How Do We Diagnose Syncope?

Diagnosis of Syncope. Introduction : The Eastbourne Syncope Assessment Study aims to increase diagnostic yield in unexplained syncope while reducing investigational costs. The initial study phase was a retrospective analysis of every presentation to the Eastbourne General Hospital (a busy nontertiary center in the United Kingdom serving a population of 250,000; 24% are older than 65 years) with syncope for the year 1998. Methods and Results : A total of 1,334 cases with syncopal codes were identified. Six hundred sixty patients (mean age 64 years) had actually suffered an episode of syncope. Forty percent had recurrent syncope, with a mean of 4.7 previous episodes. Twenty‐nine percent of syncope cases remained undiagnosed. Forty‐four percent were diagnosed as vasovagal, 12% neurologic, 6% due to an arrhythmia, 2% drug related, and 2% due to hemorrhage. Thirteen different types of investigation were undertaken, with an overall total of 3,264 investigations performed at a cost of £104285. Diagnosis was achieved by history and examination alone in 61% of cases. Excluding history and examination, the most cost‐effective diagnostic tools were the 7‐day patient‐activated recorder (R test) and tilt testing (£260 and £401 per diagnosis, respectively). Investigations also were graded by their relative diagnostic power. Hospital admission alone accounted for 67% of the cost of investigating syncope. Conclusion : In syncope, diagnostic rates can be improved and investigational costs reduced by concentrating on the most specific, sensitive, and cost‐effective investigations and by minimizing hospital stay. Such a protocol currently is under investigation at our institution.