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Syncope diagnostic evaluation in a Southern European population: clinical practice, resource use, and the cost of low-value care
Session:
Sessão de Posters 58 - Otimizar os cuidados cardiovasculares: perspetivas de enfermagem e de técnicos de cardiopneumologia
Speaker:
Cristiana Almeida
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
07. Syncope and Bradycardia
Subtheme:
07.3 Syncope and Bradycardia - Diagnostic Methods
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Cristiana Almeida; Mário M. Oliveira; Sérgio Laranjo; Julian Perelman
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Background and aims: </span></strong><span style="font-family:"Arial",sans-serif">Syncope is a common reason for emergency department (ED) visits, characterized by heterogeneous clinical practice and a substantial economic impact. In Portugal, research on costs using real-world data remains limited. To the best of our knowledge, no studies have been published to date in the private sector. The primary objective of this study was to quantify direct hospital costs per patient associated with the evaluation of syncope. Secondary aims were to characterize the patterns of resource utilization</span><span style="font-family:"Arial",sans-serif">, determine the cost structure by care pathway and functional component</span><span style="font-family:"Arial",sans-serif">, and identify determinants of total per-patient cost. Additionally, we estimated potential emergency department cost savings resulting from adherence to the 2018 European Society of Cardiology syncope guidelines.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Methods and results:</span></strong><span style="font-family:"Arial",sans-serif"> We conducted an observational, retrospective cohort study at a private hospital in Lisbon, Portugal, from 1 January to 31 December 2023, including pediatric (<18 years) and adult (≥18 years) patients with a principal ED diagnosis of syncope (ICD-9-CM 780.2/992.1). Direct costs were assessed by micro-costing (bottom-up approach) from the hospital perspective (base year 2023), with patient-level analysis. Total per-patient cost was modeled using a generalized linear model as a function of age, sex, etiology, and total number of comorbidities. ED savings were estimated via counterfactual simulation independently by two specialist physicians. We analyzed 375 patients (mean age 49.4 ± 26.5 years; bimodal age distribution peaking at 15 and 80 years; 60.3% female). Etiology was defined in 41.1% of the cohort, with reflex syncope predominating (32.3%), whereas 58.1% remained unexplained. Aggregate total cost was €661,992.74, and mean cost was €1,765.31 ± €4,995.96 per patient. Costs ranged from €408 per patient for emergency department-only management to €13,048 for episodes requiring hospitalization. In the cost breakdown, diagnostic testing accounted for 63.3% of total cost. In multivariable analysis, age ≥80 years, male sex, higher comorbidity burden and cardiac etiology were associated with significantly higher hospital costs. Potential ED savings were €80,228.28, corresponding to a mean of €213.94 ± €411.09 per patient.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Conclusion:</span></strong><span style="font-family:"Arial",sans-serif"> Syncope represents a significant hospital economic burden in a context of heterogeneous management. Standardization of clinical processes, aligned with international guidelines, may support a more parsimonious use of diagnostic tests and improve the efficiency of resource allocation.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Keywords:</span></strong><span style="font-family:"Arial",sans-serif"> Syncope; Costs and Cost Analysis; Guideline Adherence; Emergency Service, Hospital; Hospitals, Private.</span></span></span></p>
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