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
Copyright © 2022 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved..
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.
| Errataetall: |
CommentIn: Heart Rhythm. 2022 Oct;19(10):1723-1724. - PMID 35724871 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:19 |
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| Enthalten in: |
Heart rhythm - 19(2022), 10 vom: 01. Okt., Seite 1712-1722 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
du Fay de Lavallaz, Jeanne [VerfasserIn] |
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| Links: |
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| Themen: |
Admission |
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| Anmerkungen: |
Date Completed 04.10.2022 Date Revised 22.10.2022 published: Print-Electronic CommentIn: Heart Rhythm. 2022 Oct;19(10):1723-1724. - PMID 35724871 Citation Status MEDLINE |
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| doi: |
10.1016/j.hrthm.2022.05.024 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a 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 |
| 264 | 1 | |c 2022 | |
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| 500 | |a Date Completed 04.10.2022 | ||
| 500 | |a Date Revised 22.10.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Heart Rhythm. 2022 Oct;19(10):1723-1724. - PMID 35724871 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2022 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Admission | |
| 650 | 4 | |a Diagnosis | |
| 650 | 4 | |a Guidelines | |
| 650 | 4 | |a Safety | |
| 650 | 4 | |a Syncope | |
| 700 | 1 | |a Zimmermann, Tobias |e verfasserin |4 aut | |
| 700 | 1 | |a Badertscher, Patrick |e verfasserin |4 aut | |
| 700 | 1 | |a Lopez-Ayala, Pedro |e verfasserin |4 aut | |
| 700 | 1 | |a Nestelberger, Thomas |e verfasserin |4 aut | |
| 700 | 1 | |a Miró, Òscar |e verfasserin |4 aut | |
| 700 | 1 | |a Salgado, Emilio |e verfasserin |4 aut | |
| 700 | 1 | |a Zaytseva, Xenia |e verfasserin |4 aut | |
| 700 | 1 | |a Gafner, Michele Sara |e verfasserin |4 aut | |
| 700 | 1 | |a Christ, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Cullen, Louise |e verfasserin |4 aut | |
| 700 | 1 | |a Than, Martin |e verfasserin |4 aut | |
| 700 | 1 | |a Martin-Sanchez, F Javier |e verfasserin |4 aut | |
| 700 | 1 | |a Di Somma, Salvatore |e verfasserin |4 aut | |
| 700 | 1 | |a Peacock, W Frank |e verfasserin |4 aut | |
| 700 | 1 | |a Keller, Dagmar I |e verfasserin |4 aut | |
| 700 | 1 | |a Costabel, Juan Pablo |e verfasserin |4 aut | |
| 700 | 1 | |a Sigal, Alan |e verfasserin |4 aut | |
| 700 | 1 | |a Puelacher, Christian |e verfasserin |4 aut | |
| 700 | 1 | |a Wussler, Desiree |e verfasserin |4 aut | |
| 700 | 1 | |a Koechlin, Luca |e verfasserin |4 aut | |
| 700 | 1 | |a Strebel, Ivo |e verfasserin |4 aut | |
| 700 | 1 | |a Schuler, Sereina |e verfasserin |4 aut | |
| 700 | 1 | |a Manka, Robert |e verfasserin |4 aut | |
| 700 | 1 | |a Bilici, Murat |e verfasserin |4 aut | |
| 700 | 1 | |a Lohrmann, Jens |e verfasserin |4 aut | |
| 700 | 1 | |a Kühne, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Breidthardt, Tobias |e verfasserin |4 aut | |
| 700 | 1 | |a Clark, Carol L |e verfasserin |4 aut | |
| 700 | 1 | |a Probst, Marc |e verfasserin |4 aut | |
| 700 | 1 | |a Gibson, Thomas A |e verfasserin |4 aut | |
| 700 | 1 | |a Weiss, Robert E |e verfasserin |4 aut | |
| 700 | 1 | |a Sun, Benjamin C |e verfasserin |4 aut | |
| 700 | 1 | |a Mueller, Christian |e verfasserin |4 aut | |
| 700 | 0 | |a BASEL IX and SRS Investigators |e verfasserin |4 aut | |
| 700 | 1 | |a Widmer, Velina |e investigator |4 oth | |
| 700 | 1 | |a Leu, Kathrin |e investigator |4 oth | |
| 700 | 1 | |a Reichlin, Tobias |e investigator |4 oth | |
| 700 | 1 | |a Shrestha, Samyut |e investigator |4 oth | |
| 700 | 1 | |a Freese, Michael |e investigator |4 oth | |
| 700 | 1 | |a Krisai, Philipp |e investigator |4 oth | |
| 700 | 1 | |a Belkin, Maria |e investigator |4 oth | |
| 700 | 1 | |a Kawecki, Damian |e investigator |4 oth | |
| 700 | 1 | |a Morawiec, Beata |e investigator |4 oth | |
| 700 | 1 | |a Muzyk, Piotr |e investigator |4 oth | |
| 700 | 1 | |a Nowalany-Kozielska, Ewa |e investigator |4 oth | |
| 700 | 1 | |a Geigy, Nicolas |e investigator |4 oth | |
| 700 | 1 | |a Martinez-Nadal, Gemma |e investigator |4 oth | |
| 700 | 1 | |a Fuenzalida Inostroza, Carolina Isabel |e investigator |4 oth | |
| 700 | 1 | |a Mandrión, José Bustamante |e investigator |4 oth | |
| 700 | 1 | |a Poepping, Imke |e investigator |4 oth | |
| 700 | 1 | |a Greenslade, Jaimi |e investigator |4 oth | |
| 700 | 1 | |a Hawkins, Tracey |e investigator |4 oth | |
| 700 | 1 | |a Rentsch, Katharina |e investigator |4 oth | |
| 700 | 1 | |a Mitrovic, Sandra |e investigator |4 oth | |
| 700 | 1 | |a von Eckardstein, Arnold |e investigator |4 oth | |
| 700 | 1 | |a Buser, Andreas |e investigator |4 oth | |
| 700 | 1 | |a Osswald, Stefan |e investigator |4 oth | |
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| 700 | 1 | |a Adler, David H |e investigator |4 oth | |
| 700 | 1 | |a Bastani, Aveh |e investigator |4 oth | |
| 700 | 1 | |a Baugh, Christopher W |e investigator |4 oth | |
| 700 | 1 | |a Caterino, Jeffrey M |e investigator |4 oth | |
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