Identifying Guideline-Practice Gaps to Optimize Evaluation and Management for Patients with Syncope.

Abstract Syncope is a common and complex symptom that requires efficient evaluation to determine the etiology. Recent guidelines focus on high-value testing, but a systematic evaluation of their implementation has not been performed. To this end, we used a mixed methods approach of surveys, chart reviews and focus groups to understand current practices relating to the diagnosis and management of patients with syncope and to identify barriers and facilitators to the implementation of guideline-supported recommendations. Surveys were distributed to 1,500 providers in the specialties of hospital medicine, cardiology, emergency medicine, and family medicine and 175 responses were received. Knowledge of Class I and III guideline recommendations were assessed using clinical vignettes, which were answered correctly 60-80% of the time. Chart reviews focused on patients’ history and testing for syncope. Per the guidelines,