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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.
du Fay de Lavallaz, Jeanne; Zimmermann, Tobias; Badertscher, Patrick; Lopez-Ayala, Pedro; Nestelberger, Thomas; Miró, Òscar; Salgado, Emilio; Zaytseva, Xenia; Gafner, Michele Sara; Christ, Michael; Cullen, Louise; Than, Martin; Martin-Sanchez, F Javier; Di Somma, Salvatore; Peacock, W Frank; Keller, Dagmar I; Costabel, Juan Pablo; Sigal, Alan; Puelacher, Christian; Wussler, Desiree; Koechlin, Luca; Strebel, Ivo; Schuler, Sereina; Manka, Robert; Bilici, Murat; Lohrmann, Jens; Kühne, Michael; Breidthardt, Tobias; Clark, Carol L; Probst, Marc; Gibson, Thomas A; Weiss, Robert E; Sun, Benjamin C; Mueller, Christian.
Affiliation
  • du Fay de Lavallaz J; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network. Electronic address: jeanne.dufay@usb.ch.
  • Zimmermann T; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network.
  • Badertscher P; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network.
  • Lopez-Ayala P; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network.
  • Nestelberger T; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network; Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
  • Miró Ò; GREAT Network; Hospital Clinic, Barcelona, Catalonia, Spain.
  • Salgado E; GREAT Network; Hospital Clinic, Barcelona, Catalonia, Spain.
  • Zaytseva X; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; University Hospital Zürich, Zürich, Switzerland.
  • Gafner MS; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network.
  • Christ M; Department of Emergency Medicine, Kantonsspital Luzern, Lucerne, Switzerland.
  • Cullen L; GREAT Network; Royal Brisbane & Women's Hospital, Herston, Australia.
  • Than M; GREAT Network; Christchurch Hospital, Christchurch, New Zealand.
  • Martin-Sanchez FJ; GREAT Network; Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain.
  • Di Somma S; GREAT Network; Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Rome, Italy.
  • Peacock WF; GREAT Network; Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas.
  • Keller DI; University Hospital Zürich, Zürich, Switzerland.
  • Costabel JP; Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.
  • Sigal A; Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.
  • Puelacher C; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network.
  • Wussler D; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network.
  • Koechlin L; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network; Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland.
  • Strebel I; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network.
  • Schuler S; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; University Hospital Zürich, Zürich, Switzerland.
  • Manka R; University Hospital Zürich, Zürich, Switzerland.
  • Bilici M; Department of Orthopedics and Traumatology, Basel University Hospital, Basel, Switzerland.
  • Lohrmann J; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Kühne M; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Breidthardt T; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network.
  • Clark CL; Beaumont Health System-Royal Oak, Royal Oak, Michigan.
  • Probst M; Department of Emergency Medicine, Mount Sinai School of Medicine, New York, New York.
  • Gibson TA; Department of Biostatistics, University of California Fielding School of Public Health, Los Angeles, California.
  • Weiss RE; Department of Biostatistics, University of California Fielding School of Public Health, Los Angeles, California.
  • Sun BC; Department of Emergency Medicine, Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Mueller C; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network.
Heart Rhythm ; 19(10): 1712-1722, 2022 10.
Article in En | MEDLINE | ID: mdl-35644354
BACKGROUND: Current American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) and European Society of Cardiology (ESC) guidelines recommend different strategies to avoid low-yield admissions in patients with syncope. OBJECTIVE: The purpose of this study was to directly compare the safety and efficacy of applying admission criteria of both guidelines to patients presenting with syncope to the emergency department in 2 multicenter studies. METHODS: The international BASEL IX (BAsel Syncope EvaLuation) study (median age 71 years) and the U.S. SRS (Improving Syncope Risk Stratification in Older Adults) study (median age 72 years) were investigated. 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 2560 patients in the BASEL IX and 2085 in SRS studies, 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% vs 32%; P <.01). Recommendations were discordant in ∼25% of patients. In BASEL IX, sensitivity for cardiac syncope and 30d-MACE among patients without admission criteria was comparable for ACC/AHA/HRS and ESC criteria (64% vs 65%, P = .86; and 67% vs 71%, P = .15, respectively). In SRS, sensitivity for 30d-MACE was lower with ACC/AHA/HRS (54%) vs ESC criteria (88%; P <.001). Similarly, specificity for cardiac syncope and 30d-MACE in BASEL IX was comparable for both guidelines, but in SRS the ACC/AHA/HRS guidelines showed a higher specificity for 30d-MACE than the ESC guidelines. CONCLUSION: ACC/AHA/HRS and ESC guidelines showed disagreement regarding admission for 1 in 4 patients and had only modest sensitivity, all indicating possible opportunities for improvements.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Cardiology / American Heart Association Type of study: Clinical_trials / Diagnostic_studies / Guideline / Risk_factors_studies Limits: Aged / Humans Country/Region as subject: America do norte Language: En Journal: Heart Rhythm Year: 2022 Document type: Article Country of publication: United States
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Cardiology / American Heart Association Type of study: Clinical_trials / Diagnostic_studies / Guideline / Risk_factors_studies Limits: Aged / Humans Country/Region as subject: America do norte Language: En Journal: Heart Rhythm Year: 2022 Document type: Article Country of publication: United States