Unités de syncope : état des lieux en France

Transcription

1 Unités de syncope : état des lieux en France sboveda@clinique-pasteur.com 19 Janvier 2018 Paris

2 Disclosure Statement of Financial Interest I currently have, or have had over the last two years, an affiliation or financial interests or interests of any order with a company or I receive compensation or fees or research grants with a commercial company : Consultant Fees from Medtronic, Boston Scientific and Livanova. Speaker's name: Serge BOVEDA

3 30-40% of the population will experience a T- LOC in their life ESC Guidelines, EHJ ,475 pts attending the ER 454 (1,21%) syncope 285 (63%) admitted 169 (37%) discharged 24% no diagnosis (further visit 50%) Internal medicine N = 151 Cardiology N = 65 Neurology N = 44 Other Dpt N= 25 EHJ 2002

4 Etiology of Syncope Moya A et al. Syncope guidelines, Eur Heart J 2009; 30: 2642

5 Syncope Outcomes A cardiac etiology doubles the risk of death Soteriades ES. N Engl J Med 2002; 347:

6 How not to evaluate a Syncope Yesterday Need for «simple» algorithms for syncope evaluation

7 Saklani et al Circulation. 2013;127: Nowadays

8 Who SHOULD Access the Syncope Unit T-LOC of suspected syncopal nature who, because of frequency or severity of the episodes, need to establish a diagnosis and to ascertain the need for a specific therapy. Patients with an already established diagnosis in order to receive a specialist s consultancy on the best evidence-based therapy or to start specific treatment Patients who need follow-up to make a final diagnosis or assess efficacy of therapy 8

9 Who SHOULD NOT Access the Syncope Unit Patients with a certain diagnosis and/or an established indication for therapy, e.g., patients with bradycardia with guideline-based indications for cardiac pacing Patients in whom syncope is a symptom secondary to underlying disease which requires urgent and specific diagnostic and therapeutic pathways which cannot be followed within an SU e.g., syncope due to acute myocardial infarction or acute bleeding 9

10 The Missions of a SU Kenny RA et al., Europace 2015

11 Quality Syncope Unit is not a fixed model Cardiologie Soins externes Urgences Soins externes Cardiologue Gériatre/MG IDE Cardio/neuro MG Urgentiste Cardio/ Gériatre Kenny RA et al., Europace 2015

12 Quality The Syncope Specialist Responsibility for the comprehensive management of the patient from risk stratification to diagnosis, therapy and follow-up, through a standardized protocol. A physician who has sufficient knowledge to recognize all major T-LOC forms, including mimics, syndromes of orthostatic intolerance. Syncope specialists need not all have the same skill levels, but the SU as a whole must be able to provide a minimum skill set, so a combination of specialty skills is optimal.

13 Quality A Dedicated Equipped Facility Kenny RA et al., Europace 2015

14 Reducing Costs Blanc et al., 2005 / Education Urgentistes -25% in-patients -11% un-explained syncopes > -20% cost reduction Kenny RA et al., Europace 2015

15 Management Harmonization Guidelines based assessment Version 2018 Available on Circulation 2017

16 Management Harmonization Based on Initial Assessment Kenny RA et al., Europace 2015

17 18 Arrhythmology departments of Tertiary Hospitals in France (JC Deharo JDR 2017) Syncope unit Syncope specialist (if no SU) Fast track from ER Other SU in the region No Yes

18 Example Chest Pain and Syncope Unit Inexpensive Dept Reorganization Cooperation Boveda S, 2014

19

20 HDJ pour syncope : GHM = 05M20Z :

21 Take Home Message There is no specific organization for syncope evaluation in France in the majority of the regions There is a lack of knowledge (and of awareness) of the cost of syncope evaluation in France The development of syncope facilities is strongly and urgently needed This development is feasible, inexpensive, needing mostly local department reorganization and cooperation (between specialties, and between MDs and Stakeholders (Administration )