Syncope Spotlight Project

Overview

Syncope will affect 40% of people during their lifetime. Whilst some syncopal episodes cause limited harm, others cause significant trauma and debility, or herald severe illness and sudden death.

Furthermore, misdiagnosis is common and therapeutic opportunities are missed.

Project Aims

  • To improve the wellbeing of patients with syncope though improved detection, assessment and management of patients with syncope, syncopal falls and orthostatic intolerance in primary care.
  • To reduce misdiagnosis and improve cost-effective and appropriate investigation and referral patterns.

Project Outputs

The RCGP Syncope Toolkit

The toolkit will guide GPs through the initial assessment, appropriate investigation and management of patients with syncope and orthostatic intolerance.

The resource will contain sections on:

  • causes, investigations and management of syncope
  • common misdiagnoses
  • syncope red flags and cardiac syncope
  • orthostatic hypotension – causes and management
  • the postural tachycardia syndromes
  • drug induced long QT syndrome
  • psychogenic pseudosyncope (PPS)
  • syncope and driving
  • falls and syncope
  • sections on syncope in athletes and in pregnancy.

The toolkit will be available to view online soon.

Workshops

During the past 18 months there have been three workshops held in Birmingham, Oxford and Cambridge. These were part of a programme of Easily Missed Diagnoses multi-topic workshops and included lectures on Lyme disease and Inflammatory Bowel Disease.

Dr Kate Gee, Cardiology Nurse Consultant at University Hospitals Birmingham, joined the project to provide lively ECG teaching sessions during the workshops. All workshops were oversubscribed with approximately 80 attendees at each. Unfortunately, additional workshops have been suspended because of the COVID-19 pandemic. PowerPoint slides from earlier workshops are available on the website: 

Workshop Survey Results

Attendees were invited to test their knowledge of syncope before and after a workshop. Pre-workshop, 54% of questions were answered correctly and post-workshop this increased to 72%. Areas where knowledge improved included mortality and red flags in syncope, appropriate investigations and signs that facilitate differentiation between convulsive vasovagal syncope and epilepsy.

Syncope checklist

There are tragic examples of avoidable deaths where GPs have missed syncope red flags or failed to give and document driving advice. We have created a Syncope Checklist [Word] which is a one-page A4 checklist designed to cover key aspects of the consultation when a patient presents to the GP with blackouts. This is a printer-friendly version and we encourage all GPs to use it during their consultations.

It has been difficult to pilot this during the pandemic; if you have the opportunity to use the checklist at your practice, please do share any feedback you may have with circ@rcgp.org.uk.

ECG Library

All patients with an unexplained blackout should have an ECG (NICE CG109). This reference will contain examples of ECG that would indicate that urgent specialist assessment of the patients is indicated.

Webinars and podcasts

Work to develop webinars and podcasts on syncope and orthostatic intolerance will start in the second year of the project.

Clinical Team

Dr Lesley Kavi, RCGP Clinical Champion for Syncope

Dr Lesley KaviLesley obtained her medical degree at Glasgow University and now works as a GP in Solihull in the West Midlands. She is visiting professor at Birmingham City University where teaches on the MSc Advanced Practice. In addition, she runs PoTS UK, a charity that supports patients with postural tachycardia syndrome.

Lesley's interest in syncope developed after working with STARS, a charity that provides support for patients with blackouts. She subsequently undertook a diploma in Syncope and related Disorders at RCPI, Dublin. She has authored a number of publications related to syncope and PoTS, and her work has shown that GPs often fail to enquire about syncope red flags. She sees the Spotlight Project as an enormous and exciting opportunity to share information and improve knowledge and confidence in managing syncope patients in primary care.

Dr Harjeevan Gill, RCGP Clinical Support Fellow for Syncope Spotlight Project

Dr Harjeevan GillHarj qualified from the University of Birmingham Medical School and completed Core Medical Training prior to training in General Practice. He works as a GP in Birmingham.

He developed an interest in syncope after working in cardiology and care of the elderly and is confident that the Syncope Spotlight Project will help improve the quality of care delivered to syncope patients in General Practice.

 

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