Abstract
Introduction: Syncope is a common clinical problem[1] posing a diagnostic and therapeutic challenge, due to varied presentations and underlying pathologies[2]. Although an MDT approach is a recognised key component in patient care[3], there is no current guidance in the context of syncope.
The Syncope Service in QEUH Glasgow is run by Geriatricians with a specialist interest in Syncope. A formalised monthly MDT, introduced in November 2017, involves Geriatricians, Cardiologists, a Neurologist and Cardiac Physiologists.
Method: A retrospective case note analysis undertaken for patients reviewed at the Syncope MDT (November 2017-March 2023), assessed the impact on diagnosis, further investigation and treatment initiation.
Results: 151 patients, with an average age of 65, were discussed at the MDT. The reasons for referral were cardiology specialist advice (62.9%), neurology specialist advice (19.2%) and multi-specialty case review (16.6%).
Following discussion, cases of unexplained syncope decreased from 28.5% to 19.8%. The diagnosis of a cardiac rhythm abnormality increased from 11.4% to 19.8%, and a provisional diagnosis of a seizure disorder increased from 12.8% to a confirmed 15.9%, without the need for additional specialty clinic review.
The MDT facilitated prompt access to investigations such as ILR (9.3%) and commencement of appropriate treatment such as anti-epileptic medication (6%) or PPM insertion (8.6%).
Conclusion: By leveraging the collective expertise of diverse healthcare professionals, the syncope MDT enhances diagnostic precision, facilitates comprehensive investigations and streamlines the patient journey.
References:
[1]Chen,L.Y., Shen,W.K., Mahoney,D.W., Jacobsen,S.J., Rodeheffer,R.J.(2006). Prevalence of syncope in a population aged more than 45 years.Am J Medi,119(12),pp.1088-e1.
[2]McLintock,B., Reid,J., Capek,E., Anderton,L., Mitchell,L.(2019).Unscheduled care bed days can be reduced with a syncope pathway and rapid access syncope clinic.Br J Cardiol,26,pp.133-136.
[3]McAlister,F.A., Stewart,S., Ferrua,S., McMurray,J.J.(2004).Multidisciplinary strategies for the management of heart failure patients at high risk for admission:a systematic review of randomised trials.J Am Coll Cardiol.44(4):810-9.