TY - JOUR
T1 - Contemporary management of patients with syncope in clinical practice
T2 - An EHRA physician-based survey
AU - Dan, Gheorghe Andrei
AU - Scherr, Daniel
AU - Jubele, Kristīne
AU - Frakowski, Michal M.
AU - Iliodromitis, Konstantinos
AU - Conte, Giulio
AU - Jȩdrzejczyk-Patej, Ewa
AU - Vitali-Serdoz, Laura
AU - Potpara, Tatjana S.
N1 - Publisher Copyright:
© 2020 Published on behalf of the European Society of Cardiology. All rights reserved. The Author(s) 2020. For permissions, please email: [email protected].
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Syncope is a heterogeneous syndrome encompassing a large spectrum of mechanisms and outcomes. The European Society of Cardiology published an update of the Syncope Guidelines in 2018. The aim of the present survey was to capture contemporary management of syncope and guideline implementation among European physicians. A 23-item questionnaire was presented to 2588 European Heart Rhythm Association (EHRA) members from 32 European countries. The response rate was 48%, but only complete responses (n = 161) were included in this study. The questionnaire contained specific items regarding syncope facilities, diagnostic definitions, diagnostic tools, follow-up, and therapy. The survey revealed that many respondents did not have syncope units (88%) or dedicated management algorithms (44%) at their institutions, and 45% of the respondents reported syncope-related hospitalization rates >25%, whereas most (95%) employed close monitoring and hospitalization in syncope patients with structural heart disease. Carotid sinus massage, autonomic testing, and tilt-table testing were inconsistently used. Indications were heterogeneous for implanted loop recorders (79% considered them for recurrent syncope in high-risk patients) or electrophysiological studies (67% considered them in bifascicular block and inconclusive non-invasive testing). Non-pharmacological therapy was consistently considered by 68% of respondents; however, there was important variation regarding the choice of drug and device therapy. While revealing an increased awareness of syncope and good practice, our study identified important unmet needs regarding the optimal management of syncope and variable syncope guideline implementation.
AB - Syncope is a heterogeneous syndrome encompassing a large spectrum of mechanisms and outcomes. The European Society of Cardiology published an update of the Syncope Guidelines in 2018. The aim of the present survey was to capture contemporary management of syncope and guideline implementation among European physicians. A 23-item questionnaire was presented to 2588 European Heart Rhythm Association (EHRA) members from 32 European countries. The response rate was 48%, but only complete responses (n = 161) were included in this study. The questionnaire contained specific items regarding syncope facilities, diagnostic definitions, diagnostic tools, follow-up, and therapy. The survey revealed that many respondents did not have syncope units (88%) or dedicated management algorithms (44%) at their institutions, and 45% of the respondents reported syncope-related hospitalization rates >25%, whereas most (95%) employed close monitoring and hospitalization in syncope patients with structural heart disease. Carotid sinus massage, autonomic testing, and tilt-table testing were inconsistently used. Indications were heterogeneous for implanted loop recorders (79% considered them for recurrent syncope in high-risk patients) or electrophysiological studies (67% considered them in bifascicular block and inconclusive non-invasive testing). Non-pharmacological therapy was consistently considered by 68% of respondents; however, there was important variation regarding the choice of drug and device therapy. While revealing an increased awareness of syncope and good practice, our study identified important unmet needs regarding the optimal management of syncope and variable syncope guideline implementation.
KW - Cardiac syncope
KW - Driving with syncope
KW - EHRA survey
KW - Event recorder
KW - Implanted loop recorder
KW - Orthostatic hypotension
KW - Orthostatic intolerance
KW - Reflex syncope
KW - Syncope risk score
KW - Syncope unit
UR - http://www.scopus.com/inward/record.url?scp=85086052939&partnerID=8YFLogxK
U2 - 10.1093/europace/euaa085
DO - 10.1093/europace/euaa085
M3 - Review article
C2 - 32449760
AN - SCOPUS:85086052939
SN - 1099-5129
VL - 22
SP - 980
EP - 987
JO - Europace
JF - Europace
IS - 6
ER -