Effectiveness and Cost-Efficacy of Syncope Workup of Military Personnel in a Dedicated Outpatient Syncope Center

Syncope is a common medical problem in young apparently healthy people which takes a large financial toll, especially for diagnostic tests, some of which may be unnecessary.

We hereby describe a targeted guideline-based workup of syncope in a dedicated outpatient syncope center (SC), where 318 young military persons (age 20.06±4.00) were evaluated during 2015-2016.

Tests performed in the community prior to evaluation at SC included: holter 25.5% (with only 5% justified by guidelines), echo 31.8% (8% justified), tilt-test 8.1% (3.4% justified), ergometry 13.3% (4.7% justified), external loop recorder 0.9% (all of them unnecessary), EEG 7.5% (4.4% justified ), head CT 4.4% (3.4% justified), unnecessary head MRI (0.3%), neurologist consultation 14.5 % (only 4.7% justified).

Tests performed during evaluation at our SC included: holter (9.1%), orthostatic test (94.6%), echo (21%), tilt-test (86.7%), ergometry (12%), adenosine test (2.2%), ajmalin test (0.6%), EPS (0.3%), external loop recorder (0.9%). Final diagnosis was reached in 88%. Final diagnosis in 81% was vasovagal syncope proved by positive TILT-TEST or typical clinical presentation, in 18% the final diagnosis was suspected neurocardiogenic syncope with negative TILT-TEST but still with typical complaints. One epilepsy, 1 pseudosyncope and 1 type 2 long-QT with subsequent ICD implantation were diagnosed.

By reviewing the appropriateness (by ESC syncope guidelines) and cost of tests that were performed in the community prior to referral to SC unnecessary tests included 13 EEGs (1099$), 4 head CTs (650$), 76 echoes (8,933$), 65 holters (9019$), 29 ergometries (2255$), and 1 head MRIs (465$). Total savings from the examination of 318 patients in a specialized Syncope Center in 1 years would be at least 14,947$

Thus the work-up of young healthy military patients in a SC has a very high diagnostic yield and saves unnecessary tests and costs.