Syncope Service Research Articles

331 Patient experience in a Falls and Syncope service in a large Irish teaching hospital

Abstract Background The measurement of patient satisfaction provides valuable information about patients’ perceptions of their received healthcare. It is an excellent measure of the quality of care delivered by a healthcare facility. This allows service providers to continue to move towards patient-centred care. A positive patient experience is an important aim that leads to better clinical outcomes. Methods A 20-question patient satisfaction survey was developed for an outpatient Falls and Syncope Unit in order to assess the patient’s perception of service delivery. All patients attending the service were invited to complete the survey over a 2-month period in 2022. Results 71 responses were received. 76% of respondents found their appointment beneficial, and 94% felt their appointment was necessary. Satisfaction with staff ranged between 97–99%. 98% of patients felt they were treated with respect and 88% felt free to express complaints, with 97% satisfactory telephone interaction with the service. 60% of patients received a patient information leaflet, with 97% of patients finding the information leaflets provided useful. Twenty-five respondents (31%) indicated further information on their care would have been beneficial. Conclusion This patient satisfaction survey provided positive feedback for all staff on care delivered in the Falls and Syncope service. Recommendations for changes in practice included increased use of patient information leaflets, in order to improve patients’ experience, since 97% of patients found information leaflets useful and 40% of patients did not receive a leaflet.

1287 THE VALUE OF A MULTIDISCIPLINARY TEAM (MDT) IN MANAGING PATIENTS WITH COMPLEX OR UNEXPLAINED SYNCOPE

Abstract Introduction Syncope is a common clinical problem with a lifetime prevalence of 20%.1 Syncope shares clinical features with other disorders including seizures, metabolic disturbances and sleep disorders.2 The assessment and management of syncope can be challenging. The syncope service at the QEUH is run by geriatricians and cardiologists with an interest in syncope. Although MDTs are recognised key components in contemporary patient care in areas such as heart failure and cancer management, there is no guidance on MDT working in syncope management.3/4 In November 2017, a syncope MDT was introduced at the QEUH involving cardiologists, geriatricians, a neurologist and cardiac physiologists. This in-person MDT occurs monthly with outcomes recorded on electronic medical records in addition to a database. The aim of this review was to understand the potential impact of the MDT on diagnostic yield and time to further investigation or management. Method A retrospective case note analysis was performed for patients reviewed at the Syncope MDT between November 2017 and December 2021. Results 103 patients were discussed with an average age of 64 years. The main reason for referral was cardiology specialist advice (65%), neurology specialist advice (19.4%) and complex case review (13.6%). After MDT discussion, the percentage of patients with unexplained TLoC reduced from 26.2% to 14.6% without requirement for additional investigations. 8.7% of patients were started on anti-epileptic medication prior to outpatient neurology review after a diagnosis of seizure disorder was established and 23.1% of patients were streamlined for pacemaker or ILR insertion. Conclusion Introduction of a syncope MDT reduces unexplained syncope rates in complex patients, streamlines investigations, reduces the need for multi-speciality outpatient reviews and allows earlier introduction of anti-epileptic medication for those with a new seizure disorder. These benefits improve the patient experience by reducing time to diagnosis and treatment.

Abstract 10774: An Ambulatory Syncope Service is a Safe Pathway to Reduce Hospital Admissions

