Editorial comment
The importance of dedicated teams for the management of patients with syncope
A importância de equipas dedicadas à abordagem de doentes com síncope
Denise Tessariol Hachul
Heart Institute (InCor), University of Sao Paulo, School of Medicine, Brazil
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However, the wide spectrum of etiologies involving syncope, from benign to potentially fatal, mandates the immediate recognition of patients at highest risk, in order to intervene in their natural history, through appropriate preventive and therapeutic measures.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There is currently no independent gold standard method for diagnosing syncope. Therefore, data obtained from the witness of a crisis, findings on physical examination, and alterations observed in diagnostic tests during or shortly after a spontaneous episode are extremely important. These data may include severe hypertension or hypotension, dyspnea, bradycardia, tachycardia, active bleeding, pallor, sweating, cyanosis, malnutrition or dehydration observed on physical examination, or ischemic changes on the electrocardiogram (ECG), both during the loss of consciousness and after recovery.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Population studies have shown that cardiac syncope, both arrhythmic and originating from structural changes in the heart, is associated with a poor prognosis. By contrast, patients with syncope of neurally-mediated origin have an excellent prognosis, similar to the general population without a history of syncope.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Multiple etiological factors can coexist in an individual with syncope, which makes it even more difficult to determine prognosis and to institute appropriate treatment. For this reason, several risk scores have been proposed in recent years, the main objective of which is to establish criteria and factors to differentiate syncope of cardiac and non-cardiac origin. Risk stratification based on these scores has been widely applied in different centers to patients with syncope of undetermined origin.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The current concept of susceptibility to hypotension, proposed by Sutton et al.,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> is based on the demonstration that vasodepressor phenomena can occur in patients with syncope of other than dysautonomic etiology, including those with cardiac syncope (approximately 45% of positive results on tilt table testing). This approach highlights the need for well-established criteria for diagnosis and indication of complementary tests, so that high-risk patients are not mistakenly considered to have a good prognosis.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The EGSYS score,<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">7,8</span></a> which uses clinical and electrocardiographic variables, was designed to distinguish cardiac from non-cardiac syncope in the ED. It is relatively simple and easy to assimilate and is quite appropriate for quick decisions, especially in the ED. EGSYS scores factors previously correlated with cardiovascular disorders positively, and factors suggestive of reflex syndromes negatively. Positive factors include the existence of previous heart disease or abnormalities on the 12-lead ECG, palpitations preceding syncope, syncope associated with physical exertion and syncope in horizontal decubitus. Among the negative factors are neurovegetative prodromal symptoms and repeated precipitating factors.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the ED, an EGSYS score>3 has proved to be quite effective for decision-making concerning hospitalization and faster investigation, or for patient discharge and an outpatient assessment. Sensitivity and specificity for diagnosis of cardiac syncope in the original publication was 92% and 69%, respectively.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Journal</span>, de Sousa et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> sought to assess the role of the EGSYS score in the context of outpatient consultations, in patients previously assessed in the ED or referred by other health services for consultations with cardiology specialists. The study was retrospective, based on data from electronic medical records, and telephone contact was used in a two-year follow-up to determine patients’ clinical course. The low sensitivity (48.2%) of an EGSYS score ≥3 to predict syncope of cardiac etiology in outpatient consultations is most likely due to the fact that high-risk patients had been preselected in the originating departments. However, its reasonable specificity and considerable negative predictive value (77.9% and 88.3%, respectively) suggest its utility as a marker of good prognosis in an outpatient setting. As an easily remembered and easily applied questionnaire without additional costs, its use during outpatient consultations can be a good basis for reassuring the patient and family members.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In recent years, particular attention has been given to the concept of multidisciplinary syncope units,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> which are virtual or physical spaces with access to specialists in the area and specialized equipment and in which a pragmatic approach is adopted, based on consensus on current practice and on the available evidence.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The main purpose of a syncope unit is to determine with greater precision, among patients with a defined diagnosis, which need immediate interventions and, among those still without diagnosis, what is the best investigation strategy, according to their risk stratification, with the best cost-benefit ratio for the health system.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">There is agreement that the initial assessment, consisting of history, physical examination and ECG, can provide a confident diagnosis when the recommendations of specialists are followed. In addition, according to the latest European Heart Rhythm Association (EHRA)/European Society of Cardiology (ESC) guidelines (2018),<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> there is strong consensus that the clinical judgment of syncope specialists is often more effective than the various published risk scores for predicting the patient's short-term prognosis.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Risk factors for cardiac syncope and higher mortality are generally accepted to include advanced age (>60 years), male gender, pre-existing ischemic or structural heart disease, previous arrhythmias, ventricular dysfunction, palpitations preceding syncope, brief or absent prodromes, effort-induced syncope, syncope in the supine position, low number of episodes (potentially greater risk in recent history), abnormal cardiac physical examination, known congenital heart disease, known hereditary heart disease, and history of sudden death in relatives under 50 years of age.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Factors associated with a better prognosis are younger age, systemic diseases, syncope in orthostatic position or postural changes, autonomic prodromes (nausea, vomiting, heat), dehydration, painful or distressing stimuli, medical procedures, situational triggers (coughing, laughing, defecation, urination, swallowing), and frequent recurrences (old history with similar precipitating factors).</p><p id="par0080" class="elsevierStylePara elsevierViewall">In the presence of at least one risk factor, the patient should be referred for observation in the ED to undergo specific diagnostic exams, until acute and potentially fatal causes are ruled out. If high risk is confirmed, hospital admission is indicated. In cases of intermediate risk, patients should be referred to a syncope unit for more rapid investigation.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In the study by de Sousa et al., even though the patients were previously selected, it can be seen that the cases diagnosed with syncope of cardiac origin in outpatient consultations showed a statistically significant difference from those with non-cardiac syncope in two risk factors: a higher incidence of previous heart disease or abnormal ECG, and less frequent situational precipitating factors.