Identifying at-risk ventricular arrhythmia patients

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As far back as 2005, Dr. Venkatesh Thiruganasambandamoorthy felt that the outcomes of adults with syncope seen in Canadian Emergency Departments (EDs) needed to be more fully investigated. So he led the study Outcomes in Canadian Emergency Department Syncope Patients – Are We Doing a Good Job? to see what could be learned.

The study, published in 2012, came to the conclusion that ED physicians should be aware of the significant risk for serious adverse outcomes in syncope patients after seven days, and that future studies should be done to develop a risk-stratification system to identify which ED syncope patients need to be admitted, and which ones can be safely followed up in an outpatient clinic.

This led Dr. Thiruganasambandamoorthy to develop the Optimal Management of Low-Risk Syncope Patients program. This program looks at all aspects of syncope care at both patient and health system levels and will impact patients, communities at large, EMS workers, and hospital EDs.

One project within the program is the validation of the Canadian Syncope Risk Score (CSRS), which will be used to standardize ED syncope management and identify low-risk patients for early disposition. Using the CSRS, ED physicians can predict 30-day serious outcomes for syncope patients after being released from the ED. They will be able to determine if a patient is deemed to be at risk for ventricular arrhythmia and whether they should be admitted.

Another project in Dr. Thiruganasambandamoorthy’s program is the development of risk stratification tools that EMS workers will use to assess and release low-risk syncope patients – thereby reducing the number of patients transported to the ED every year. These tools, developed in Ottawa, Ontario, will be used by another CANet Network Investigator, Dr. Satish Raj, in his Community Alternatives for Syncope Management in the Emergency Room (CASMER) program in Calgary, Alberta. This is a great example of the scope of work being undertaken by CANet-funded researchers, and the way in which CANet is helping connect researchers across the country as they work to improve the lives of Canadians suffering from arrhythmias.

In addition to focusing on keeping low-risk patients out of the ED, Dr. Thiruganasambandamoorthy is dedicated to monitoring patients outside of the hospital, to make sure any changes in their condition are caught, before they become dangerous. So one of his other projects is the Remote Cardiac Monitoring of Higher-Risk Emergency Department Syncope Patients after Discharge (REMOSYNC) study, comparing two methods of monitoring syncope patients after they are released from the ED. The study hypothesizes that if patients are discharged home with an external cardiac event monitor, there is a better chance that an arrhythmia will be identified than by the current practice of monitoring patients for 48 hours with a Holter monitor.

Optimal Management of Low-Risk Syncope Patients has lofty, exciting, and profound goals: to improve syncope care, decrease healthcare costs, decrease EMS burden, reduce ED and hospital overcrowding, and improve patient satisfaction.

CANet is proud to help bring this program to fruition.

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