Introduction: Syncope affects up to 50% of people during a lifetime and is a common presentation to Emergency Departments (EDs). The Ambulatory Emergency Care Unit (AECU) Syncope pathway was established at our institution as a route by which low-risk patients presenting with syncope can undergo investigations without requiring hospital admissions as well as reducing length of stay for patients awaiting cardiology input. Hypothesis: The AECU Syncope pathway at Northwick Park Hospital, London, UK is safe and effective in reducing hospital admissions. Methods: We conducted a retrospective study of patients seen via the AECU Syncope pathway in 2020. These were referrals from the Emergency Department, General Practice and Inpatient departments for 24-hour tapes and echocardiograms. Results: A total of 221 patients were referred to the AECU syncope pathway in 2020. Of these, 36 patients (16%) had abnormalities on 24-hour tape. The majority were ectopics (n=12) but patients were also found to have arrhythmias (n=10), bradycardia (n=8) and heart block (n=6). 10 patients had aortic valve dysfunction identified on echocardiogram: 4 had severe aortic stenosis and the rest had milder classifications of aortic valve dysfunction. In total, 42 of the 221 patients had an abnormality on echocardiogram and/or 24-hour tape. Of these 42 patients, 14 were discharged as their abnormalities were insignificant for further cardiology input. 28 were referred to cardiology clinic for review as an outpatient. In terms of readmissions, 6 patients had readmissions within 30 days but only 1 patient had a readmission attributed to syncope, and this was a presyncope episode for which the patient was safety netted for during the previous admission. There were no deaths reported within 30 days of presentation. Within 1 year, there were 2 deaths, but neither were attributed to a major adverse cardiovascular event. Conclusions: The AECU syncope pathway presents a viable, efficient and safe route by which low-risk patients who are under investigation for a presumed syncopal episode can receive cardiology input without requiring a prolonged hospital admission. In doing so, there is a significant benefit to hospitals by reducing strain on bed space and staffing, thereby improving patient flow.

281 PREVALENCE OF STOPPFALL FALLS-RISK-INCREASING DRUGS (FRIDS) IN PATIENTS PRESENTING TO HOSPITAL WITH A FALL

Abstract Background Falls cause presentation and admission to hospital. Falls-Risk-Increasing-Drugs (FRIDs) are a modifiable risk factor. STOPPFalls criteria was developed, using an expert Delphi panel, to achieve consensus on a comprehensive list of FRIDs. The aim of this study was to identify the prevalence of STOPPFall PRIDs in patients presenting to hospital with falls and identify whether review by a specialist Falls and Syncope Service (FASS) reduces FRIDs. Methods This was a retrospective observational study. Patients ≥65 years reviewed by the hospital FASS in the emergency department (over 6-months) and in house (over 2-months), were included. Medication appropriateness at admission and discharge were assessed using STOPPFall criteria. Ethical approval was received from the local research and innovation office (ref7013). Results Of 156 patients, 87(55.8%) were ≥65 years; 46% female, mean age 78.1(SD7.5) years. The mean number of conditions was 4(SD4.4); the mean number of regular medications was 6.9(SD4.5). Reasons for referral to FASS included falls (34.5%), dizziness/near fall (35.6%), and transient loss of consciousness (29.9%). For 21.8% there was an associated injury; 11.5% a fracture. Thirty-seven (42.5%) had experienced at least one fall in the previous 12-months. Sixty-four (73.6%) were on ≥1 STOPPFall FRID. The most common STOPPFall FRID prescribed to older adults were diuretics (24.1%), anti-depressants (20.7%) and benzodiazepines/benzodiazepine-related drugs (13.8%). At least 1 STOPPFall FRID was stopped in 31.3%. The most commonly deprescribed STOPPFall FRIDs were diuretics (20%), alpha blockers (6%) and benzodiazepines/benzodiazepine-related drugs (4.7%). Adults <65years (n=69) were more likely to be prescribed a STOPPFall FRID at admission than older adults (≥65years); 88.4% vs 73.6%, p=0.021. Conclusion STOPPFall FRIDs are prevalent in fallers of all ages. Even one review by a specialist FASS leads to medication optimization. The effectiveness of STOPPFalls criteria in the prevention of falls should be evaluated further in intervention studies.

Feasibility, reliability and safety of self-assessed orthostatic blood pressure at home.

