The Impact of a Nurse-Led Syncope Clinic: Experience from a single UK tertiary center

Abstract

Background: Syncope is a leading cause of hospital admission and is associated with significant morbidity and mortality. Our Syncope Clinic commenced in 2014 and we sought to evaluate its impact on outcomes (1-yr mortality and syncope re-hospitalization) in patients discharged following syncope admission. Methods: A single-center study of all consecutive patients discharged with syncope (ICD-10 R55) between April 2012 and 2017. Patient demographics, comorbidities, hospital stay, syncope re-hospitalization, and mortality at one-year were collected. Those subsequently referred and seen in Syncope Clinic were compared with those who were not and predictors of poor outcome were evaluated. Results: In total 2950 patients were discharged from hospital with syncope (median age: 73years, 51% male) with 1220 (41%) discharged same-day; after commencement of Syncope Clinic 231were subsequently reviewed here. Overall mortality was 11%, which was lower in the Syncope Clinic group (3% vs 12%, P '.001). Temporal analysis revealed reduced re-hospitalization following commencement of Syncope Clinic (2% vs 6%, P =.027). Independent predictors of mortality were increasing age (HR 1.03, 95% CI 1.03-1.04), AF (HR 1.6, 95% CI 1.2-2.1), HF (HR 2.2, 95% CI 1.6-3.0), COPD (HR 1.9, 95% CI 1.4-2.7), and CHADS2 score ≥ 1 (HR 1.45, 95% CI 1,12-1.87). Syncope Clinic attendance was associated with reduced mortality (HR 0.3, 95% CI 0.1-0.6). Conclusions: Syncope patients discharged from hospital had reduced 1yr mortality if seen in subsequent Syncope Clinic. Independent predictors of mortality were COPD, HF, AF, and CHADS2≥1. Prospective randomized trials of Syncope Clinics are warranted.