163 Examining the appropriateness of tilt-testing within a community integrated care hub for older persons services

Abstract

Abstract Background Tilt-testing has been widely used in acute hospitals for more than 20 years in Ireland. Its use in community settings has been promoted in recent years with the development of the National Integrated Care Programme for Older Persons (NICPOP). In our integrated care hub our focus lies in the assessment of falls and frailty. We propose to examine if the current rational for performing tilt-testing has showed a diagnostic yield. Methods We retrospectively reviewed all tilt reports in the ambulatory care hub from November 2021 to May 2023. We examined the rationale for ordering the test, the number of patients who received a diagnosis of Orthostatic Hypotension (OH) and treatment that was commenced. Results 59 tilt reports were examined between the 18 month period. The average age of the patients were 83 (range 68–93). The male to female ratio was 1:1.3. All patients had an indicator for testing. The 5 indicators that emerged were falls, syncope, orthostatic intolerance, lying and standing blood pressure drop and dizziness. 11/59 (19%) patients had one indicator, 18/59 (31%) patients had two indicators, 15/59 (25%) patients had three indicators and 15/59 (25%) patients had four indicators for performing a tilt. OH was diagnosed in 36/59 (61%) patients of whom 9/36 (25%) had symptomatic OH during both HUT and AS, 8/36 (22%) had symptoms during HUT alone, 6/36 (17%) had symptoms during AS and 9/36 (25%) were asymptomatic throughout testing. 4/36 (11%) had no documentation regarding their symptoms during tilting. De-prescribing was performed in 16/36 (44%) patients and Midodrine was commenced in 18/36 (50%) patients with fludrocortisone being started on 2/36 (6%) patients. Conclusion We demonstrated a high yield from the tilt-test investigations and in combination with Ambulatory BP monitoring had a significant number of medications de-prescribed. The greater preponderance of more than one indicator for tilt-testing was greater than what we perceived.