A postural blood pressure assessment is required to diagnose Orthostatic Hypotension. With increasing remote consultations, alternative methods of performing postural blood pressure assessment are required. Determine whether postural blood pressure measurement at home, without a clinician, is reliable, feasible and safe. Service improvement project within a falls and syncope service in Northeast England. Eligibility criteria: aged ≥60 years; postural blood pressure measurement is indicated and is physically and cognitively able to perform. Exclusion criteria: nursing home residents, attending clinic in person. Postural blood pressure measurements were performed in patients' homes under clinical observation. Patient-led assessments were performed independent of the clinician, following written guidance. This was followed by a clinical-led assessment after 10-minute supine rest. Agreement between patient and clinician derived postural blood pressure values and diagnosis of Orthostatic Hypotension; intervention safety, feasibility and acceptability. Twenty-eight patients were eligible and 25 participated (mean age 75, median Clinical Frailty Score five).There was 95% agreement (Cohen's kappa 0.90 (0.70, 1.00)) between patient and clinician derived readings to diagnose orthostatic hypotension.Postural systolic blood pressure drop correlated strongly (r = 0.80), with patient derived readings overestimating by 1 (-6, 3) mmHg. Limits of agreement, determined via Bland Altman analysis, were +17 and -20 mmHg, greater than pre-determined maximum clinically important difference (±5mmHg).Twenty participants performed valid postural blood pressure assessments without clinical assistance. Patient-led postural blood pressure assessment at home is a reliable, safe and acceptable method for diagnosing Orthostatic Hypotension.

204 FRAILTY BUT NOT AGE IS ASSOCIATED WITH IMPAIRED ORTHOSTATIC CEREBRAL OXYGENATION

Abstract Background The effects of age and frailty on cerebrovascular function are poorly understood. Here we investigate the hypotheses that aging, and frailty are accompanied by impaired regulation of cerebral oxygenation during standing in a patient population of older adults. Methods We recruited patients from a national Falls and Syncope service. All patients underwent an active stand test (5–10 min lying, 3 min standing) with continuous monitoring of blood pressure (BP) and heart rate. Tissue saturation index (TSI) was concurrently measured using near-infrared spectroscopy and its recovery measured at 30s after standing. Frailty was assessed as a comorbidity count using a 27-item questionnaire. Robust linear regression was used to investigate the association between TSI, age and frailty in a multivariate model with covariate adjustment, including the concurrent BP values. A p-value <0.05 was considered significant. Results 304 patients (median(IQR): 71(14) years, 57% females) were recruited. Age was not associated with cerebral oxygenation after standing (β: −0.001 (−0.017 0.015), p = 0.899), even after stratification by sex (males: β: −0.010 (−0.045 0.024), p = 0.558, females: β: 0.000 (−0.017 0.018), p = 0.967). Frailty, was associated with a lower TSI at 30s after standing (β: −0.153 (−0.248–0.058), p = 0.002). After sex stratification, no associations with frailty were observed in males (β: −0.052 (−0.226 0.123), p = 0.557), while frailer females demonstrated a lower TSI at 30 seconds after standing (β: −0.179 (−0.294–0.063), p = 0.003) despite BP correction. Conclusion Our results suggest alternative mechanisms of cerebral oxygenation regulation independent of blood pressure (and presumably cerebral autoregulation) are involved in frailty related impairments of brain haemodynamics which are also independent of ageing. Such impairments represent novel biomarkers of frailty and represent potentially novel modifiable risk factors (independent of BP management) of hypoperfusion related disorders in clinical ageing.

