Risk Stratification of Older Adults Who Present to the Emergency Department With Syncope: The FAINT Score

Marc A. Probst, Thomas Gibson, Robert E. Weiss, Annick N. Yagapen, Susan E. Malveau, David H. Adler, Aveh Bastani, Christopher W. Baugh, Jeffrey M. Caterino, Carol L. Clark, Deborah B. Diercks, Judd E. Hollander, Bret A. Nicks, Daniel K. Nishijima, Manish N. Shah, Kirk A. Stiffler, Alan B. Storrow, Scott T. Wilber, Benjamin C. Sun

Research output: Contribution to journalArticle

Abstract

Study objective: Older adults with syncope are commonly treated in the emergency department (ED). We seek to derive a novel risk-stratification tool to predict 30-day serious cardiac outcomes. Methods: We performed a prospective, observational study of older adults (≥60 years) with unexplained syncope or near syncope who presented to 11 EDs in the United States. Patients with a serious diagnosis identified in the ED were excluded. We collected clinical and laboratory data on all patients. Our primary outcome was 30-day all-cause mortality or serious cardiac outcome. Results: We enrolled 3,177 older adults with unexplained syncope or near syncope between April 2013 and September 2016. Mean age was 73 years (SD 9.0 years). The incidence of the primary outcome was 5.7% (95% confidence interval [CI] 4.9% to 6.5%). Using Bayesian logistic regression, we derived the FAINT score: history of heart failure, history of cardiac arrhythmia, initial abnormal ECG result, elevated pro B-type natriuretic peptide, and elevated high-sensitivity troponin T. A FAINT score of 0 versus greater than or equal to 1 had sensitivity of 96.7% (95% CI 92.9% to 98.8%) and specificity 22.2% (95% CI 20.7% to 23.8%), respectively. The FAINT score tended to be more accurate than unstructured physician judgment: area under the curve 0.704 (95% CI 0.669 to 0.739) versus 0.630 (95% CI 0.589 to 0.670). Conclusion: Among older adults with syncope or near syncope of potential cardiac cause, a FAINT score of zero had a reasonably high sensitivity for excluding death and serious cardiac outcomes at 30 days. If externally validated, this tool could improve resource use for this common condition.

Original languageEnglish (US)
JournalAnnals of Emergency Medicine
DOIs
StateAccepted/In press - Jan 1 2019

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Syncope
Hospital Emergency Service
Confidence Intervals
Troponin T
Brain Natriuretic Peptide
Area Under Curve
Observational Studies
Cardiac Arrhythmias
Electrocardiography
Heart Failure
Logistic Models
Prospective Studies
Physicians
Mortality
Incidence

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Probst, M. A., Gibson, T., Weiss, R. E., Yagapen, A. N., Malveau, S. E., Adler, D. H., ... Sun, B. C. (Accepted/In press). Risk Stratification of Older Adults Who Present to the Emergency Department With Syncope: The FAINT Score. Annals of Emergency Medicine. https://doi.org/10.1016/j.annemergmed.2019.08.429

Risk Stratification of Older Adults Who Present to the Emergency Department With Syncope : The FAINT Score. / Probst, Marc A.; Gibson, Thomas; Weiss, Robert E.; Yagapen, Annick N.; Malveau, Susan E.; Adler, David H.; Bastani, Aveh; Baugh, Christopher W.; Caterino, Jeffrey M.; Clark, Carol L.; Diercks, Deborah B.; Hollander, Judd E.; Nicks, Bret A.; Nishijima, Daniel K.; Shah, Manish N.; Stiffler, Kirk A.; Storrow, Alan B.; Wilber, Scott T.; Sun, Benjamin C.

In: Annals of Emergency Medicine, 01.01.2019.

