Mobile Cardiac Outpatient Telemetry for Unexplained Syncope: Time to Treatment, Arrhythmia Diagnosis and Outcomes

We aim to establish the efficacy of ED-based, post-discharge mobile cardiac outpatient telemetry for patients discharged with a diagnosis of unexplained syncope.

About

This study seeks to provide evidence that the use of Philips MCOT devices may improve patient care for patients who present to EDs with syncope, which is a temporary loss of consciousness also known as fainting, or who present experiencing a near temporary loss of consciousness ("near syncope"). Syncope and near syncope are common ED presentations, posing diagnostic challenges and leading to wide practice variations and high costs. Despite efforts to reduce hospital admissions for low diagnostic yield, costs remain high. Wearable technology, like external loop recorders (ELRs), offers a promising solution. ELRs have shown increased diagnostic yield and patient satisfaction compared to traditional monitoring methods. However, ED-based studies in the U.S. are lacking. Research suggests that ELRs placed at ED disposition can lead to changes in medical management for patients with unexplained syncope, highlighting their potential for improving diagnostic accuracy and reducing healthcare costs. A study performed in Scotland suggests that ED-placed ELRs can provide arrhythmia diagnosis in patients with unexplained syncope. To date, no studies performed in the U.S. have addressed ED-based use of MCOT for unexplained syncope.

Eligibility Criteria

Inclusion Criteria

  1. ED presentation for syncope or near syncope without identified cause of syncope during ED evaluation
  2. Willingness to enroll in the trial
  3. Greater than or equal to 50 years of age
  4. Home or cell phone service for follow up calls
  5. Ability to answer questionnaires without assistance    
  6. English language speaker

Exclusion Criteria

  1. Unwillingness to participate in the study
  2. Inability to consent on their own
  3. Seizure as presumptive cause of loss of consciousness
  4. Stroke or transient ischemic attack as presumptive loss of consciousness
  5. Loss of consciousness following head trauma
  6. Confusion from baseline mental status (altered mental status)
  7. Intoxication (alcohol or other drugs)
  8. Medical or electrical intervention required to restore consciousness
  9. Hypoglycemia as presumptive cause of loss of consciousness
  10. Inability to provide follow up via telephone (phone that is not regularly in service)
  11. Lack of permanent address (e.g., not a homeless shelter, half-way house, psychiatric treatment facility, or correctional facility)
  12. Lack of continuous cellular phone service with ATT, Verizon or T-Mobile for MCOT relay
  13. Known pregnancy
  14. Illiteracy

Primary Investigator

Andrew B. Moore MD

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Dr. Andrew Moore is an Emergency Medicine physician with over 10 years of clinical and research experience. He is an assistant professor of emergency medicine and health systems and implementation sciences at the Virginia Tech Carilion School of Medicine. He is board certified by the American Board of Emergency Medicine in Emergency Medicine. He completed his residency in Emergency Medicine at Northwestern University and a two-year research fellowship with the Center for Policy and Research in emergency medicine at Oregon Health and Science University.

Andrew B. Moore MD

Contact Information

Bridget Mason, BS
Clinical Research Coordinator