239 IS ORTHOSTATIC HYPOTENSION ASSOCIATED WITH ALTERED CEREBRAL PERFUSION DURING ACTIVE STANDING?

Abstract Background Orthostatic Hypotension (OH) is associated with poor health outcomes in later life including depression, cognitive impairment, frailty and falls. Whilst it is hypothesised that OH compromises cerebral autoregulation leading to hypoperfusion, this has not been robustly demonstrated to date. This study investigated the association between OH and cerebral perfusion during orthostasis using a non-invasive surrogate of cerebral perfusion, Near Infrared Spectroscopy (NIRS). Methods Four hundred and ninety one participants (58% female, median age 65, IQR 38–92) attending a falls and syncope service underwent measurement of beat-to-beat blood pressure (BP) by finometry and real-time frontal lobe perfusion (% TSI: Tissue Saturation Index) by NIRS during the active stand manoeuvre. We examined the association between OH and change in cerebral perfusion (delta TSI) using mixed-effects linear regression, with adjustment for important clinical covariates. Results Nearly two-fifths of the sample (189/491,38.5%) met criteria for OH occurring between 30 and 120 seconds after standing. Using mixed effects linear regression models, we observed a significant relationship between OH and TSI at the same timepoint (β −0.53, −0.59 to −0.46, p < 0.001) which persisted following adjustment for confounders including age, sex, baseline blood pressure, cerebrovascular and cardiovascular disease, depression/anxiety, diabetes, systolic blood pressure, antihypertensives, and antidepressants (β −0.51, −0.58 to −0.44, p < 0.001). Cerebral perfusion levels differed for those with OH compared to those without. Conclusion OH is independently associated with lower frontal lobe cerebral perfusion. This association may indicate disruption to dynamic cerebral autoregulation and explain the significant link between OH and poor health outcomes.

Impact of a specialist service in the Emergency Department on admission, length of stay and readmission of patients presenting with falls, syncope and dizziness.

Up to half of patients presenting with falls, syncope or dizziness are admitted to hospital. Many are discharged without a clear diagnosis for their index episode, however, and therefore a relatively high risk of readmission. To examine the impact of ED-FASS (Emergency Department Falls and Syncope Service) a dedicated specialist service embedded within an ED, seeing patients of all ages with falls, syncope and dizziness. Pre- and post-cohort study. Admission rates, length of stay (LOS) and readmission at 3 months were examined for all patients presenting with a fall, syncope or dizziness from April to July 2018 (pre-ED-FASS) inclusive and compared to April to July 2019 inclusive (post-ED-FASS). There was a significantly lower admission rate for patients presenting in 2019 compared to 2018 [27% (453/1676) vs. 34% (548/1620); X2 = 18.0; P < 0.001], with a 20% reduction in admissions. The mean LOS for patients admitted in 2018 was 20.7 [95% confidence interval (CI) 17.4-24.0] days compared to 18.2 (95% CI 14.6-21.9) days in 2019 (t = 0.98; P = 0.3294). This accounts for 11 344 bed days in the 2018 study period, and 8299 bed days used after ED-FASS. There was also a significant reduction in readmission rates within 3 months of index presentation, from 21% (109/1620) to 16% (68/1676) (X2 = 4.68; P = 0.030). This study highlights the significant potential benefits of embedding dedicated multidisciplinary services at the hospital front door in terms of early specialist assessment and directing appropriate patients to effective ambulatory care pathways.

74 Effects of Community Falls Prevention Service Closure on Ischaemic Heart Disease Attendances in Secondary Care: An Interrupted Time Series Approach

Abstract Background In 2009 we implemented a novel multidisciplinary, multifactorial falls, syncope and dizziness service model utilising proactive, primary care-based screening (≥60 years). Participants underwent comprehensive geriatric assessment, while 25% of the 4032 service participants had exercise training. All had additional lifestyle advice on exercise, alcohol intake, weight loss and smoking cessation. The preliminary outcomes of this approach have been previously reported, with occult atrial fibrillation, murmurs, ECG-evident ischaemic heart disease (IHD) etc reported to GPs for further action.1 Funding was withdrawn and the service closed on 31/01/2014. We examined IHD secondary care attendances with and without service provision. Methods Patients: North Tyneside residents ≥60 years at time of closure of the service in January 2014, who were presented acutely to secondary care with IHD using an interrupted time series method. ICD-10 coded IHD numbers were determined (Hospital Episode Statistics from 01/02/2012[date of a change in coding compared to service commencement in 2009] until 31/05/2017) including 25-months with, and 40-months without, service provision. Results The Table summarises the change in IHD +/- service provision; there was a significant reduction in IHD non-elective admissions during both time series’, but the reduction was significantly lower without service provision. In addition, immediately following the service closure there was an initial increase in IHD complications of 18.4% (p=0.059) followed by an increase in the time trend of 2.7% (p=0.029), resulting in a 0.6% post-service monthly reduction in IHD complications. Conclusions Disinvestment in this service resulted in a slowdown in the underlying reduction of IHD diagnoses in secondary care. However, further research is needed to control for patient-level characteristics, the economic impact and to look at the effect of the service on other cardiovascular diseases. Reference 1. Parry SW. JAGS 2016; 64 (11):2368–2373.

