Author + information
- Received July 31, 2017
- Revision received August 30, 2017
- Accepted September 7, 2017
- Published online November 1, 2017.
- Roopinder K. Sandhu, MD, MPHa,∗ (, )
- Dat T. Tran, MPHb,c,
- Robert S. Sheldon, MD, PhDd and
- Padma Kaul, PhDb,c
- aDivision of Cardiology, University of Alberta, Edmonton, Canada
- bSchool of Public Health, University of Alberta, Edmonton, Canada
- cCanadian VIGOUR Centre, University of Alberta, Edmonton, Canada
- dDivision of Cardiology, University of Calgary, Calgary, Canada
- ↵∗Address for Correspondence:
Dr. Roopinder K. Sandhu, Division of Cardiology, University of Alberta, 8440-112 Street, 2C2 WMC, Edmonton, Alberta T6G 2B7, Canada.
Objectives This study sought to examine outcomes and costs of patients with syncope admitted and discharged from the emergency department (ED).
Background ED visits for syncope are common, yet the impact on health care utilization is relatively unknown.
Methods A total of 51,831 consecutive patients presented to the ED with a primary diagnosis of syncope (International Classification of Diseases-9 code 780.2 and International Classification of Diseases-10 code R55) in Alberta, Canada from 2006 to 2014. Outcomes included 30-day syncope ED and hospital readmissions; 30-day and 1-year mortality; and annual inpatient, outpatient, physician, and drug costs, cumulative.
Results Of adults presenting to the ED, 6.6% were hospitalized and discharged with a primary diagnosis of syncope (Cohort 1), 8.7% were hospitalized and discharged with a primary diagnosis other than syncope (Cohort 2), and 84.7% were discharged home with a syncope diagnosis (Cohort 3). The 30-day ED revisits for syncope varied from 1.2% (Cohort 2) to 2.4% (Cohort 1) (p < 0.001), and readmission rates were <1% among cohorts. Short- and long-term mortality rates were highest for Cohort 2 and lowest for Cohort 3 (30-day mortality: Cohort 1 of 1.2%, Cohort 2 of 5.2%, Cohort 3 of 0.4%; p < 0.001) (1-year mortality: Cohort 1 of 9.2%, Cohort 2 of 17.7%, Cohort 3 of 3.0%; p < 0.001). Total cost of syncope presentations was $530.6 (Cohort 1: $75.3 million; $29,519/patient, Cohort 2:$138.1 million; $42.042/patient, Cohort 3: $317.3 million; $9,963/patient; p<0.001).
Conclusions Most patients with syncope presenting to the ED were discharged and had a favorable prognosis but overall costs were high compared with patients hospitalized. Further research is needed for cost-saving strategies across all cohorts.
Funded by the University Hospital Foundation of the University of Alberta and the Cardiac Arrhythmia Network of Canada. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 31, 2017.
- Revision received August 30, 2017.
- Accepted September 7, 2017.
- 2017 American College of Cardiology Foundation
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