The European Society of Cardiology issued updated syncope guidelines in 2018 which included recommendations for managing syncope in the emergency department (ED) setting. However, these guidelines lack detailed process-oriented instructions regarding the fact that ED syncope patients initially present with a transient loss of consciousness (TLOC), which can have a broad spectrum of causes. This study aims to establish a European consensus on the general process of the workup and care for patients with suspected syncope and provides rules for sufficient and systematic management of the broad group of syncope (initially presenting as TLOC) patients in the ED. A variety of European diagnostic and therapeutic standards for syncope patients were reviewed and summarized in three rounds of a modified Delphi process by the European Society for Emergency Medicine syncope group. Based on a consensus statement, a detailed process pathway is created. The primary outcome of this work is the presentation of a universal process pathway for the structured management of syncope patients in European EDs. The here presented extended event process chain (eEPC) summarizes and homogenizes the process management of European ED syncope patients. Additionally, an exemplary translation of the eEPC into a practice-based flowchart algorithm, which can be used as an example for practical use in the ED, is provided in this work. Syncope patients, initially presenting with TLOC, are common and pose challenges in the ED. Despite variations in process management across Europe, the development of a universally applicable syncope eEPC in the ED was successfully achieved. Key features of the consensus and eEPC include ruling out life-threatening causes, distinguishing syncope from nonsyncopal TLOCs, employing syncope risk stratification categories and based on this, making informed decisions regarding admission or discharge.

OBJECTIVE: We aimed to identify all syncope units (SUs) in the Netherlands and assess the extent to which these SUs fulfil the essential requirements outlined by the consensus statements of the European Heart Rhythm Association and the European Society of Cardiology syncope guidelines. For this, we developed the SU-19 score, a novel guideline based validation tool for best practice.
RESULTS: All outpatient clinics of cardiology, neurology, and internal medicine in the Netherlands were screened for presence of any form of structured specialized syncope care. If present, these were included as SUs and requested to complete a questionnaire regarding syncope care. We assessed all SUs using the SU-19 score regarding structure (3 points), available tests (12 points), and initial evaluation (4 points). Twenty SUs were identified in the Netherlands, both academic (5/20) and non-academic hospitals (15/20), 17/20 reported multidisciplinary involvement during initial evaluation. In 19/20, neurology, cardiology, or both were responsible for the syncope management. Non-physicians were involved performing the head-up tilt test (44%) and initial evaluation (40%). The mean SU-19 score was 18.0 ± 1.1, 45% achieved the maximum score of 19 points. Variations were observed in protocols for active standing test, carotid sinus massage, and head-up tilt test.
CONCLUSIONS: There is a network of 20 SUs in the Netherlands. Forty-five per cent fully met the SU-19 score (mean 18.0 ± 1.1). Slight variety existed in protocols for autonomic function tests. Neurology and cardiology were mostly involved in syncope management. Non-physicians play an important role in syncope care.

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.
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\'s diagnosis with the reference diagnosis.
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).
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.
Netherlands Trial Register, NTR6268.

