@article{8f55e9e47e3b421fb8405f0a97e743c3,
title = "Diagnostic and societal impact of implementing the syncope guidelines of the European Society of Cardiology (SYNERGY study)",
abstract = "Background: Syncope management is fraught with unnecessary tests and frequent failure to establish a diagnosis. We evaluated the potential of implementing the 2018 European Society of Cardiology (ESC) Syncope Guidelines regarding diagnostic yield, accuracy and costs. Methods: A multicentre pre-post study in five Dutch hospitals comparing two groups of syncope patients visiting the emergency department: one before intervention (usual care; from March 2017 to February 2019) and one afterwards (from October 2017 to September 2019). The intervention consisted of the simultaneous implementation of the ESC Syncope Guidelines with quick referral routes to a syncope unit when indicated. The primary objective was to compare diagnostic accuracy using logistic regression analysis accounting for the study site. Secondary outcome measures included diagnostic yield, syncope-related healthcare and societal costs. One-year follow-up data were used to define a gold standard reference diagnosis by applying ESC criteria or, if not possible, evaluation by an expert committee. We determined the accuracy by comparing the treating physician{\textquoteright}s diagnosis with the reference diagnosis. Results: We included 521 patients (usual care, n = 275; syncope guidelines intervention, n = 246). The syncope guidelines intervention resulted in a higher diagnostic accuracy in the syncope guidelines group than in the usual care group (86% vs.69%; risk ratio 1.15; 95% CI 1.07 to 1.23) and a higher diagnostic yield (89% vs. 76%, 95% CI of the difference 6 to 19%). Syncope-related healthcare costs did not differ between the groups, yet the syncope guideline implementation resulted in lower total syncope-related societal costs compared to usual care (saving €908 per patient; 95% CI €34 to €1782). Conclusions: ESC Syncope Guidelines implementation in the emergency department with quick referral routes to a syncope unit improved diagnostic yield and accuracy and lowered societal costs. Trial registration: Netherlands Trial Register, NTR6268.",
keywords = "Admission, Epilepsy, Healthcare efficiency, QALY, Syncope, Tilt table testing, Transient loss of consciousness",
author = "M. Ghariq and {van den Hout}, {W. B.} and Dekkers, {O. M.} and M. Bootsma and {de Groot}, B. and Groothuis, {J. G. J.} and Harms, {M. P. M.} and Hemels, {M. E. W.} and Kaal, {E. C. A.} and Koomen, {E. M.} and {de Lange}, {F. J.} and Peeters, {S. Y. G.} and {van Rossum}, {I. A.} and Rutten, {J. H. W.} and {van Zwet}, {E. W.} and {van Dijk}, {J. G.} and Thijs, {R. D.}",
note = "Funding Information: This study was funded by the Netherlands Organisation for Health Research and Development (project number 843002707). Funding Information: We thank Kirsten Reedijk-de Vries, Dyan Barto-Kamer and Tien Heijns-Rijnsburger for their support of the trial. The SYNERGY CONSORTIUM consists of the following: Leiden University Medical Centre : M. Ghariq, MD, Department of Neurology; M. Bootsma, MD, PhD, Department of Cardiology; B. de Groot, MD, PhD, Department of Emergency Medicine; J.G. van Dijk, MD, PhD, FESC, Department of Neurology; R.D. Thijs, MD, PhD FRCP, FEAN, Department of Neurology Diakonessenhuis, Utrecht, The Netherlands : J.G.J. Groothuis, MD, PhD, Department of Cardiology; R.M. Tuinema, MD, Department of Emergency Medicine; W. Voet, MD, Department of Neurology Rijnstate Hospital, Arnhem, The Netherlands : M.E.W. Hemels, MD, PhD, FEHRA, FESC, Department of Cardiology; Department of Cardiology; D.B. Boerman, MD, Department of Neurology Maasstad Hospital, Rotterdam, The Netherlands : E.C.A. Kaal, MD, PhD, Department of Neurology; M. Firouzi, MD, Department of Cardiology Gelre Hospital, Apeldoorn, The Netherlands : E.M. Koomen, MD, Department of Cardiology, C. Fokke, MD, Department of Neurology @roland_thijs (R. D. Thijs) Implementing the ESC 2018 Syncope Guidelines in the ED with quick referral routes to multidisciplinary Syncope Units improves diagnostic yield and accuracy, and lowers societal costs. Funding Information: RDT receives research support from the Dutch National Epilepsy Fund, The Netherlands Organisation for Health Research and Development (ZonMW), Medtronic, Vriendenlotterij and the Christelijke Vereniging voor de Verpleging van Lijders aan Epilepsie, The Netherlands. RDT and JR receive research support from Michael J Fox Foundation. Publisher Copyright: {\textcopyright} 2023, BioMed Central Ltd., part of Springer Nature.",
year = "2023",
month = dec,
day = "1",
doi = "https://doi.org/10.1186/s12916-023-03056-6",
language = "English",
volume = "21",
journal = "BMC medicine",
issn = "1464-2662",
publisher = "BioMed Central",
number = "1",
}