P833Diagnostic outcomes of a Dutch multidisciplinary pathway in elderly syncope patients

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Background: The most prevalent causes of syncope are very different in the elderly compared with younger patients. Structural cardiac diseases and rhythm and conduction disorders are more often found with old age, while a first presentation of vasovagal syncope is less common. Elderly patients often have multiple potential causes present at the same time, and a definite diagnosis is not always found. We developed a common, multidisciplinary diagnostic approach for fall and T-LOC patients, based on current guidelines. Aims: To assess the diagnostic outcomes of a multidisciplinary, clinical pathway for elderly syncope patients. Methods: Observational cohort study at a fall and syncope day clinic, including consecutive syncope patients aged ≥65 years between 2011–2014. Measurements: The sort, number and accuracy of diagnoses resulting in syncope. Secondary outcomes: the reliability of the medical history and the number of electrocardiogram (ECG) abnormalities. Results: The 117 included patients (72% females) had a mean age of 80±6.5 years and a mean of 11±5 (mainly cardiovascular) comorbidities. We found 212 contributing causes. Orthostatic and/or postprandial hypotension were present in 83%, cardiac causes in 44% (rhythm or conduction disorders 24%, aortic stenosis 4%, cardiomyopathies 2%, suspected cardiac causes 15%), and reflex syncope in 21%; in 7 patients (6%) no cause was found. The diagnosis of the cause of syncope was uncertain in 34.2%, probable in 15.4%, and definite/most likely in 50.4%. Cognitive impaired patients were less likely to give a reliable medical history regarding their syncope (72% vs. 98% in cognitive intact patients, P=0.001), and in only 25% of patients a useful eyewitness account was available. 64% of ECGs showed relevant abnormalities; 26% was suggestive of cardiac syncope, of which 20% showed an indication for device implantation.

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