87 Effects of Community Falls Prevention Service Closure on ICD-10 Coded Fracture Rates in Older People: An Interrupted Time Series Approach

Abstract Introduction Guidelines on falls prevention recommend case ascertainment based on opportunistic case ascertainment and referral in those who have fallen. In October 2009 we implemented a novel multidisciplinary, multifactorial falls, syncope and dizziness service with enhanced case-ascertainment through proactive, primary care-based screening for associated risk factors. In addition to comprehensive geriatric assessment, 25% of 4032 service participants underwent strength and balance training. The baseline outcomes have been previously reported.1 Funding was withdrawn, and the service closed on 31/01/2014. We examined the effect of service-closure on fractures presenting to secondary care with and without the service running. Methods An interrupted time series method was used. ICD-10 coded fracture numbers attending secondary care were determined (Hospital Episode Statistics from 01/02/2012-31/05/2017) for all North Tyneside residents ≥60 years at the time of service closure, including 25-months with, and 40-months without, service provision. Results There was a 0.9% (p=0.018) monthly reduction in falls over 25-months of service provision which increased during the winter months of a 9.8% (p=0.015) increase. In the month following the service closure there was an initial increase in fractures of 8.5% (p=0.231), followed by an increase in the monthly time trend of 1% (p=0.018). This resulted in a post-service monthly increase in fractures of 0.1%, an estimated extra 625 fractures over the 40-month post-service cessation period. At an average £8600 per fracture, the estimated cost may have been £5,375,000. Conclusions In this naturalistic experiment, following an initial drop in fractures, disinvestment in this service resulted in a rise in elders’ fractures presenting to secondary care. The closure of the service may have had a large unintended cost, averaging £1.5 million annually, versus annual running costs of £220,000. Further research is needed to control for patient-level characteristics and to establish the cost-effectiveness of the service.

46 The Relationship between Cognitive Function and Physical Performance among Older Adults Attending a Falls and Syncope Service in Kuala Lumpur

Abstract Introduction Recent studies identified a relationship between gait difficulties and risk of developing dementia, a condition now termed motoric cognitive risk. We interrogated a clinical dataset to determine the relationship between cognitive assessment scores and physical performance scores to identify the strength of association between these two types of measures. Methods Consecutive patients referred to the falls and syncope service and the University of Malaya Medical Centre were recruited. The cognitive function of consenting individuals was assessed using the Montreal Cognitive Assessment (MoCA) and Visual Cognitive Assessment Tool (VCAT). Physical performance was assessed using hand grip strength (HGS), timed-up-and-go (TUG) and functional reach (FR). Results One hundred and forty-seven individuals, mean age (standard deviation,SD)=76.1 (7.8) years, 85 (58%) women were included. The mean (SD) for right and left HGS, FR and TUG scores for the overall population were 19.1 (7.0)kg, 19.0 (12.1)kg, 28.9 (39.7)cm, TUG 19.2 (11.0)s respectively. The mean MoCA and VCAT scores were 21.1 (7.1) and 20.3 (6.3) respectively. Right HGS correlated moderately with MoCA (r=0.367) and VCAT scores (r=0.397). Left HGS had a weak to moderate correlation with MoCA (r=0.281) and VCAT (0.271). FR, however, was not correlated with either MoCA (r=0.073) and VCAT (0.020). TUG scores were moderately negatively correlated with MoCA (-0.3206) but weakly correlated with VCAT (-0.175) Conclusion Our evaluation of the relationship between cognitive scores and physical performance in a falls and syncope clinic setting found that a relationship exists between muscle strength measured with grip strength and composite assessment of gait and balance using the TUG. Dynamic balance measured with functional reach, however, was not associated with cognitive function. Future studies will need to identify the possible mechanisms linking cognitive function with strength and gait in order to establish cognitive function as a modifiable risk factor for falls in older adults.

