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Day 2: Rod Little Prize Hall 1 14:00-15:30
018 One-year prognosis after syncope and the failure of the ROSE decision instrument to predict 1-year adverse events
  1. S S Henderson1,
  2. M J Reed1,2,
  3. D E Newby3,
  4. A J Gray1,2
  1. 1College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
  2. 2Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, UK
  3. 3Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK

Abstract

Objectives and Backgrounds (1) To investigate the incidence of adverse events at 1-year in the cohort of Emergency Department (ED) syncope patients enrolled in the original ROSE study; (2) To investigate the time to adverse event; and (3) To investigate the test performance of the ROSE decision instrument to detect events at 1-year.

Methods This report details the 1-year follow-up of adult syncope patients presenting to the ED who were enrolled into the ROSE study, a single centre, prospective, observational cohort study. The primary end point was the combination of serious outcome (SO) and all-cause death (ACD) at 1 year. SO encompassed acute myocardial infarction, life-threatening arrhythmia, need for pacemaker/implantable defibrillator, pulmonary embolus, cerebrovascular accident, intracranial or subarachnoid haemorrhage, interventional procedure or haemorrhage requiring blood transfusion. Secondary endpoints were ACD and cardiovascular SO at 1 year.

Results 1043 patients were available for analysis; 162 patients (15.5%) had a primary outcome. 28 (17%) of these were within 24 h, 56 (35%) were within 1 week and 77 (48%) were within 1 month. The remaining 85 (52%) outcomes occurred between months 2 and 12. At 1 year, 71 (6.8%) patients had died and 76 (7.3%) had a cardiovascular SO. The sensitivity and specificity of the ROSE decision instrument for 1-year SO and ACD was 71.6% (63.9–78.3) and 71.1% (67.9–74.0), for 1-year ACD was 76.1% (64.2–85.1) and 67.4% (64.3–70.3) and for 1-year cardiovascular SO was 75.0% (63.5–83.9) and 67.5% (64.5–70.5).

Conclusions The proportion of patients with SO and ACD 1 year after syncope is similar to recent international syncope studies. We have defined the proportion of patients with cardiovascular SO at 1-year, and have shown that most events occurred in the first month with decreased frequency of events noted after that time frame especially marked for cardiovascular SO. More than 50% of the outcomes observed however occurred after the first month. The ROSE decision instrument does not perform well at predicting 1-year outcome of ED syncope patients.

Abstract 018 Figure 1

Kaplan–Meier survival curve showing 1-year combined SO and ACD, 1-year ACD, 1-year CVS SO and 1-year combined SO and ACD for ROSE positive and ROSE negative patients.

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