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Despite the evidence of their benefit, there are major barriers to the establishment of syncope units, from underestimating the consequences of syncope (in terms of both morbidity and mortality) to the low number of syncope specialists and hence a lack of formal training programs. The study of syncope is not recognized as a medical subspecialty and there is no proper integration between the physicians involved in this area (neurologists, cardiologists, emergency doctors, psychiatrists, geriatricians and general practitioners), which tends to lead to multiple and duplicated diagnostic exams that are often unnecessary and costly, resulting in low efficiency in the results of these workups.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> Patients with syncope of undetermined origin require special attention, not only in the ED, but also in outpatient consultations. They should preferably be referred to specialists in the area,<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">5,11</span></a> for the application of effective methods and algorithms that have been recognized and validated in consensus, in order for their diagnosis and prognosis to be determined as rapidly and as accurately as possible.</p><p id="par0095" class="elsevierStylePara elsevierViewall">For this, the creation of syncope units should be encouraged worldwide, with the aim of improving results and reducing costs.</p><p id="par0100" class="elsevierStylePara elsevierViewall">In addition to the potential risk of sudden death and morbidity resulting from falls, recurrent syncope can cause disabling conditions, and significantly impact patients’ quality of life.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Accurate and early recognition of the underlying mechanisms involved in syncope is the only way to prevent recurrences and to administer appropriate therapies, enabling these patients to return to their normal lives.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A guide to disorders causing transient loss of consciousness: focus on syncope" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G.J. Van Dijk" 1 => "R.D. Thijs" 2 => "D.G. Benditt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Nature Rev Neurol" "fecha" => "2009" "volumen" => "5" "paginaInicial" => "438" "paginaFinal" => "448" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0065" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Syncope clinical management in the emergency department: a consensus from the first international workshop on syncope risk stratification in the emergency department" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Costantino" 1 => "C. Sun Benjamin" 2 => "F. Barbic" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehv378" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2016" "volumen" => "37" "paginaInicial" => "1493" "paginaFinal" => "1498" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26242712" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0070" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Syncope: classification and risk stratification" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Puppala" 1 => "O. Dickinson" 2 => "D. Benditt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jjcc.2013.03.019" "Revista" => array:6 [ "tituloSerie" => "J Cardiol" "fecha" => "2014" "volumen" => "63" "paginaInicial" => "171" "paginaFinal" => "177" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24405895" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0075" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence and prognosis of syncope" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E.S. Sotoriades" 1 => "J.C. Evans" 2 => "M.G. Larson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa012407" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2002" "volumen" => "347" "paginaInicial" => "878" "paginaFinal" => "885" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12239256" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0080" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Syncope risk stratification tools vs clinical judgment: an individual patient data meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Costantino" 1 => "G. Casazza" 2 => "M. Reed" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjmed.2014.05.022" "Revista" => array:6 [ "tituloSerie" => "Am J Med" "fecha" => "2014" "volumen" => "127" "paginaInicial" => "1126.e13" "paginaFinal" => "1126.e25" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24862309" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0085" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Twenty-eight years of research permit reinterpretation of tilt-testing: hypotensive susceptibility rather than diagnosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Sutton" 1 => "M. Brignole" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehu255" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2014" "volumen" => "35" "paginaInicial" => "2211" "paginaFinal" => "2212" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24980488" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0090" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Del Rosso" 1 => "A. Ungar" 2 => "R. Maggi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/hrt.2008.143123" "Revista" => array:6 [ "tituloSerie" => "Heart" "fecha" => "2008" "volumen" => "94" "paginaInicial" => "1620" "paginaFinal" => "1626" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18519550" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0095" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Validation of EGSYS score in prediction of cardiogenic syncope" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Kariman" 1 => "S. Harati" 2 => "S. Safari" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Int J Emer Med" "fecha" => "2015" "paginaInicial" => "1" "paginaFinal" => "5" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0100" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Score EGSYS para predição de etiologia cardíaca na síncope: tem utilidade no contexto de consulta?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.S. Bispo" 1 => "P. Azevedo" 2 => "T. Mota" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2020.03.001" "Revista" => array:4 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2020" "volumen" => "39" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32205011" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0105" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Syncope unit: rationale and requirement – the European Heart Rhythm Association position statement endorsed by the Heart Rhythm Society" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.A. Kenny" 1 => "M. Brignole" 2 => "G.A. Dan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/europace/euv115" "Revista" => array:6 [ "tituloSerie" => "Europace" "fecha" => "2015" "volumen" => "17" "paginaInicial" => "1325" "paginaFinal" => "1340" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26108809" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0110" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ESC Scientific Document Group 2018 ESC Guidelines for the diagnosis and management of syncope" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Brignole" 1 => "A. Moya" 2 => "F. De Lange" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehy037" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2018" "volumen" => "39" "paginaInicial" => "1883" "paginaFinal" => "1948" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29562304" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003900000005/v2_202006270656/S0870255120302134/v2_202006270656/en/main.assets" "Apartado" => array:4 [ "identificador" => "29261" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Artigos Originais" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003900000005/v2_202006270656/S0870255120302134/v2_202006270656/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255120302134?idApp=UINPBA00004E" ]
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