Abstract
Introduction & Aims
Syncope is a significant cause of morbidity and mortality that is reported to affect up to 20% of adults over 75 years old. We aimed to describe the current Bradford syncope service for older adults.
Methods
Descriptive statistics were generated using data collected from outpatients discharged from the clinic in September and October 2024. Data were recorded manually using clinic letters and notes. SNOMED CT diagnostic and procedural codes recorded were requested from the Informatics team.
Results
The study included 46 patients aged 80 years (mean, range 70 to 94), 60% (27) of whom were female. From referral to discharge, patients attended a 3 ± 1 (mean, SD) clinic appointments.
From a total of 46 patients, 87% (40) underwent both ambulatory blood pressure and ECG measurement, 43% (20) tilt-table testing, 17% (8) carotid sinus massage and 7% (3) loop recorders implantation. 72% (33) had Vitamin D levels measured, 9% (4) DEXA scans.,13% (6) RESPECT discussions, and 2%(1) were referred to palliative care.
On discharge, the commonest diagnoses underlying syncope were orthostatic hypotension (41%,19), vasovagal syncope (33%,15), vestibular illness (13%,6), atrio-ventricular node dysfunction (11%,5), structural heart disease (7%, 3), atrial fibrillation (4%,2), psychogenic syncope (2%,1), SIADH (2%,1), TIA (2%,1) and depression (7%, 3).
In the electronic health record data, SNOMED_CT diagnostic codes were recorded for none of the 46 patients. SNOMED_CT procedural codes, as a proportion of those ordered, were recorded for ambulatory ECG measurement in 98% (39), ambulatory BP measurement in 100% (40), and tilt-table testing in 65% (13).
Conclusion
The Bradford syncope service for older adults undertakes investigation and management of syncope according to 2018 ESC syncope guidelines in the context of a comprehensive geriatric assessment approach. Coding using SNOMED CT diagnostic codes would facilitate future audit using electronic health record data.