38 * Effectiveness of ECG-based triage in older patients with TLoC attending a rapid access blackouts triage clinic: conduction tissue abnormalities predict a higher mortality, recurrent TLoC and a good response to cardiac pacing

Abstract

Introduction: Transient loss of consciousness (TLOC) is common and increasing rapidly with a rising burden on health care expenditure. It often leads to hospitalisation in the elderly population. In the elderly, electrocardiographic (ECG) findings suggesting conduction tissue disease are frequently found, but it is not always clear if they accurately represent the underlying cause of TLOC. We therefore compared outcomes in elderly patients attending the rapid access blackout clinic (RABTC) with conduction tissue abnormalities (ECG-CTA) with patients attending with a normal ECG. Methods: Our twice-weekly RABTC is staffed by specialist nurses and a cardiologist. Detailed clinical assessment is given using a secure web-based 13 page RABTC Assessment Tool. Risk is assessed with 8 “Red Flags”, which include an abnormal ECG. We sequentially selected 85 patients with normal ECG, Group A, and 65 patients with ECG-CTA, Group B, >65 years of age, presenting to RABTC between 1st January 2007 till 1st January 2013 where all had 3 years of follow-up. Group B patients had ECG-CTA (38 had first degree AV block, 15 had left axis deviation, 8 had Right Bundle branch block, 14 had Left bundle branch block,). Results: 2586 patients were assessed in the RABTC during the period. Mean age 56±10 yrs, 51% female (F). Group A, Age 75±7sd, 62% F, Group B Age 77±8sd, 51% F. The rate of recurrent TLOC was higher in Group B, (73% v 81%, P<0.004), significant injury/fracture was similar, (45% v 51%), use of implantable ECG recorders was similar, (26 v 24%), and annual rate of hospital admission was similar, (1.77 v 2.25 /patient/year). 12 Group A patients received pacemakers, and 31 Group B patients (Group B1). Amongst Group B1 patients, pacing relieved symptoms and prevented re-admission in 20 (64%). Three-year all cause mortality overall in Group A was 6% and in Group B 15% (p<0.03), but pacing did not seem to alter mortality risk (Group B1=14%, Group B2=16%, ns) Conclusion: Amongst TLOC patients referred to an RABTC for clinical and ECG assessment, baseline characteristics are similar, but the finding of ECG-CTA confers a poor outcome. Pacing appears to reduce admission and relieve symptoms but not mortality.