Abstract
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.
| Original language | English |
|---|---|
| Pages (from-to) | 1712-1722 |
| Number of pages | 11 |
| Journal | Heart Rhythm |
| Volume | 19 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 2022 |
Keywords
- Admission
- Diagnosis
- Guidelines
- Safety
- Syncope
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In: Heart Rhythm, Vol. 19, No. 10, 10.2022, p. 1712-1722.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - 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
AU - BASEL IX and SRS Investigators
AU - du Fay de Lavallaz, Jeanne
AU - Zimmermann, Tobias
AU - Badertscher, Patrick
AU - Lopez-Ayala, Pedro
AU - Nestelberger, Thomas
AU - Miró, Òscar
AU - Salgado, Emilio
AU - Zaytseva, Xenia
AU - Gafner, Michele Sara
AU - Christ, Michael
AU - Cullen, Louise
AU - Than, Martin
AU - Martin-Sanchez, F. Javier
AU - Di Somma, Salvatore
AU - Peacock, W. Frank
AU - Keller, Dagmar I.
AU - Costabel, Juan Pablo
AU - Sigal, Alan
AU - Puelacher, Christian
AU - Wussler, Desiree
AU - Koechlin, Luca
AU - Strebel, Ivo
AU - Schuler, Sereina
AU - Manka, Robert
AU - Bilici, Murat
AU - Lohrmann, Jens
AU - Kühne, Michael
AU - Breidthardt, Tobias
AU - Clark, Carol L.
AU - Probst, Marc
AU - Gibson, Thomas A.
AU - Weiss, Robert E.
AU - Sun, Benjamin C.
AU - Mueller, Christian
AU - Widmer, Velina
AU - Leu, Kathrin
AU - Reichlin, Tobias
AU - Shrestha, Samyut
AU - Freese, Michael
AU - Krisai, Philipp
AU - Belkin, Maria
AU - Kawecki, Damian
AU - Morawiec, Beata
AU - Muzyk, Piotr
AU - Nowalany-Kozielska, Ewa
AU - Geigy, Nicolas
AU - Martinez-Nadal, Gemma
AU - Fuenzalida Inostroza, Carolina Isabel
AU - Mandrión, José Bustamante
AU - Poepping, Imke
N1 - Funding Information: Funding Sources: This work was supported by research grants from the Swiss National Science Foundation, the Swiss Heart Foundation, the University Hospital Basel, the University Basel (Switzerland), BRAHMS, Roche, Singulex, and the Emergency Medicine Foundation (Australia). The Syncope Risk Score study was supported by the National Institutes of Health Grant R01HL111033 (USA). Disclosures: Dr Mueller has received research support from the Swiss National Science Foundation, the Swiss Heart Foundation, the University of Basel, the University Hospital Basel, the KTI, Abbott, Astra Zeneca, Beckman Coulter, BRAHMS, Idorsia, Ortho Diagnostics, Novartis, Roche, Siemens, and Singulex; and speaker/consulting honoraria from Amgen, Astra Zeneca, Bayer, BMS, Boehringer Ingelheim, Daiichi Sankyo, Idorsia, Novartis, Osler, Roche, and Sanofi, outside the submitted work. Dr Sun has received consulting honoraria from Medtronic, outside the submitted work. Dr Than reports grants and personal fees from Abbott; grants and personal fees from Alere; grants from Beckman; and grants and personal fees from Roche, outside the submitted work. Dr Cullen reports grants and personal fees from Abbott Diagnostics, Beckman Coulter and Siemens, outside the submitted work. Dr Kühne reports personal fees from Bayer, Daiichi-Sankyo, Pfizer-BMS, and Böhringer-Ingelheim, outside the submitted work. Dr Peacock reports research grants from Abbott, Becton Dickenson, Brainbox, Calcimedica, CSL Behring, Cue, Ortho Clinical Diagnostics, Relypsa, Roche, Salix, and Siemens; having served as a consultant for Abbott, Astra-Zeneca, Beckman, Bosch, Fast Biomedical, Forrest Devices, Ischemia Care, Dx, Instrument Labs, Janssen, Nabriva, Ortho Clinical Diagnostics, Osler, Relypsa, Roche, Quidel, Salix, Siemens, and