FAINT score predicts outcomes in syncope: derivation study

  • Annals Emerg Med

  • de Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • For emergency department (ED) risk stratification in elderly people presenting after syncope, a 5-variable risk score predicted serious 30-day outcomes.
  • Authors caution clinicians not to use this rule before external validation.

Why this matters

  • Accurate risk stratification is the “holy grail of syncope research.”
  • Low-yield hospitalizations are common.
  • This study used a large elderly population, novel biomarkers, and objective criteria.

Study design

  • Prospective observational multicenter study of adults aged ≥60 years presenting to EDs after unexplained syncope or near-syncope (n=3177). 
  • Authors used logistic regression to derive FAINT score: 
    • History of heart failure. 
    • History of arrhythmia.
    • Initial abnormal ECG result. 
    • Elevated pro B-type natriuretic peptide. 
    • Elevated high-sensitivity troponin T. 
  • Outcome: 30-day all-cause mortality or serious cardiac outcome.
  • Funding: NIH.

Key results

  • Primary outcome occurred in 5.7%; mortality was 0.82%.
  • Performance of FAINT score of 0 vs ≥1:
    • Sensitivity: 96.7% (95% CI, 92.9%-98.8%).
    • Specificity: 22.2% (95% CI, 20.7%-23.8%). 
  • FAINT vs unstructured physician judgment area under the curve: 0.704 (95% CI, 0.669-0.739) vs 0.630 (95% CI, 0.589-0.670).

Limitations

  • Risk for sampling bias.
  • External validation required.