Improving the wellbeing of patients with syncope

Fainted lady

15 November 2019

Dr Lesley Kavi, RCGP Clinical Champion for Syncope

The terms blackout and syncope are often used interchangeably. However, these terms have slightly different meanings; a blackout is transient loss of consciousness (TLoC) regardless of the mechanism and includes various conditions such as epilepsy and hypoglycaemia. Syncope is a subgroup of blackouts and refers to TLoC due to reduced cerebral blood flow.

The RCGP Syncope Spotlight Project, launched last summer, is working to raise awareness of syncope to GPs and their teams and patients. The aim of the project is to improve the wellbeing of patients with syncope through improved detection, assessment, treatment and orthostatic intolerance in primary care.

Isn’t it just a simple faint?

Whilst most faints, especially in young people, are vasovagal in nature, fainting can be the first symptom of a serious underlying cardiac condition. In some circumstances the next event can be sudden death. Although this occurs rarely, in some subgroups of patients experiencing cardiac syncope, mortality may be as high as 33% at one year.1

In a review of assessments of patients with syncope, it was found that GPs  can miss questions about red flags that would help to detect underlying serious cardiac conditions.2 Although vasovagal syncope is often considered benign, in fact it carries a significant socioeconomic burden and negative impact upon quality of life, especially in the elderly.3

Misdiagnosis is common

Misdiagnosis in blackouts is common. Up to 32% of patients in the UK on anticonvulsants for epilepsy do not have epilepsy and in many the underlying cause for the blackout is cardiovascular.4

Due to short or absent prodrome prior to fainting, and amnesia for the syncopal episode, in older people vasovagal syncope can be mistakenly reported as a fall.3 

Spotlight project progress

The project made a flying start with a free multi-topic workshop in Oxford in July in collaboration (held jointly with the Lyme Disease and Inflammatory Bowel Disease Spotlight Projects), with almost 100 delegates registering to attend. A second workshop in Cambridge in October proved to be equally popular and there are more planned for 2020 at venues throughout the UK.

The workshop included presentations on assessment and management of syncope and orthostatic intolerance. Dr Kate Gee, cardiology nurse consultant at University Hospitals Birmingham, joined the project to provide lively ECG teaching sessions during the workshops.

Work has commenced on a Syncope Toolkit, which will describe causes and advise on the assessment and management of syncope and will include a library of ECGs relevant in syncope and a quick syncope checklist to aid assessment of patients who present to the GP with syncope.

Visit the Syncope Spotlight page for updates as the project progresses.     

References:

  1. Koene RJ, Adkisson WO, Benditt DG. Syncope and the risk of sudden cardiac death: Evaluation, management, and prevention. J Arrhythm. 2017;33(6):533-44.
  2. Kavi L. Transient loss of consciousness (TLoC) in primary care: a review of patients presenting with first blackout. Br J Cardiol. 2017;24:62-5.
  3. Kenny RA, McNicholas T. The management of vasovagal syncope. QJM. 2016;109(12):767-73.
  4. Juarez-Garcia A, Stokes T, Shaw B, Camosso-Stefinovic J, Baker R. The costs of epilepsy misdiagnosis in England and Wales. Seizure. 2006;15(8):598-605.

 

 

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