Upstream; and having stocks or ownership interests at AseptiScope Inc, Brainbox Inc, Braincheck Inc, Coagulo Inc, Comprehensive Research Associates LLC, Emergencies in Medicine LLC, Fast Inc, Forrest Devices, Ischemia DX LLC, Lucia Inc, Prevencio Inc, ScPharma, Trivirum Inc, and Upstream Inc. Dr Puelacher reports a research grant from Roche Diagnostics for work outside of the submitted study. Dr Martin-Sanchez received speaker, advisory, or consulting fees from Novartis, MSD, Bristol-Myers Squibb, Pfizer, The Medicine Company, Otsuka, Thermo Fisher, Cardiorentis, and Sanofi; and research grants from the Spanish Ministry of Health and FEDER, Mapfre, Novartis, Bayer, MSD, Abbott, and Orion-Pharma. Dr Nestelberger has received research support from the Swiss National Science Foundation (P400PM_191037/1), the Swiss Heart Foundation, the Prof. Dr. Max Cloëtta Foundation, the Margarete und Walter Lichtenstein-Stiftung (3MS1038), and the University Hospital Basel; and speaker honoraria/consulting honoraria from Siemens, Beckman Coulter, Bayer, Ortho Clinical Diagnostics, and Orion Pharma, outside the submitted work. Dr Bilici reports receiving Research-Fellowship grants from the Allgöwer-Fund of the Department of Surgery of the University Hospital Basel, outside the submitted study. Dr Koechlin received a research grant from the University of Basel, the Swiss Academy of Medical Sciences, the Gottfried and Julia Bangerter-Rhyner Foundation, and the “Freiwillige Akademische Gesellschaft Basel” for work outside of the submitted work. Dr Clark reports receiving research funding from Abbott, Astra Zeneca, Janssen, Siemens, Radiometer, Ortho Scientific, Hospital Quality Foundation National Institute of Health, and Portola; and educational consulting fees from Janssen. Dr Weiss reports receiving grants from NIH during the conduct of the study. Dr Lopez-Ayala has received research funding from the Swiss Heart Foundation (FF20079). Dr Breidthardt received speaker or advisory fees from AstraZeneca, Daiichi-Sankyo, Roche, and Vifor. These payments were made directly to the University Hospital Basel and no personal payments were received. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The sponsors had no role in designing or conducting the study and no role in gathering or analyzing the data or writing the manuscript. Funding Information: Funding Sources: This work was supported by research grants from the Swiss National Science Foundation , the Swiss Heart Foundation , the University Hospital Basel , the University Basel (Switzerland), BRAHMS, Roche, Singulex, and the Emergency Medicine Foundation (Australia). The Syncope Risk Score study was supported by the National Institutes of Health Grant R01HL111033 (USA). Disclosures: Dr Mueller has received research support from the Swiss National Science Foundation, the Swiss Heart Foundation, the University of Basel, the University Hospital Basel, the KTI, Abbott, Astra Zeneca, Beckman Coulter, BRAHMS, Idorsia, Ortho Diagnostics, Novartis, Roche, Siemens, and Singulex; and speaker/consulting honoraria from Amgen, Astra Zeneca, Bayer, BMS, Boehringer Ingelheim, Daiichi Sankyo, Idorsia, Novartis, Osler, Roche, and Sanofi, outside the submitted work. Dr Sun has received consulting honoraria from Medtronic, outside the submitted work. Dr Than reports grants and personal fees from Abbott; grants and personal fees from Alere; grants from Beckman; and grants and personal fees from Roche, outside the submitted work. Dr Cullen reports grants and personal