousness (blackouts) in adults and young people. Br. J. Gen. Pract. 61(582), 40–42 (2012).

13.

Shen WK, Sheldon RS, Benditt DG et al. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. J. Am. Coll. Cardiol. 70(5), e39–e110 (2017).

14.

Shaw DB, Kekwick CA, Veale D, Gowers J, Whistance T. Survival in second degree atrioventricular block. Br. Heart J. 53, 587–593 (1985).

15.

Srinivasan NT, Schilling RJ. Sudden cardiac death and arrhythmias. Arrhythmia Electrophysiol. Rev. 7(2), 111 (2018).

16.

Krahn AD, Klein GJ, Yee R, Hoch JS, Skanes AC. Cost implications of testing strategy in patients with syncope: randomized assessment of syncope trial. JACC 42(3), 495–501 (2003).

17.

Kenny RA, Brignole M, Dan GA et al. Syncope Unit: rationale and requirement-the European Heart Rhythm Association position statement endorsed by the Heart Rhythm Society. Europace 17(9), 1325–1340 (2015).

•• This EHRA position statement explains the benefit and supporting evidence of a syncope unit and provides practical guidance how it is managed and evaluated.

18.

Ruwald MH, Hansen ML, Lamberts M et al. Accuracy of the ICD-10 discharge diagnosis for syncope. Europace 15(4), 595–600 (2012).

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