19 The Efficacy, Safety and Acceptability of Non-Pharmacologic Therapy for Orthostatic Hypotension in Older People: A Mixed Methods Study

Abstract Introduction First-line treatment for OH is typically with non-pharmacologic therapy. However, the current evidence base is poor, particularly in older people. Aim Determine the safety, efficacy and acceptability of single and combination therapies for OH in older people. Methods A three-stage, mixed-methods study consisting of a phase 2 efficacy study with a nested qualitative study. Stage One calculated response rates to therapy (defined as an improvement in standing systolic blood pressure (SSBP) by ≥10 mmHg). Stage Two explored the tolerability of therapies in qualitative interviews. Stage Three evaluated response rates to combinations of the most efficacious and tolerable therapies. All participants were aged ≥60 years, had OH and were recruited from a UK Falls and Syncope Service. Results Stage One. Response rates to therapies were evaluated in 25 older people (74 years, 60-92): Bolus-water drinking 56% (95%CI 35, 76); abdominal compression 52% (95%CI 31, 72), physical counter-maneuvers 44% (PCM, 95%CI 24, 65), full-leg length compression 32% (95%CI 15, 54). Stage Two. PCM was considered an acceptable therapy as no equipment is required, is only needed during postural change and can be performed conspicuously. Water was largely acceptable but there were concerns around urinary frequency. Compression stockings were considered unacceptable due to cosmesis, practicalities and discomfort. There were mixed views on the tolerability of abdominal compression. There were no adverse events. Stage Three. Response rates to combination therapy were evaluated in 37 older people (71 years, 60-94). Bolus water drinking + PCM 38% (95%CI 22, 55); water + PCM + abdominal compression 46% (95%CI 29, 63). Conclusions Due to its superior efficacy, safety and acceptability, bolus water drinking should become standard first-line therapy. Conversely, compression stockings should be disregarded in this population, as they are the least efficacious and most unacceptable treatment. Surprisingly, there is no additional benefit of combining therapies.

Syncope, Dizziness and Falls Overlap Among Patients Referred to a Falls and Syncope Service at the University of Malaya Medical Centre

Syncope, Dizziness and Falls Overlap Among Patients Referred to a Falls and Syncope Service at the University of Malaya Medical Centre

A Novel Approach to Proactive Primary Care-Based Case Finding and Multidisciplinary Management of Falls, Syncope, and Dizziness in a One-Stop Service: Preliminary Results.

National and international evidence and guidelines on falls prevention and management in community-dwelling elderly adults recommend that falls services should be multifactorial and their interventions multicomponent. The way that individuals are identified as having had or being at risk of falls in order to take advantage of such services is far less clear. A novel multidisciplinary, multifactorial falls, syncope, and dizziness service model was designed with enhanced case ascertainment through proactive, primary care-based screening (of individual case notes of individuals aged ≥60) for individual fall risk factors. The service model identified 4,039 individuals, of whom 2,232 had significant gait and balance abnormalities according to senior physiotherapist assessment. Significant numbers of individuals with new diagnoses ranging from cognitive impairment to Parkinson's disease to urgent indications for a pacemaker were discovered. More than 600 individuals were found who were at high risk of osteoporosis according to World Health Association Fracture Risk Assessment Tool score, 179 with benign positional paroxysmal vertigo and 50 with atrial fibrillation. Through such screening and this approach, Comprehensive Geriatric Assessment Plus (Plus falls, syncope and dizziness expertise), unmet need was targeted on a scale far outside the numbers seen in clinical trials. Further work is needed to determine whether this approach translates into fewer falls and decreases in syncope and dizziness.