BACKGROUND: The general regulations for an active participation in the road traffic in the Federal Republic of Germany are laid down in the Driving License Ordinance (\"Fahrerlaubnisverordnung\" ) (including appendices). Cardiovascular diseases with a need for precautionary measures and the circumstances according to which the driving fitness is to be determined are reviewed in appendix 4 of the ordinance. The guidelines of the Federal Highway Research Institute (\"Bundesanstalt für Straßenwesen\") must also be considered when assessing the fitness to drive.
OBJECTIVE: Presentation of the current legal recommendations in the assessment of the driving fitness in the respect to cardiovascular diseases.
METHODS: The current official regulations and the recommendations on the fitness to drive in the case of cardiovascular diseases were assessed. In addition, the pocket guidelines of the German Society for Cardiology (DGK) on the subject were reviewed.
RESULTS: As the type of vehicle and time at the wheel influence the probability and the extent of damage in the case of a traffic accident, the official requirements for driving aptitude distinguish between private (group 1) and professional drivers (group 2). The official recommendations for assessing fitness to drive in the case of cardiac arrhythmias, device therapy, coronary heart disease, cardiac insufficiency, valve diseases and syncope are presented.
CONCLUSIONS: Driving fitness plays an important role in the cardiological patient collective and should be determined in accordance with the official recommendations. For everyday clinical practice, the DGK recommendations for fitness to drive are presented in a clearer and more practice-relevant manner.
UNASSIGNED: HINTERGRUND: Die allgemeinen Regelungen für die aktive Teilnahme am Straßenverkehr in der Bundesrepublik Deutschland sind in der Fahrerlaubnisverordnung (FeV; inkl. Anlagen) festgelegt. In der Anlage 4 der FeV wurden die kardiovaskuläre Erkrankungen mit Vorsorgebedarf aufgelistet sowie auch die Umstände, wann eine Fahreignung vorliegt. Zur Beurteilung der Fahreignung ist auch die Begutachtungsleitlinie der Bundesanstalt für Straßenwesen (BASt) zu berücksichtigen.
UNASSIGNED: Darstellung der aktuellen rechtlichen Empfehlungen für die Beurteilung der Fahreignung bei kardiovaskulären Erkrankungen.
METHODS: Die aktuellen behördlichen Verordnungen und Empfehlungen zur Fahreignung bei kardiovaskulären Erkrankungen werden dargestellt. Zusätzlich wurden die Pocket-Leitlinien der Deutschen Gesellschaft für Kardiologie (DGK) für Fahreignung berücksichtigt.
UNASSIGNED: Da die Art des Fahrzeugs und die Zeit am Steuer einen Einfluss auf die Schadenswahrscheinlichkeit haben, unterscheiden die behördlichen Vorgaben zur Fahreignung zwischen Privat- (Gruppe 1) und Berufsfahrern (Gruppe 2). Die behördlichen Empfehlungen für die Beurteilung der Fahreignung bei Herzrhythmusstörungen, Devicetherapie, koronarer Herzerkrankung, Herzinsuffizienz, Klappenerkrankungen, Synkopen wurden dargestellt.
CONCLUSIONS: Das Thema Fahreignung spielt eine wichtige Rolle im kardiologischen Patientenkollektiv und soll entsprechend den Vorgaben in der FEV mit Anlage 4 sowie Begutachtungsleitlinien BASt berücksichtigt werden. Für den klinischen Alltag sind die DGK-Empfehlungen zur Fahreignung übersichtlicher und praxisrelevanter dargestellt.

BACKGROUND: The evaluation of syncope in emergency departments (EDs) and during hospitalization can be ineffective. The European Society of Cardiology (ESC) guidelines were established to perform the evaluation based on risk stratification.
OBJECTIVE: To investigate whether the initial screening of syncope adheres to the recent ESC guidelines.
METHODS: Patients with syncope who were evaluated in our ED were included in the study and retrospectively classified based on whether they were treated according to ESC guidelines. Patients were divided into two groups according to the ESC guideline risk profile: high risk or low risk.
RESULTS: The study included 114 patients (age 50.6 ± 21.9 years, 43% females); 74 (64.9%) had neurally mediated syncope, 11 (9.65%) had cardiac syncope, and 29 (25.45%) had an unknown cause. The low-risk group included 70 patients (61.4%), and the high-risk group included 44 (38.6%). Only 48 patients (42.1%) were evaluated according to the ESC guidelines. In fact, 22 (36.7%) of 60 hospitalizations and 41 (53.2%) of 77 head computed tomography (CT) scans were not mandatory according to guidelines. The rate of unnecessary CT scans (67.3% vs. 28.6%, respectively, P = 0.001) and unnecessary hospitalization (66.7% vs. 6.7%, respectively, P < 0.02) were higher among low-risk patients than high-risk patients. Overall, a higher percentage of high-risk patients were treated according to guidelines compared to low-risk patients (68.2% vs. 25.7% respectively, P < 0.0001).
CONCLUSIONS: Most syncope patients, particularly those with a low-risk profile, were not evaluated in accordance with the ESC guidelines.

暂无摘要。

暂无摘要。

暂无摘要。

Syncopal events in patients with hypertrophic cardiomyopathy (HCM) are of concern as they are a vital consideration in algorithms for risk stratification for sudden cardiac death (SCD) and ICD implantation. However, the cause of syncope is often under-investigated and/or unexplained. Current syncope guidelines do not provide a detailed definition of unexplained syncope. To address this important gap, an international panel of experts in the field of both syncope and HCM wrote a consensus document with the aim of providing practical guidance for the diagnosis and management of syncope in patients with HCM.

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.
CONCLUSIONS: 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.