Optimal Management of Low-Risk Syncope Patients

We recently completed the largest syncope study with 4,030 patients and derived the Canadian Syncope Risk Score (CSRS) to predict the possibility of serious outcomes, including arrhythmia, within 30-days of emergency discharge. The total scores range from -3 to +11; higher scores indicating greater risk. We will be completing CSRS validation by February 2017.

For this study, we will conduct a randomized-controlled study at 8 Canadian emergency departments to compare serious arrhythmia detection in two study arms among at-risk syncope patients (score ≥3) discharged home after obtaining written informed consent. Analysis will compare arrhythmia detection in the intervention arm (15- day live external monitoring using a device called Cardiophone) with 48-hour holter monitoring. A mobile cardiac telemetry device will be used for the control arm for 15-days including a 13-day event recording after 48-hour holter (for arrhythmia surveillance). All patients will be linked to a cardiologist for follow-up 15 days after completion of heart monitoring. If serious arrhythmia is detected in the intervention arm, patients will be transported to the emergency and if non-serious arrhythmias are detected, an interim report will be issued to the cardiologist for appropriate follow-up. We plan to recruit 566 patients (283 per arm) to prove the usefulness of prolonged cardiac monitoring.

We anticipate that prolonged home monitoring will lead to improved patient safety and healthcare efficiency (better syncope care at lower cost).