Abstract
Introduction:
The head-up tilt test (HUTT) is a common diagnostic test in patients presenting with syncope. A fast Italian protocol for HUTT shortens the traditional protocol from 40 to 25 mins (5 min supine phase, 10 min passive phase, 10 min GTN phase). This has been demonstrated to be as sensitive and specific in identifying vasovagal syncope in young adults as the traditional protocol, but not in older adults. We aimed to determine in our practice what proportion of positive results identified using the traditional Italian protocol, could have been identified using the fast Italian protocol.
Methods:
Data were collected from HUTTs performed in our Older Person’s care syncope service between 01/11/2024 and 01/11/2025. A positive response was defined as syncope in the presence of hypotension or bradycardia.
Results:
A total of 49 HUTTs were performed. The median age of patients at time of test was 76 years (range 64-94) and mostly female (n=28, 57%). Duration of passive phase was mean 15.4 (range 10-20) mins, and none suffered syncope. The majority of patients were given GTN spray (n=43, 88%). Duration of post-GTN phase was mean 7.2 (range 0-20) mins. A positive response was observed only post-GTN (n=24, 56%) at a mean 3.44 (range 1-10) mins. Positive responses were mostly vaso-depressive (n=20, 41%) the remainder cardioinhibitory vasovagal syncope.
Conclusion:
All positive responses were recorded during the post-GTN phase of the within the 10 minute duration of the fast Italian protocol. It is uncertain if preceded by a shorter passive phase, we would have seen fewer responses during the post-GTN phase. A randomised trial is now required to determine whether the diagnostic value of the Fast Italian protocol is similar to the Traditional protocol in older people.