A major cardiology trial presented at the European Society of Cardiology Congress has found that fitting patients with a two-week heart monitor after an unexplained fainting episode did not reduce how often they fainted over the following year.
The findings come from the ASPIRED trial, presented at ESC Congress and published in the New England Journal of Medicine. The study looked at patients who had experienced syncope (fainting or blacking out) that doctors could not explain even after assessment in an emergency department. Researchers compared two approaches: sending patients home with an electrocardiogram (ECG) monitor worn continuously for 14 days, which records the heart’s electrical activity, versus standard care, which may include shorter or later monitoring as per NICE guidance, but without the immediate 14-day patch device.
The result was clear-cut. Patients given the extended ECG monitoring did not report markedly fewer fainting episodes at the one-year mark than those who received standard care. In other words, the extra monitoring — though it may capture more data about heart rhythm — did not translate into fewer episodes for patients.
That’s a finding worth sitting with. Many clinicians have assumed that catching an abnormal heart rhythm earlier would allow faster treatment, and in turn reduce recurrence. The ASPIRED results suggest that assumption may need revisiting.
Syncope is one of the most common reasons people attend emergency departments across the UK. It can range from a simple faint caused by standing up too quickly to a sign of an underlying heart rhythm problem (arrhythmia). The NHS advises anyone who faints unexpectedly — above all if it happens more than once, or if there is no obvious trigger — to see their GP.
The trial does not suggest patients should avoid monitoring if their doctor recommends it. Clinical decisions depend on individual circumstances, and cardiologists may still have good reasons to use ECG monitoring in specific cases.
Anyone concerned about fainting episodes should contact their GP in the first instance, or call NHS 111 for advice. In an emergency, call 999.
Source: @NEJM