New concepts in the assessment of syncope.

Significant progress has been made in the past 3 decades in our understanding of the various causes of loss of consciousness thanks to the publication of several important studies and guidelines. In particular, the recent European Society of Cardiology guidelines provide a reference standard for optimal quality service delivery. This paper gives the reader brief guidance on how to manage a patient with syncope, with reference to the above guidelines. Despite the progress made, the management of patients with syncope remains largely unsatisfactory because of the presence of a significant gap between knowledge and its application. Two new concepts aimed at filling that gap are currently under evaluation: syncope facilities with specialist backup and interactive decision-making software. Preliminary data have shown that a standardized syncope assessment, especially when coupled with interactive decision-making software, decreases admission rate and unnecessary testing and improves diagnostic yield, thus reducing cost per diagnosis. The long-term effects of such a new health care model on the rate of diagnosis and survival await future studies.