75 * A retrospective analysis of 12 lead ECGs from young patients referred to a syncope service using the "Seattle Criteria"

Introduction: In 2012, ESC, AMSSM, EACPR, F-MARC and PACES released a consensus statement for ECG screening of young athletes. It's principal aim was to identify features suggestive of channelopathy or cardiomyopathy rather than those associated with athletic training, and was dubbed the Criteria. Bradford Royal Infirmary runs a nurse-led syncope service with approximately 100 patients under age of 35 referred for assessment per annum. We sought to assess presence of ECG features, if any, in patients referred. Method: All patients under 35 years of age referred to syncope service at Bradford Royal Infirmary between January 2012 and April 2014 were included. ECGs recorded on online hospital database were reviewed in all cases. All data was anonymised and retrospectively reviewed independently by two separate assessors (JF, PP) in accordance with Seattle criteria, and abnormalities were documented. Any ECGs with adverse features or finding of an ambiguous nature were reveiwed by CAM. Results: In total, 271 patients were referred between January 2012 and April 2014. Age ranged between 15-35 years of age (mean 25.0 years). 60.5% (155/271) were female. Patients had a median of 4 ECGs performed (range 1-12). 17/271 (6.6%) had ECGs deemed abnormal by Criteria. 1 patient had pathological Q waves. 3 patients had prolonged QT intervals (measured using Bazett's formula). 4 patients had T wave inversion in leads V1-V6. 1 patient had anterior ST depression. 1 patient had bifasicular block and 2 had left anterior hemiblock. 2 patients had atrial tachyarrhythmias; 1 with atrial fibrillation and other with features suggestive of atrioventricular nodal reentrant tachycardia. 3 patients had >2 ventricular ectopics on their 10 second ECG recording, all with unifocal ectopics (1 had right bundle branch pattern other 2 had left bundle branch type pattern). Conclusion: The use of Seattle Criteria for ECG screening of young patients referred to syncope service highlighted a significant proportion with abnormal features suggestive of primary electrical disorders or potential cardiomyopathy. These screening guidelines are a simple and standardised method for ECG interpretation; they help to heighten clinical suspicion and scrutiny in certain patients at risk of sudden cardiac death. We advocate use of this criteria in such clinical cohorts to greater stratify risk of sudden cardiac death.

Tu2006 Internet-Delivered Cognitive Behavior Therapy for Adolescents With Functional Gastrointestinal Disorders: A Pilot Study

the association with foregut symptoms. Methods: We conducted a retrospective review of the medical notes and electronic patient records for all children diagnosed with JHS (Beighton score >4/9) referred to the syncope service based at Hammersmith Hospital. The study period was June 2011 to October 2013. Cardiovascular autonomic function was evaluated using the tilt table test. Results: A total of 53 children were recruited with a median age range of 15.2 yrs (range 8.1yrs-18.7 yrs). The gender distribution was 28 females (53%) and 25 males (47%). All patients had autonomic nervous system-related symptoms including postural dizziness or syncope (53%), palpitations (40%), migraine (25%) and chest pain (19%). Of the 53 JHS patients with autonomic symptoms, 48 (91%) patients had GI-related symptoms. 45 (85%) of these patients had confirmed cardiovascular autonomic dysfunction on tilt testing. All these patients also complained of foregut symptoms, predominantly nausea and bloating. Summary: Foregut dysfunction was a co-morbid presentation in all JHS patients with cardiovascular dysautonomia. Conclusion: Children with JHS presenting with foregut symptoms are likely to have associated cardiovascular autonomic dysfunction. Recognition of these symptoms by paediatricians is important as formal evaluation and treatment of the dysautonomia may improve the quality of life for these patients. Further studies are required to evaluate the objective improvement of GI symptoms following treatment for dysautonomia.

