Il percorso del paziente dopo il DEA. Dal documento EHRA ... · SINCOPE 2 0 1 7 CasagrandaI et al...
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www.gimsi.it Il percorso del paziente dopo il DEA. Dal documento EHRA sulla Syncope Unit al mondo reale Il percorso del paziente dopo il DEA. Dal documento EHRA sulla Syncope Unit al mondo reale Martina Rafanelli Syncope Unit , Geriatria e UTIG, Università degli Studi di Firenze, AOU Careggi Firenze Martina Rafanelli Syncope Unit , Geriatria e UTIG, Università degli Studi di Firenze, AOU Careggi Firenze
Transcript of Il percorso del paziente dopo il DEA. Dal documento EHRA ... · SINCOPE 2 0 1 7 CasagrandaI et al...
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IlpercorsodelpazientedopoilDEA.DaldocumentoEHRAsullaSyncopeUnital
mondoreale
IlpercorsodelpazientedopoilDEA.DaldocumentoEHRAsullaSyncopeUnital
mondorealeMartinaRafanelli
SyncopeUnit,Geriatria eUTIG,Università degli Studi diFirenze,AOUCareggi Firenze
MartinaRafanelliSyncopeUnit,Geriatria eUTIG,
Università degli Studi diFirenze,AOUCareggi Firenze
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Syncope is a commonmedical problem.
There is wide variation in practice of syncope evaluation, andwide variation in adoption of recommendations frompublished guidelines.
Syncope is a commonmedical problem.
There is wide variation in practice of syncope evaluation, andwide variation in adoption of recommendations frompublished guidelines.
• Higher health costs• unnecessary hospitalizations and diagnostic
procedures• prolongation of hospital stays• lower diagnostic rates• higher rates of symptom recurrences
• Higher health costs• unnecessary hospitalizations and diagnostic
procedures• prolongation of hospital stays• lower diagnostic rates• higher rates of symptom recurrences
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Referral from familypractitioners, ED, in-hospital and out-hospital services, orself-referral from thepatient
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Casagranda Ietal2016
Define the diagnostic pathway and themanagement of patients referred to the EDfor TLoC of suspected syncopal cause,which is still unexplained after the initialevaluation
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Casagranda I.etal2016
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CostantinoG.etal2015
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Casagranda Ietal2016
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• Età>65anni+1• Noprodromi +1• ECGpatologico+1• Cardiopatia+1
≥2punti=altorischio
OESILrisk score:
• Età>65anni+1• Noprodromi +1• ECGpatologico+1• Cardiopatia+1
≥2punti=altorischio
Colivicchi F.etal.2003
• ECGpatologico+1• Scompensocardiaco+1• Ematocrito<30%+1• Dispnea+1• PAS<90mmHg +1
≥1=altorischio
SFSR:
• ECGpatologico+1• Scompensocardiaco+1• Ematocrito<30%+1• Dispnea+1• PAS<90mmHg +1
≥1=altorischio
Quinn J.V.etal.2004
• ECGpatologico/cardiopatia+3• Cardiopalmoprimadellasincope
+4• Sincopedasforzo+3• Sincopesupina +2• Prodromineurovegetativi -1• Assenzadisituazioni scatenanti-1
≥3punti=altorischio
EGSYSrisk score:
• ECGpatologico/cardiopatia+3• Cardiopalmoprimadellasincope
+4• Sincopedasforzo+3• Sincopesupina +2• Prodromineurovegetativi -1• Assenzadisituazioni scatenanti-1
≥3punti=altorischio
DelRossoA.etal.2008
ScoredirischioScoredirischio
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www.gimsi.itCostantinoGetal2014
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CostantinoGetal2015
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CostantinoGetal2015
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CostantinoGetal2015
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CostantinoGetal2015
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CostantinoGetal2015
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IlpercorsodelpazientedopoilDEA.DaldocumentoEHRAsullaSyncope Unital
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IlpercorsodelpazientedopoilDEA.DaldocumentoEHRAsullaSyncope Unital
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351Pz.consecutivi,valutatipersincopeinED
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Grossman A.M.etal.2016
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Grossman A.M.etal.2016
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Settembre2003-Settembre2006
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Sun B.J.Etal.2014
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• Blanc J.J.Etal.Eur Heart J2002Ricoveripersincope63%
• Elesber A.A.etalAmHeartJ2005Ricoveri persincope 57.5%
• BartolettiA.etal.Eur Heart J2006Ricoveripersincope 50.1%
• Disertori M.etal.Europace 2003Ricoveri persincope 43%
• Brignole MEur HeartJ2006Ricoveri persincope 39%
• Blanc J.J.Etal.Eur Heart J2002Ricoveripersincope63%
• Elesber A.A.etalAmHeartJ2005Ricoveri persincope 57.5%
• BartolettiA.etal.Eur Heart J2006Ricoveripersincope 50.1%
• Disertori M.etal.Europace 2003Ricoveri persincope 43%
• Brignole MEur HeartJ2006Ricoveri persincope 39%
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compared the short-term prognosis ofpatients at intermediate risk
versus those athigh risk identified factorsassociated with serious events analyzedthe currentmanagement of intermediate-riskpatients
In a cohort of patients with undetermined syncope, weprospectively compared the short-term prognosis ofpatients at intermediate risk (i.e., with stable heartdiseases or comorbidities, of any age) versus those athigh risk for cardiogenic syncope and identified factorsassociated with serious events. Secondarily, we analyzedthe currentmanagement of intermediate-riskpatients.
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347patients,250at intermediateand97athighrisk
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2vs27
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Intermediate-risk patientscould be safely discharged.In prognostic stratification,priority is to seek riskfactors for cardiogenicsyncope.
Intermediate-risk patientscould be safely discharged.In prognostic stratification,priority is to seek riskfactors for cardiogenicsyncope.
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Consecutive patients referred to the EDof Careggi Hospital for T-LOC in whichsyncope was suspected as the maindiagnosis, from 1 January to 30 June2010
Consecutive patients referred to the EDof Careggi Hospital for T-LOC in whichsyncope was suspected as the maindiagnosis, from 1 January to 30 June2010
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Consecutive patients referred to the EDof Careggi Hospital for T-LOC in whichsyncope was suspected as the maindiagnosis, from 1 January to 30 June2010
Consecutive patients referred to the EDof Careggi Hospital for T-LOC in whichsyncope was suspected as the maindiagnosis, from 1 January to 30 June2010
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ED295 patients
Admitted85 pz(29%)
Short stay60 pt(20%)
Syncope UnitFast Track
58 pt(21%)
Discharded92 pt(31%)
29%vs39%EGSYS229%vs39%EGSYS2
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1-month-mortality rate was 0.03% (1/295)12-months-mortality rate was 5.4% (16/295)No events betweenED and SU evaluation
1-month-mortality rate was 0.03% (1/295)12-months-mortality rate was 5.4% (16/295)No events betweenED and SU evaluation
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IlpercorsodelpazientedopoilDEA.DaldocumentoEHRAsullaSyncope Unital
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IlpercorsodelpazientedopoilDEA.DaldocumentoEHRAsullaSyncope Unital
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Grazieperl’attenzioneGrazieperl’attenzione