fees from Abbott Diagnostics, Beckman Coulter and Siemens, outside the submitted work. Dr Kühne reports personal fees from Bayer, Daiichi-Sankyo, Pfizer-BMS, and Böhringer-Ingelheim, outside the submitted work. Dr Peacock reports research grants from Abbott, Becton Dickenson, Brainbox, Calcimedica, CSL Behring, Cue, Ortho Clinical Diagnostics, Relypsa, Roche, Salix, and Siemens; having served as a consultant for Abbott, Astra-Zeneca, Beckman, Bosch, Fast Biomedical, Forrest Devices, Ischemia Care, Dx, Instrument Labs, Janssen, Nabriva, Ortho Clinical Diagnostics, Osler, Relypsa, Roche, Quidel, Salix, Siemens, and Upstream; and having stocks or ownership interests at AseptiScope Inc, Brainbox Inc, Braincheck Inc, Coagulo Inc, Comprehensive Research Associates LLC, Emergencies in Medicine LLC, Fast Inc, Forrest Devices, Ischemia DX LLC, Lucia Inc, Prevencio Inc, ScPharma, Trivirum Inc, and Upstream Inc. Dr Puelacher reports a research grant from Roche Diagnostics for work outside of the submitted study. Dr Martin-Sanchez received speaker, advisory, or consulting fees from Novartis, MSD, Bristol-Myers Squibb, Pfizer, The Medicine Company, Otsuka, Thermo Fisher, Cardiorentis, and Sanofi; and research grants from the Spanish Ministry of Health and FEDER, Mapfre, Novartis, Bayer, MSD, Abbott, and Orion-Pharma. Dr Nestelberger has received research support from the Swiss National Science Foundation (P400PM_191037/1), the Swiss Heart Foundation, the Prof. Dr. Max Cloëtta Foundation, the Margarete und Walter Lichtenstein-Stiftung (3MS1038), and the University Hospital Basel; and speaker honoraria/consulting honoraria from Siemens, Beckman Coulter, Bayer, Ortho Clinical Diagnostics, and Orion Pharma, outside the submitted work. Dr Bilici reports receiving Research-Fellowship grants from the Allgöwer-Fund of the Department of Surgery of the University Hospital Basel, outside the submitted study. Dr Koechlin received a research grant from the University of Basel, the Swiss Academy of Medical Sciences, the Gottfried and Julia Bangerter-Rhyner Foundation, and the “Freiwillige Akademische Gesellschaft Basel” for work outside of the submitted work. Dr Clark reports receiving research funding from Abbott, Astra Zeneca, Janssen, Siemens, Radiometer, Ortho Scientific, Hospital Quality Foundation National Institute of Health, and Portola; and educational consulting fees from Janssen. Dr Weiss reports receiving grants from NIH during the conduct of the study. Dr Lopez-Ayala has received research funding from the Swiss Heart Foundation (FF20079). Dr Breidthardt received speaker or advisory fees from AstraZeneca, Daiichi-Sankyo, Roche, and Vifor. These payments were made directly to the University Hospital Basel and no personal payments were received. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The sponsors had no role in designing or conducting the study and no role in gathering or analyzing the data or writing the manuscript. Publisher Copyright: © 2022 Heart Rhythm Society
PY - 2022/10
Y1 - 2022/10
N2 - 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.
AB - 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.
KW - Admission
KW - Diagnosis
KW - Guidelines
KW - Safety
KW - Syncope
UR - http://www.scopus.com/inward/record.url?scp=85134723917&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2022.05.024
DO - 10.1016/j.hrthm.2022.05.024
M3 - Article
C2 - 35644354
AN - SCOPUS:85134723917
SN - 1547-5271
VL - 19
SP - 1712
EP - 1722
JO - Heart Rhythm
JF - Heart Rhythm
IS - 10
ER -