@article{dff9746b997f4906bc10f4e9ad536be6,
title = "Risk Stratification of Older Adults Who Present to the Emergency Department With Syncope: The FAINT Score",
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.",
author = "Probst, {Marc A.} and Thomas Gibson and Weiss, {Robert E.} and Yagapen, {Annick N.} and Malveau, {Susan E.} and Adler, {David H.} and Aveh Bastani and Baugh, {Christopher W.} and Caterino, {Jeffrey M.} and Clark, {Carol L.} and Diercks, {Deborah B.} and Hollander, {Judd E.} and Nicks, {Bret A.} and Nishijima, {Daniel K.} and Shah, {Manish N.} and Stiffler, {Kirk A.} and Storrow, {Alan B.} and Wilber, {Scott T.} and Sun, {Benjamin C.}",
note = "Funding Information: Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) under award R01HL111033. Dr. Probst is supported by a Career Development Award from the National Heart, Lung, and Blood Institute of the NIH (K23HL132052). Dr. Adler has received research funding from Roche. Dr. Bastani has received research funding from Radiometer and Portola and has been a consultant for Portola. Dr. Shah reports receiving research funding from Roche and Omron, Inc. Dr. Baugh has received advisory board and speaker's fees from Roche, research funding from Janssen and Boehringer Ingelheim, and consulting and advisory board fees from Janssen. Dr. Caterino has received funding from Astra Zeneca. Dr. Clark has received research funding from Radiometer, Ortho Clinical Trials, Janssen, Pfizer, NIH, Portola, Biocryst, GlaxoSmithKlein, the Hospital Quality Foundation, Astra Zeneca, and Abbott. Dr. Clark is also a consultant for Portola, Janssen, and the Hospital Quality Foundation. Dr. Diercks is a consultant for Janssen and Roche, has received institutional research support from Novartis, Ortho Scientific, and Roche, and is on the editorial board for Academic Emergency Medicine and Circulation. Dr. Hollander has received research funding from Alere, Echosense, Siemens, Roche, Portola, and Trinity. Dr. Nishijima has received honoraria from Pfizer. Dr. Storrow is a consultant for Siemens and Quidel and is on the data and safety monitoring board for Trevena. Dr. Sun is a consultant for Medtronic. Roche Diagnostics supplied high-sensitivity troponin T and NT-proBNP assays. Author contributions: MAP and BCS designed the study and drafted the article. BCS obtained funding for the study. ANY and SEM were responsible for data collection and management. TG and REW provided statistical advice on study design and analyzed the data. All authors contributed substantially to article revisions. TG, REW, ANY, SEM, and BCS had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved the final report for submission. BCS takes responsibility for the paper as a whole. Publisher Copyright: {\textcopyright} 2019 American College of Emergency Physicians",
year = "2020",
month = feb,
doi = "10.1016/j.annemergmed.2019.08.429",
language = "English (US)",
volume = "75",
pages = "147--158",
journal = "Journal of the American College of Emergency Physicians",
issn = "0196-0644",
publisher = "Mosby Inc.",
number = "2",
}