Abstract 11294: Rates of Testing in Syncope Patients in the United States Using a National Database

Introduction:Syncope is a prevalent health problem. Most causes of syncope are benign and can be diagnosed based on history and physical examinations. Nonetheless, overtesting for syncope is a major healthcare problem associated with increased costs. In this study, we sought to assess the testing trends for the evaluation of syncope.Methods:We used data from the IBM MarketScan Research Database, which captures deidentified, individual-level information in the United States from approximately 100 commercial payers and self-insured corporations, not including Medicaid claims. We identified patients with the first diagnosis of syncope from 2010-2020 using ICD-9 and ICD-10 codes. Patients were followed up for three months to determine the rate of testing for syncope.Results:We identified 2,500,850 patients (57.9% women) with a mean age of 48.5 years. The overall rate of anatomical neurological testing was higher than cardiac anatomical testing (43.3% vs. 25.5%, p<0.001). The rate of the following tests decreased over time: cardiac stress testing (17.4% to 11.4%, p<0.001, figure 1A), carotid ultrasound (13.1% to 7.2%, p<0.001, figure 1C) and EEG (7.3% to 5.7%, p<0.001, figure 1C). The rate of CT chest angiography increased significantly (3.6% to 6.1%, p<0.001, figure 1B). The rates of long-term ECG monitoring, echocardiogram, chest x-ray, and neck and brain imaging remained the same (Figures 1A-C).Conclusion:Although prior studies demonstrated low yield for most cardiac and neurological evaluations for syncope and the reduction of testing over time (stress testing, carotid doppler, EEG), high rates of testing remained prevalent in syncope patients. Efforts are needed to reduce the use of low-yield diagnostic studies in syncope patients.