Physicians' Academy for Cardiovascular Education

Updated ESC Guidelines on diagnosis and management of syncope

News - Apr. 30, 2018

An updated version of the ESC Guidelines for the diagnosis and management of syncope has been published by a dedicated and multidisciplinary ESC Task Force.

Syncope is defined as transient loss of consciousness due to cerebral hypoperfusion, characterised by a rapid onset, short duration and spontaneous complete recovery. Three types are distinguished, namely reflex syncope, syncope due to orthostatic hypotension or cardiac syncope. Clinical features that belong to the three categories of syncope are outlined, and the diagnostic work up to characterisation of the type of syncope, and additional steps to evaluate possible underlying disease, are described. Moreover, low- and high-risk features are described for the syncopal event, the past medical history and the physical examination, which allow to either discharge patients at low-risk, or to further investigate patients with a high risk of a serious outcome. The latter group is more likely to have cardiac syncope, and structural heart disease and primary electrical disease are major risk factors for sudden cardiac death and overall mortality in patients with syncope.

The document aimed to be patient-oriented and focussed on therapy, to reduce the risk of recurrence of syncope and the life-threatening consequences thereof. Although strong evidence from trials is scarce, as much advice as possible is given on the most appropriate therapy based on the practical expertise of the members of the Task Force. Where possible, therapeutic and decision-making algorithms are included.

A major challenge in syncope management is the reduction of inappropriate admissions and inappropriate use of tests, while maintaining the safety of the patient. That is why the document focusses on care pathways and organizational issues, including on how to set up outpatient syncope clinics aimed at reducing hospitalization, under- and misdiagnoses and costs.

Some recommendations have been updated in this 2018 update, as compared with the previous version published in 2009. A clear table (follow link posted below) summarizes the changes using colour-coding.

A new online feature is that the document contains Supplementary data as an integral part: the online content allows expansion to extra information on practical issues, and information that aims to fill the gap between the best available scientific evidence and the need for dissemination of these concepts into clinical practice.

Find the 2018 ESC guidelines on syncope online at Eur Heart J