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National Clinical Guideline Centre for Acute and Chronic Conditions (UK). Transient Loss of Consciousness (‘Blackouts’) Management in Adults and Young People [Internet]. London: Royal College of Physicians (UK); 2010 Aug. (NICE Clinical Guidelines, No. 109.)
We checked this guideline in March 2019. We found no new evidence that affects the recommendations in this guideline.
Transient Loss of Consciousness (‘Blackouts’) Management in Adults and Young People [Internet].
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| Parameter description | Point estimate | Probability distribution | Notes | Source |
|---|---|---|---|---|
| Costs | ||||
| Ambulatory ECG using Holter or EER | £54 IQR (37 – 63) | Gamma (66.75, 0.81) | Estimated by fitting 95%CI of Gamma to interquartile range of HRG cost | HRG reference costs 07/09 |
| Tilt testing | £117 IQR (64 – 156) | Gamma (24.66, 4.74) | HRG reference costs 07/09 | |
| IER implantation | £1,895 IQR (1160 – 2564) | Gamma (27.83, 68.11) | HRG reference costs 07/09 | |
| IER removal | £5,26 IQR (347 – 575) | Gamma (80.87, 6.50) | HRG reference costs 07/09 | |
| Pacemaker implantation | £2430 IQR (1352–3762) | Gamma (15.46, 157.31) | HRG reference costs 07/09 | |
| Pacemaker follow-up | £105 IQR (75–122) | Gamma (76.93, 1.37) | ||
| Ambulance attendance due to recurrence | £208 IQR (176–229) | Gamma (106.24, 1.26) | HRG reference costs 07/09 | |
| ED attendance due to recurrence | £134 IQR (111 – 161) | Gamma (237.60, 0.88) | HRG reference costs 07/09 | |
| Hospital admission due to recurrence | £318 IQR (237–365) | Gamma (94.83, 3.36) | HRG reference costs 07/09 | |
| Conventional monitoring (additional cost compared to IER monitoring) | £809 95%CI (123 – 2766) | Gamma (1.28, 631.92) | Used in sensitivity analysis only | Farwell 2004 |
| Recurrence rates for paced and unpaced patients with SSS and AVB | ||||
| Year 1 for pacing | 6% | Beta (2,34) | Alboni 1997 | |
| Year 2 for pacing | 0% | Beta (0+1*,58+1*) | *(1,1) added to event rates as uninformative prior | Alboni 1997 |
| Year 1 for no pacing | 16.4% | Beta (6,29) | Alboni 1997 | |
| Year 2 for no pacing | 16.7% | Beta (4,19) | Alboni 1997 | |
| Effect of treatment on HRQoL | ||||
| Utility gain due to pacing | 0.165 (SE = 0.02) | Beta (40.19, 203.36) | Lopez-Jimenez 2002 | |
| Utility gain due to ICD | 0.117 (SE = 0.05) | Beta (5.13, 38.71) | Estimates ranging from 0.069 to 0.165 | HRQoL review in appendix H |
| Diagnostic outcomes for testing strategies to direct pacing | ||||
| Prob of diagnosis by IER | 27% | Beta (106, 392) | Brignole 2006 | |
| Distribution of IER diagnoses: | Brignole 2006 | |||
| Asystole | 54% | Dirichlet (57, 4, 29, 16) | ||
| Bradyarrhythmia | 4% | |||
| No arrhythmia or slight | 27% | |||
| Tachyarrhythmia | 15% | |||
| Sensitivity of tilt (for asystole only) | 13% | Beta(6,41) | Brignole 2006 | |
| Specificity of tilt (for asystole only) | 96% | Beta(45,2) | Brignole 2006 | |
| Proportion of asystole that are AV block | 28% | Beta (16,41) | Brignole 2006 | |
| Sensitivity of tilt when including bradyarrhythmia | 12% | Beta (6,45) | Used in sensitivity analysis only | Brignole 2006 |
| Specificity of tilt when including bradyarrhythmia | 95% | Beta(41,2) | Used in sensitivity analysis only | Brignole 2006 |
| Proportion of asystole and bradycardia that are AV block | 26% | Beta (16,45) | Used in sensitivity analysis only | Brignole 2006 |
| Diagnostic outcomes for ambulatory ECG (suspected arrhythmia and unexplained TLoC and initial assessment and secondary investigations) As detailed in section 5.8.9, we used the event rates in Tables 25, 26 and 27 to specify beta functions and dirichlet distributions for the event rates used to model the diagnostic outcomes. We added uninformative priors with one event per outcome to the data shown in Tables 25 and 26 in order to handle zero event rates. As the event rates for each strategy have already been specified in Tables 25 to 27, these are not repeated here. | ||||
Abbreviations: ECG, electrocardiogram; EER, external event recorder; IER, implantable event recorder; IQR, interquartile range; HRG, healthcare resource group; ICD, implantable cardioverter defibrillator; atrioventricular; SSS, sick sinus syndrome; ED, emergency department; CI, confidence interval; SE, standard error; SD, standard deviation
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