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43/A comparison of arrhythmia nurse specialist’s versus clinician’s syncope risk stratification – Diagnostic yield of implantable loop recorders

European Journal of Arrhythmia & Electrophysiology. 2019;5(Suppl. 1):abstr43

Background and aims: Syncope guidelines 2018 recommend further research to estimate the effect of syncope clinics, and establish benefits of the nurse’s role. Data was collected from the nurse-led syncope clinic on the nurse’s effectiveness at risk stratifying for Implantable loop recorders (ILR) to aid symptom-rhythm correlation. Data was also collected on re-admission rates for syncope following a nurse-led syncope clinic (ANS) assessment. Our aim was to evaluate the diagnostic yield of all consecutive ILR implants over a 2-year period, comparing ILR-guided management changes between ANS and clinicians; and to compare readmission rates following first hospital attendance with syncope, comparing none referrals to clinic and those attending ANS.

Methods: Retrospective study of 1) consecutive patients undergoing ILR implant between April 2016–April 2018, including baseline patient demographics, referral source and management changes made by ILR findings; 2) readmission rates for syncope from 2016–7.

Results: Three-hundred-and-five ILR patients were identified: median age 71 yrs (interquartile range 52–81), 45% female, median follow-up time 15 months. Referrals were from general cardiology (GC) = 98 (32%), electrophysiology (EP) = 105 (34%) and ANS-led syncope clinic = 102 (34%). Indications were syncope = 203 (65.9%), palpitation = 21 (6.9%), pre-syncope = 16 (5.2%), cryptogenic stroke = 35 (11.5%) and other reasons 7 (8.9%) (falls, channelopathies). Overall, 102 (34.0%) experienced arrhythmias detected on ILR that resulted in a change of management including: pacemaker implant = 49 (16.1%), complex-device implant = 7 (2.3%) and AF = 28 (9.2%), SVT = 14 (4.6%), VT = 1 (0.3%). ANS referrals resulted in greater trend towards change of management (38.2%) of patients compared with GC (32.7%) and EP (31.4%) (p=0.593 nurse versus consultant). For those needing pacing, 24 were from ANS referrals compared to 25 for clinicians (23.5% versus 18.3% respectively, p=0.012). Median time to developing a pacing indication was 2.6 months for ANS and 4.1 months for clinicians; 25 had pacing indication within 3 months of ILR insertion. Overall, an ILR had a diagnostic yield of 34.1% (n=104). Reattendance rates after first syncopal episode was 6% (32/508) for patients not seen in the nurse-led syncope clinic compared to 2% (2/58) following a syncope clinic assessment.

Conclusions: ANS referrals trended towards greater diagnostic yield compared with clinicians and significantly more pacemaker indications. Following a first hospital attendance for syncope, those seen by ANS tended to have less hospital reattendance rates. Our data suggest ANS risk assessment for ILR and syncope management are comparable to clinician.

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