IMSANZ 2021 Internal Medicine Society of Australia and New Zealand Annual Scientific Meeting, 3-6 November 2021

Abstract

Aims: Syncope accounts for up to 3% of emergency department presentations.1 Commonly, low risk patients are admitted under the general medical team and a period of inpatient, telemetry monitoring is undertaken. However, there is limited data, particularly in Australia, regarding the benefit conferred by performing inpatient telemetry. The aim of our study was to determine the utilisation and impact on management of performing a period of inpatient telemetry for patients with low-risk syncope. Methods: A retrospective chart review was performed of all patients admitted to Cairns Hospital with syncope over a period of 2 years between January 2017 and December 2018. We reviewed the electronic patient charts and, after excluding high risk patients and patients discharged from ED, collected data including patient demographics, comorbidities, utilisation of investigations and how this impacted on patient management. Details regarding telemetry findings and how this impacted on patient management, where relevant, were recorded. Results: Two hundred and ninty-one patient records were analysed following exclusions; 229 (79%) had 12 or more hours of inpatient telemetry of which 3 (1%) patients had significant findings requiring cardiac intervention. In addition, there were five other patients who had normal inpatient telemetry that were subsequently identified as requiring cardiac intervention following further investigation. Conclusion: The yield of inpatient telemetry in the work-up of low risk syncope is low suggesting that inpatient telemetry may not be a cost-effective diagnostic tool in this setting. A cost effectiveness analysis examining telemetry monitoring in low risk syncope would be a useful next step. In addition, prospective evaluation of stringent syncope rules is required in our population to investigate the optimal work-up of these patients.