Improving Syncope Risk Stratification in Older Adults
Improving Syncope Risk Stratification in Older Adults
Syncope (temporary loss of consciousness) is a frequent reason for an emergency department
 (ED) visit among older adults. The current ED evaluation of syncope frequently leads to
 hospitalization, results in low diagnostic yield, and is enormously costly. The purpose of
 this protocol is to improve risk prediction for syncope. Improved risk prediction will inform
 the design of interventions to safely reduce unnecessary health service use.

 This is a multi-center, prospective, observational cohort study of older (age≥60 years)
 adults who present to an emergency department with syncope (otherwise known as fainting). The
 primary outcome is a composite of 30-day cardiac death and serious cardiac events.

 Study Aims and Hypotheses are:

 Specific Aim 1. Describe serious outcomes after unexplained syncope; rates and reasons for
 admission; and frequency, diagnostic yield, and therapeutic impact of inpatient diagnostic
 tests.

 H1: Current patterns of care representing a diversity of practice settings and patient
 populations are costly with low clinical benefit.

 Specific Aim 2. Derive and validate a novel risk prediction model for 30-day cardiac death
 and serious cardiac outcomes after unexplained syncope.

 H2: Explicit criteria including contemporary cardiac biomarkers will improve risk
 stratification compared to unstructured physician assessment and published risk models.

 Specific Aim 3. Assess safety and costs of a risk-tailored diagnostic algorithm compared to
 existing care for unexplained syncope.

 H3: A risk-tailored diagnostic algorithm can safely reduce the costs of evaluating
 unexplained syncope in older adults.
Inclusion Criteria:

 1. age≥60 years; AND

 2. a complaint of syncope or near-syncope. Syncope is defined as a transient loss of
 consciousness (LOC), associated with loss of postural tone, with immediate,
 spontaneous, and complete recovery. Near-syncope is the sensation of imminent syncope
 without loss of consciousness.

 Exclusion Criteria:

 -  Seizure as presumptive cause of LOC

 -  Stroke or transient ischemic attack as presumptive cause of LOC

 -  LOC AFTER head trauma Confusion from baseline mental status

 -  Intoxicated (alcohol or other drugs)

 -  Medical or electrical intervention to restore consciousness

 -  Hypoglycemia as presumptive cause of LOC

 -  inability to provide follow-up information, including patients who do not speak
 English (or Spanish, if applicable for study site), lack phone access, or lack a
 permanent address

 -  Inability or unwillingness of individual or legal guardian/representative to give
 written informed consent