Longterm outcome of patients with fainting spells at the emergency department. How effective is a standardised approach at improving the time to correct diagnosis, quality of life and decreasing healthcare costs?

SUMMARY

Rationale

Syncope is very common and has a broad differential diagnosis. The frequent failure to identify benign or malignant causes results in high costs. Syncope Algorithms (SAs) abroad have shown to improve diagnostic yield and reduced costs.



Objective:

To determine the cost-effectiveness of SAs compared to usual care in those presenting with syncope at the ED



Study design:

Multicentre trial comparing the pre- and post-implementation period

SA implementation has multiple components:

- ED triage resulting in admission, outpatient or GP referral

- E-health system to maximize the yield of history taking in syncope

- Structured outpatient evaluation

Study population:

Syncope patients in the emergency department (ED) of 1 university hospital & 4 regional hospitals



Study intervention

Structured follow-up with questionnaires at baseline, 3, 6 and 12 months in two patient cohorts before and after SA implementation



Main study parameters/endpoints:

Primary: proportion of patients with an accurate diagnosis (as determined by an expert panel at 1 year follow-up)
Secondary: number of admissions because of syncope, time to diagnosis following ED presentation, syncope recurrence, Healthcare and societal costs within 1 year following ED presentation, number of syncope-related tests and consultations, QoL

Country: The Netherlands

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In both groups (usual care and SA implementation) patients will be asked to fill out questionnaires at baseline, 3, 6 and 12 months of follow-up. The questionnaires include a check-list to assess health care consumption, productivity, and QoL measures: Syncope Functional Status (SFS) & EQ-5D-5L.

Each emergency department will adopt the ESC/EHRA syncope algorithms including a standardized assessment of historical features, ECG, physical examination and orthostatic blood pressure measurements. Prior to implementation, an educational course will offered to all physicians involved in the ED management of syncope.

Usual syncope care at the emergency department. The inclusion of the control group will start prior to the implementation of the syncope algorithms at each hospital. Five hospitals will include patients (LUMC Leiden, Gelre ziekenhuis Apeldoorn, Rijnstate Arnhem, Maasstad ziekenhuis Rotterdam, Diaconessenhuis Utrecht)