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
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
Kenny R.A. et al. 2015
Kenny R.A. et al. 2015
Referral from family practitioners, ED, inhospital and outhospital services, or self-referral from the patient
Kenny R.A. et al. 2015
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
Casagranda I. et al 2016
Costantino G. et al 2015
Casagranda I et al 2016
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. 2003 SFSR: ECG patologico +1 Scompenso cardiaco +1 Ematocrito <30% +1 Dispnea +1 PAS <90 mmhg +1 1 = alto rischio Quinn J.V. et al. 2004 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
Costantino G et al 2014
Costantino G et al 2015
Costantino G et al 2015
Costantino G et al 2015
Costantino G et al 2015
Costantino G et al 2015
Il percorso del paziente dopo il DEA. Dal documento EHRA sulla Syncope Unit al mondo reale
351 Pz. consecutivi, valutati per sincope in ED
Grossman A.M. et al. 2016
Grossman A.M. et al. 2016
Settembre 2003-Settembre 2006
Sun B.J. Et al. 2014
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%
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.
347 patients, 250 at intermediate and 97 at high risk
2 vs 27
Intermediate-risk patients could be safely discharged. In prognostic stratification, priority is to seek risk factors for cardiogenic syncope.
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
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
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%)
1-month-mortality rate was0.03% (1/295) 12-months-mortality rate was5.4% (16/295) No events between ED and SU evaluation
Il percorso del paziente dopo il DEA. Dal documento EHRA sulla Syncope Unit al mondo reale Grazie per l attenzione