Abstract 223: Patients With Cardiac Comorbidities Carry Worse Outcome as Identified by Our SELF Risk Stratification Pathway: An ACAP-SELF Syncope Dataset Analysis
Background: According to the design of published and validated SELF pathway, patients with syncope are stratified according to the SELF-1 criteria (Short period, Early-rapid onset, Loss of consciousness, Full recovery) and SELF-2 Criteria (Structural heart disease, abnormal electrocardiogram, and arrhythmia/AFib/AFl).
Methods: 3044 patients were prospectively followed after presenting to our emergency department for the evaluation of syncope. Patients were divided into four groups: Group A (SELF +/+) who met both SELF-1 and 2 criteria, Group B (SELF +/-) who met SELF-1 criteria but not SELF-2, Group C (SELF -/+) who met SELF-2 criteria but not SELF-1 and Group D (SELF -/-) who met neither SELF criteria. The primary endpoint was a composite of readmission for syncope, myocardial infarction (MI), stroke or death. Follow-up was 5 years.
Results: Group A included 1001 patients (33%), Group B included 359 patients (12%), Group C had 880 patients (29%) and Group D had 804 patients (26%). Patients who met SELF-2 criteria, i.e., patients in Groups A and C, had significantly worse outcome (Group A: HR 1.85; 95% CI: 1.47-2.36; p<0.0001; Group C: HR 2.0; 95% CI: 1.54-2.52; p<0.0001). Presence of Diabetes (HR: 1.3; 95% CI: 1.1-1.5; p=0.003), Coronary Artery Disease (HR: 1.44; 95%CI: 1.2-1.7; p=0.0001) and Congestive Heart Failure (HR 2.0; 95% CI: 1.6-2.4; p<0.0001) were also important predictors of poor outcome.
Conclusions: Using the SELF-pathway for patients presenting with syncope effectively identifies high risk patients who merit hospitalization and close follow-up post-discharge. These include patients with structural heart disease, abnormal EKG and abnormal telemetry, as well as patients with diabetes, CAD and CHF. This has important implications for the evaluation of a common disease that poses a significant economic burden on healthcare systems.
Author Disclosures: B. Pratap: None. J. Bastawrose: None. C.K. Pamidimukala: None. D. Patel: None. P. Kalamkar: None. A. Lingannan: None. N. Panneerselvam: None. A. Gurram: None. S. Patel: None. M. Pierce: None. H. Ghosh: None. E. Herzog: None. E. Aziz: None.
- © 2014 by American Heart Association, Inc.