Research output: Contribution to journalArticle

Probst, MA, Gibson, T, Weiss, RE, Yagapen, AN, Malveau, SE, Adler, DH, Bastani, A, Baugh, CW, Caterino, JM, Clark, CL, Diercks, DB, Hollander, JE, Nicks, BA, Nishijima, DK, Shah, MN, Stiffler, KA, Storrow, AB, Wilber, ST & Sun, BC 2019, 'Risk Stratification of Older Adults Who Present to the Emergency Department With Syncope: The FAINT Score', Annals of Emergency Medicine. https://doi.org/10.1016/j.annemergmed.2019.08.429
Probst, Marc A. ; Gibson, Thomas ; Weiss, Robert E. ; Yagapen, Annick N. ; Malveau, Susan E. ; Adler, David H. ; Bastani, Aveh ; Baugh, Christopher W. ; Caterino, Jeffrey M. ; Clark, Carol L. ; Diercks, Deborah B. ; Hollander, Judd E. ; Nicks, Bret A. ; Nishijima, Daniel K. ; Shah, Manish N. ; Stiffler, Kirk A. ; Storrow, Alan B. ; Wilber, Scott T. ; Sun, Benjamin C. / Risk Stratification of Older Adults Who Present to the Emergency Department With Syncope : The FAINT Score. In: Annals of Emergency Medicine. 2019.
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abstract = "Study objective: Older adults with syncope are commonly treated in the emergency department (ED). We seek to derive a novel risk-stratification tool to predict 30-day serious cardiac outcomes. Methods: We performed a prospective, observational study of older adults (≥60 years) with unexplained syncope or near syncope who presented to 11 EDs in the United States. Patients with a serious diagnosis identified in the ED were excluded. We collected clinical and laboratory data on all patients. Our primary outcome was 30-day all-cause mortality or serious cardiac outcome. Results: We enrolled 3,177 older adults with unexplained syncope or near syncope between April 2013 and September 2016. Mean age was 73 years (SD 9.0 years). The incidence of the primary outcome was 5.7{\%} (95{\%} confidence interval [CI] 4.9{\%} to 6.5{\%}). Using Bayesian logistic regression, we derived the FAINT score: history of heart failure, history of cardiac arrhythmia, initial abnormal ECG result, elevated pro B-type natriuretic peptide, and elevated high-sensitivity troponin T. A FAINT score of 0 versus greater than or equal to 1 had sensitivity of 96.7{\%} (95{\%} CI 92.9{\%} to 98.8{\%}) and specificity 22.2{\%} (95{\%} CI 20.7{\%} to 23.8{\%}), respectively. The FAINT score tended to be more accurate than unstructured physician judgment: area under the curve 0.704 (95{\%} CI 0.669 to 0.739) versus 0.630 (95{\%} CI 0.589 to 0.670). Conclusion: Among older adults with syncope or near syncope of potential cardiac cause, a FAINT score of zero had a reasonably high sensitivity for excluding death and serious cardiac outcomes at 30 days. If externally validated, this tool could improve resource use for this common condition.",
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AU - Malveau, Susan E.

AU - Adler, David H.

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AU - Baugh, Christopher W.

AU - Caterino, Jeffrey M.

AU - Clark, Carol L.

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N2 - Study objective: Older adults with syncope are commonly treated in the emergency department (ED). We seek to derive a novel risk-stratification tool to predict 30-day serious cardiac outcomes. Methods: We performed a prospective, observational study of older adults (≥60 years) with unexplained syncope or near syncope who presented to 11 EDs in the United States. Patients with a serious diagnosis identified in the ED were excluded. We collected clinical and laboratory data on all patients. Our primary outcome was 30-day all-cause mortality or serious cardiac outcome. Results: We enrolled 3,177 older adults with unexplained syncope or near syncope between April 2013 and September 2016. Mean age was 73 years (SD 9.0 years). The incidence of the primary outcome was 5.7% (95% confidence interval [CI] 4.9% to 6.5%). Using Bayesian logistic regression, we derived the FAINT score: history of heart failure, history of cardiac arrhythmia, initial abnormal ECG result, elevated pro B-type natriuretic peptide, and elevated high-sensitivity troponin T. A FAINT score of 0 versus greater than or equal to 1 had sensitivity of 96.7% (95% CI 92.9% to 98.8%) and specificity 22.2% (95% CI 20.7% to 23.8%), respectively. The FAINT score tended to be more accurate than unstructured physician judgment: area under the curve 0.704 (95% CI 0.669 to 0.739) versus 0.630 (95% CI 0.589 to 0.670). Conclusion: Among older adults with syncope or near syncope of potential cardiac cause, a FAINT score of zero had a reasonably high sensitivity for excluding death and serious cardiac outcomes at 30 days. If externally validated, this tool could improve resource use for this common condition.

AB - Study objective: Older adults with syncope are commonly treated in the emergency department (ED). We seek to derive a novel risk-stratification tool to predict 30-day serious cardiac outcomes. Methods: We performed a prospective, observational study of older adults (≥60 years) with unexplained syncope or near syncope who presented to 11 EDs in the United States. Patients with a serious diagnosis identified in the ED were excluded. We collected clinical and laboratory data on all patients. Our primary outcome was 30-day all-cause mortality or serious cardiac outcome. Results: We enrolled 3,177 older adults with unexplained syncope or near syncope between April 2013 and September 2016. Mean age was 73 years (SD 9.0 years). The incidence of the primary outcome was 5.7% (95% confidence interval [CI] 4.9% to 6.5%). Using Bayesian logistic regression, we derived the FAINT score: history of heart failure, history of cardiac arrhythmia, initial abnormal ECG result, elevated pro B-type natriuretic peptide, and elevated high-sensitivity troponin T. A FAINT score of 0 versus greater than or equal to 1 had sensitivity of 96.7% (95% CI 92.9% to 98.8%) and specificity 22.2% (95% CI 20.7% to 23.8%), respectively. The FAINT score tended to be more accurate than unstructured physician judgment: area under the curve 0.704 (95% CI 0.669 to 0.739) versus 0.630 (95% CI 0.589 to 0.670). Conclusion: Among older adults with syncope or near syncope of potential cardiac cause, a FAINT score of zero had a reasonably high sensitivity for excluding death and serious cardiac outcomes at 30 days. If externally validated, this tool could improve resource use for this common condition.

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