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Nurse-led syncope and loop-recorder implantation clinics—a win-win approach for patients, clinicians, and hospitals

Published:November 24, 2021DOI:https://doi.org/10.1016/j.hrthm.2021.11.023
      The vast expansion of electrophysiological procedures

      Deering TF, Clair WK, Delaughter MC, Fisher WG, Garlitski AC, Wilkoff BL, Gillis AM. A Heart Rhythm Society Electrophysiology Workforce Study: Current survey analysis of physician workforce trends. Heart Rhythm 2010/09/01/ 2010;7:1346-1355.

      has created challenges in care delivery, with emerging trends in practice patterns rising to meet those challenges. One is the advent of specialized clinics for management of specialized problems, such as atrial fibrillation, rhythm device, and syncope clinics. Syncope clinics, providing a standardized approach to diagnosis and treatment of syncope delivered by specialists in the field, has been recommended by the most recent European Society of Cardiology guidelines on syncope.

      Brignole M, Moya A, de Lange FJ, et al. 2018 ESC Guidelines for the diagnosis and management of syncope. 2018.

      Syncope is highly prevalent, representing 0.8-2.4% of emergency department visits.
      • Shen W.K.
      • Sheldon R.S.
      • Benditt D.G.
      • et al.
      2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
      Healthcare costs for syncope are thus correspondingly high—an estimated 1.6 billion in 2014 dollars.
      • Shen W.K.
      • Sheldon R.S.
      • Benditt D.G.
      • et al.
      2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
      ,
      • Sun B.C.
      • Emond J.A.
      • Camargo C.A.
      Direct medical costs of syncope-related hospitalizations in the United States.
      Implanted loop recorders (ILRs) may reduce the costs associated with the extensive, and often unnecessary, testing often utilized in attempts to make the often-elusive diagnosis of syncope.
      • Krahn A.D.
      • Klein G.J.
      • Yee R.
      • Hoch J.S.
      • Skanes A.C.
      Cost implications of testing strategy in patients with syncope: randomized assessment of syncope trial.
      • Burkowitz J.
      • Merzenich C.
      • Grassme K.
      • Bruggenjurgen B.
      Insertable cardiac monitors in the diagnosis of syncope and the detection of atrial fibrillation: A systematic review and meta-analysis.

      Mendu ML, McAvay G, Lampert R, Stoehr J, Tinetti ME. Yield of diagnostic tests in evaluating syncopal episodes in older patients. 2009.

      The benefits of ILRs in increasing diagnostic yield, while decreasing cost, have been documented in multiple studies.
      • Krahn A.D.
      • Klein G.J.
      • Yee R.
      • Hoch J.S.
      • Skanes A.C.
      Cost implications of testing strategy in patients with syncope: randomized assessment of syncope trial.
      ,
      • Burkowitz J.
      • Merzenich C.
      • Grassme K.
      • Bruggenjurgen B.
      Insertable cardiac monitors in the diagnosis of syncope and the detection of atrial fibrillation: A systematic review and meta-analysis.
      Further, with increasing volume, the need for trained allied professionals as the field continues to expand is well-recognized.

      Deering TF, Clair WK, Delaughter MC, Fisher WG, Garlitski AC, Wilkoff BL, Gillis AM. A Heart Rhythm Society Electrophysiology Workforce Study: Current survey analysis of physician workforce trends. Heart Rhythm 2010/09/01/ 2010;7:1346-1355.

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      References

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      2. Brignole M, Moya A, de Lange FJ, et al. 2018 ESC Guidelines for the diagnosis and management of syncope. 2018.

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