Il percorso del paziente dopo il DEA. Dal documento EHRA sulla Syncope Unit al mondo reale

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Fausto Cuomo
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1 Il percorso del paziente dopo il DEA. Dal documento EHRA sulla Syncope Unit al mondo reale Martina Rafanelli Syncope Unit, Geriatria e UTIG, Università degli Studi di Firenze, AOU Careggi Firenze

2 Syncopeis a commonmedical problem. Higher health costs unnecessary hospitalizations and diagnostic There is wide variation in practice of syncope evaluation, and procedures wide variation in adoption of recommendations from published prolongation guidelines. of hospital stays lower diagnostic rates higher rates of symptom recurrences Kenny R.A. et al. 2015

3 Kenny R.A. et al. 2015

4 Kenny R.A. et al. 2015

6 Referral from family practitioners, ED, inhospital and outhospital services, or self-referral from the patient

7 Kenny R.A. et al. 2015

8 Define the diagnostic pathway and the management ofpatients referred totheed for TLoC of suspected syncopal cause, which is still unexplained after the initial evaluation Casagranda I et al 2016

9 Casagranda I. et al 2016

10 Costantino G. et al 2015

11 Casagranda I et al 2016

12 Score di rischio OESIL risk score: Età >65 anni +1 No prodromi +1 ECG patologico +1 Cardiopatia +1 2 punti = alto rischio Colivicchi F. et al SFSR: ECG patologico +1 Scompenso cardiaco +1 Ematocrito <30% +1 Dispnea +1 PAS <90 mmhg +1 1 = alto rischio Quinn J.V. et al EGSYS risk score: ECG patologico/cardiopatia +3 Cardiopalmo prima della sincope +4 Sincope da sforzo +3 Sincope supina +2 Prodromi neurovegetativi -1 Assenza di situazioni scatenanti -1 3 punti = alto rischio Del Rosso A. et al. 2008

13 Costantino G et al 2014

14 Costantino G et al 2015

15 Costantino G et al 2015

16 Costantino G et al 2015

17 Costantino G et al 2015

18 Costantino G et al 2015

19 Il percorso del paziente dopo il DEA. Dal documento EHRA sulla Syncope Unit al mondo reale

20 351 Pz. consecutivi, valutati per sincope in ED

21 Grossman A.M. et al. 2016

22 Grossman A.M. et al. 2016

23 Settembre 2003-Settembre 2006

25 Sun B.J. Et al. 2014

29 Blanc J.J. Et al. Eur Heart J 2002 Ricoveri per sincope 63% Elesber A.A. et al Am Heart J 2005 Ricoveri per sincope 57.5% Bartoletti A. et al. Eur Heart J 2006 Ricoveri per sincope 50.1% Disertori M. et al. Europace 2003 Ricoveri per sincope 43% Brignole M Eur Heart J 2006 Ricoveri per sincope 39%

30 In a cohort of patients with undetermined syncope, we prospectively compared the short-term prognosis of patients at intermediate risk (i.e., with stable heart diseases or comorbidities, of any age) versus those at high risk for cardiogenic syncope and identified factors associated with serious events. Secondarily, we analyzed the currentmanagement ofintermediate-riskpatients.

31 347 patients, 250 at intermediate and 97 at high risk

32 2 vs 27

34 Intermediate-risk patients could be safely discharged. In prognostic stratification, priority is to seek risk factors for cardiogenic syncope.

35 Consecutive patients referred to the ED of Careggi Hospital for T-LOC in which syncope was suspected as the main diagnosis, from 1 January to 30 June 2010

36 Consecutive patients referred to the ED of Careggi Hospital for T-LOC in which syncope was suspected as the main diagnosis, from 1 January to 30 June 2010

37 ED 295 patients 29% vs 39% EGSYS 2 Admitted 85 pz (29%) Short stay 60 pt (20%) Syncope Unit Fast Track 58 pt (21%) Discharded 92 pt (31%)

39 1-month-mortality rate was0.03% (1/295) 12-months-mortality rate was5.4% (16/295) No events between ED and SU evaluation

41 Il percorso del paziente dopo il DEA. Dal documento EHRA sulla Syncope Unit al mondo reale Grazie per l attenzione

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