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Scooped by Seth Bilazarian, MD
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Choosing Wisely for Syncope: Low‐Value Carotid Ultrasound Use

Choosing Wisely for Syncope: Low‐Value Carotid Ultrasound Use | Heart and Vascular Health | Scoop.it
 

The US spends more than $750 billion/ yr  on tests and procedures that do not benefit patients. Although there is no physiological indication for carotid ultrasound in “simple” syncope in the absence of focal neurological signs or symptoms suggestive of stroke, there is concern that this practice remains common for routine syncope workups.

We found that 16.5% of all Medicare beneficiaries with simple syncope underwent carotid imaging and 6.5% of all carotid ultrasounds ordered in 2009 were for this low‐value indication.

For the 15.4% patients with stenosis ≥50%, carotid ultrasound did not yield a causal diagnosis. Only 2% of patients imaged experienced a change in medications after a positive study, and <1% of patients underwent a carotid revascularization procedure.

Seth Bilazarian, MD's insight:

The ultrasound of the carotid artery is often part of the "package" of inappropriate testing that happens with syncope or worse lightheadedness without syncope.  Other commonly ordered tests for syncope are Head CT and echocardiography without signs and symptoms indicating their utility.  Much of the problem comes from emergency room evaluation and hospital admission which leads to accelerated testing to limit patient's length of stay. Most of this would be done better (more effectively and wit greater value)  in the office based assessment by the patient's internist or cardiologist.

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Scooped by Seth Bilazarian, MD
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Why do people faint?

Why do people faint? | Heart and Vascular Health | Scoop.it
Fainting, also called syncope, is a sudden and brief loss of consciousness followed by a spontaneous return to wakefulness—people who faint “black out” and then “come to” on their own without outside intervention.

“The elderly have syncope more commonly than any other group,” which can put them at risk of falls and fractures. Often the spells are caused by actions as simple as changing position or eating a meal. When we stand up, “about half a liter of blood immediately goes to the legs and the lower abdomen,” and eating also pulls blood from the brain to the gut. Our bodies compensate by raising the heart rate to get blood to the brain. But elderly people can’t always restore their blood flow, and dehydration or certain medications can exacerbate the problem.

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