Self-management and adherence with exercise-based falls prevention programmes: a qualitative study to explore the views and experiences of older people and physiotherapists

Purpose: The aim of this study was to involve older people and physiotherapists in the development of acceptable strategies to promote uptake and adherence with an exercise-based falls prevention programme. Method: Focus groups were conducted with older people attending a regional falls and syncope service (3 groups, total 12 participants) and local physiotherapists (4 groups, total 18 participants). Framework analysis was undertaken to identify why uptake and adherence with an exercise-based falls prevention programme is currently poor and to provide suggestions for how it might be improved. Results: The older people participated in an exercise-based falls prevention programme to remain independent in activities of daily living. They valued approaches that promoted self-efficacy and self-management. In contrast, the physiotherapists perceived that many older people were reluctant to participate in an exercise-based falls prevention programme. While it was acknowledged that older people should be encouraged to take greater responsibility for the maintenance of their own health, the physiotherapists demonstrated a conflicting desire to remain in control of the treatment programme. Conclusions: A focus on self-management support may provide the key to promoting uptake and adherence with an exercise-based falls prevention programme. Physiotherapists should move from being “experts” to “enablers” who use their professional knowledge and expertise to support older people at risk of falling to maintain optimum levels of health and independence.Implications for RehabilitationDespite the established efficacy of exercise-based falls prevention programmes, their impact remains limited by low levels of uptake and adherence.Clinical encounters between physiotherapists and older people at risk of falling offer the opportunity for the exchange of new information to promote patient empowerment and shared decision-making.Physiotherapists need to move away from being experts who care for and do to their patients to enable us to use their professional knowledge and expertise to maintain optimum levels of health and independence for older people at risk of falling.

Developing an integrated care pathway for the management of falls and syncope in older people—the Newcastle experience

AbstractSyncopal events (blackouts) and falls are a major health care and cost burden for the NHS, affecting approximately 35% of adults aged more than 65 years living in the community and 45% of adults aged over 80 years. At least 10% of these events result in a fracture. Syncope, and falls are the most common reason for older adults to attend accident and emergency departments. The development of services in relation to falls is an important element of the recently published National Service Framework for Older Persons (www.open.gov.uk/doh/nsf). The present paper describes the development and implementation of an integrated care pathway for the investigation of falls and syncope within a hospital falls and syncope service. Development of the integrated care pathway has facilitated the implementation of evidence‐based investigations and interventions within a multidisciplinary framework and is an approach that could be adopted by other new and existing falls and syncope units. Copyright © 2002 Whurr Publishers Ltd.

Causes of Orthostatic Hypotension in Old Adults Referred to a Regional Syncope Service

Conference Abstract| February 01 1998 Causes of Orthostatic Hypotension in Old Adults Referred to a Regional Syncope Service NR Stout; NR Stout 1Cardiovascular Investigation Unit (CVIU), Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP Search for other works by this author on: This Site PubMed Google Scholar PH Baylis; PH Baylis 1Cardiovascular Investigation Unit (CVIU), Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP Search for other works by this author on: This Site PubMed Google Scholar RA Kenny RA Kenny 1Cardiovascular Investigation Unit (CVIU), Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP Search for other works by this author on: This Site PubMed Google Scholar Clin Sci (Lond) (1998) 94 (s38): 18P–19P. https://doi.org/10.1042/cs094018Pb Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Citation NR Stout, PH Baylis, RA Kenny; Causes of Orthostatic Hypotension in Old Adults Referred to a Regional Syncope Service. Clin Sci (Lond) 1 February 1998; 94 (s38): 18P–19P. doi: https://doi.org/10.1042/cs094018Pb Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search nav search search input Search input auto suggest search filter All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1998 The Biochemical Society and the Medical Research Society1998 Article PDF first page preview Close Modal You do not currently have access to this content.

Causes and Treatment of Orthostatic Hypotension in Old Adults Referred to a Regional Syncope Service

Causes and Treatment of Orthostatic Hypotension in Old Adults Referred to a Regional Syncope Service