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Cardiovascular Syncope and Autonomic Disorders / Psychosomatic Disorders and Their Treatments · Journal article
BMC Health Services Research · June 27, 2026
Reinforces what was already believed, rather than introducing something new.
This single-centre retrospective cohort study quantified mean direct hospital costs of €1,765.31 per syncope patient in a southern European private hospital setting, with diagnostic testing accounting for 63.3% of total expenditure and substantial variation by clinical pathway (€408 to €13,048 per patient). Guideline-concordant diagnostic testing could have generated estimated savings of €213.94 per patient. The findings characterize current practice variation and resource intensity but do not establish effectiveness of guideline-aligned interventions.
Observational, retrospective cohort study with cost analysis. Pediatric (<18 years) and adult (≥18 years) patients with a principal emergency department diagnosis of syncope presenting to a private hospital in Lisbon, Portugal during 2023.. Intervention: Hypothetical guideline-concordant diagnostic testing pathway (2018 European Society of Cardiology syncope guidelines). Compared with: Actual diagnostic testing observed in current clinical practice (counterfactual simulation). n = 375. Single private hospital in Lisbon, Portugal.
Mean per-patient total cost €1,765.31 (range €408–€13,048; n=375 patients) Diagnostic testing accounted for 63.3% of total cost Etiology established in 41.1% of cohort; 58.1% remained unexplained syncope
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians and health system planners should recognize that syncope generates substantial diagnostic costs (>60% of total) and that marked practice variation exists in a resource-rich setting. Implementation of structured, guideline-aligned diagnostic pathways may reduce unnecessary testing and per-patient costs by approximately 12%, though effectiveness requires prospective validation in the same or comparable settings.
Retrospective cost-of-illness analysis in a single centre quantifying direct per-patient syncope costs (€1,765.31 mean) and demonstrating high diagnostic testing burden; provides descriptive evidence on practice patterns and potential guideline-driven savings but lacks comparative intervention or control arm.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians and health system planners should recognize that syncope generates substantial diagnostic costs (>60% of total) and that marked practice variation exists in a resource-rich setting. Implementation of structured, guideline-aligned diagnostic pathways may reduce unnecessary testing and per-patient costs by approximately 12%, though effectiveness requires prospective validation in the same or comparable settings.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
BACKGROUND: Syncope is a common cause of emergency department visits and is associated with heterogeneous clinical practice and substantial hospital resource use. We primarily aimed to quantify the direct per-patient hospital costs of syncope. Secondary aims were to characterize patterns of resource utilization, determine the cost structure by care pathway and functional component, and identify determinants of total per-patient cost. Additionally, we estimated the potential emergency department cost savings resulting from adherence to the 2018 European Society of Cardiology syncope guidelines. METHODS: We conducted an observational, retrospective cohort study at a private hospital in Lisbon, Portugal, from 1 January to 31 December 2023, including pediatric (< 18 years) and adult (≥ 18 years) patients with a principal emergency department diagnosis of syncope (ICD-9-CM 780.2/992.1). Direct costs were assessed by micro-costing (bottom-up approach) from the hospital perspective (base year 2023), with patient-level analysis. Total per-patient cost was modeled using a generalized linear model as a function of age, sex, etiology, and total number of comorbidities as predictors. Potential emergency department savings were estimated using a counterfactual simulation of guideline-concordant diagnostic testing. RESULTS: We analyzed 375 patients (mean age 49.4 ± 26.5 years; 60.3% female). Etiology was established in 41.1% of the cohort, with reflex syncope predominating (32.3%), whereas 58.1% remained unexplained. Aggregate total cost was €661,992.74, with a mean of €1,765.31 per patient. Costs ranged from €408 per patient for emergency department-only management to €13,048 for episodes requiring hospitalization. Diagnostic testing accounted for 63.3% of total cost. In multivariable analysis, age ≥ 80 years, male sex, higher comorbidity burden and cardiac etiology were associated with significantly higher hospital costs. Potential emergency department diagnostic-testing savings were €80,228.28, corresponding to €213.94 per patient. CONCLUSION: Syncope was associated with substantial hospital costs in a context of marked practice variation and intensive diagnostic testing. Structured, guideline-aligned care pathways may support more selective diagnostic evaluation and efficient use of healthcare resources. CLINICAL TRIAL NUMBER: Not applicable.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.