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Introduction to Rapid Access T-LoC Clinics

Blackouts/T-LoCs are frequently the result of heart rhythm disorder, which could be indicative of a potentially fatal problem. A fall might also be the result of a stability or balance problem, and a blackout/T-LoC might result from epilepsy. However, most blackouts/T-LoCs are due to Reflex Syncope, which usually presents as simple fainting, and occurs in up to 50% of us,1,2 while epilepsy is estimated to occur in approximately 0.5-1% of the population.3 A severe faint can appear very like an epilepsy attack, but is more likely to be a faint.

The care required for these conditions differs considerably; distinguishing one from another can be extremely difficult without the involvement of several specialties, including cardiology, geriatrics, neurology, psychology and paediatrics. Furthermore, in the UK there are very few heart rhythm expert cardiologists, and there are relatively few consultant neurologists, so referral to the ‘wrong’ specialist is a distinct possibility which can also lead to an avoidable delay to accurate diagnosis.

Rapid Access T-LoC Clinics (RATCs) are designed to ensure patients are always diagnosed and treated by the appropriate expert. They achieve this by taking referrals from all parts of the health system when patients present with a blackout/T-LoC or a fall. Often nurse-led, the clinic combines several disciplines to develop ‘blackout/T-LoC experts’ who will direct the patient to the most appropriate specialist. Blackouts/T-LoCs are extremely common, accounting for 3% of all attendances to emergency departments and 1% of all hospital admissions.1

Yet today, misdiagnosis of blackouts/T-LoCs is remarkably prevalent among patients who experience a blackout/T-LoC. This means that fatal arrhythmias are missed, that many patients are tragically misdiagnosed with epilepsy, and that vast resources are wasted on unnecessary tests, inappropriate admissions, and the repeated re-referral of patients unsatisfied with no diagnosis.1

This effort is part of STARS and the Arrhythmia Alliance’s drive to have Chapter 8 of the CHD NSF on Arrhythmias and Sudden Cardiac Arrest implemented in the UK as rapidly as possible. If you’re a registered clinic operator, please log in above. If not, please use the links on the left to get information on Rapid Access T-LoC Clinics or to register. Registration is free.

References

  1. S Petkar, M Jackson and A Fitzpatrick. Management of blackouts and misdiagnosis of epilepsy and falls. Royal College of Physicians Journal: vol 5: September/October: Conference reports
  2. A Fitzpatrick and P Cooper. Diagnosis and Management of Patients with Blackouts. Heart 2006; 92: 559-568
  3. Sander JWAS, Shorvon SD. Epidemiology of the epilepsies. Journal of Neurology, Neurosurgery, and Psychiatry 1996;61:433-443