Syncope toolkit

Syncope is very common and will affect 42% of people during their lifetime (NICE guidance). Whilst some syncopal episodes cause limited harm, others cause significant debility, or herald severe illness or sudden death. Furthermore, misdiagnosis is common and therapeutic opportunities are missed.

Syncope woman illustration

This toolkit will guide the GP through the initial assessment, appropriate investigation and management of patients with syncope and orthostatic intolerance (presyncope symptoms). It will increase practitioner confidence in diagnosis, awareness of key indicators and red-flags, and enable timely signposting of patients towards life-improving or life-saving care.

"The only difference between syncope and sudden death is that in one you wake up" - George Engel

Syncope key facts

Why is syncope important?

  • Syncope is common and occurs in 42% of people by the age of 70
  • Health related quality of life is poor in people with recurrent vasovagal syncope
  • After attending A&E with syncope, 0.7% of patients die in the next 7-30 days, and 10% within a year - mortality is highest in those with cardiac syncope.
  • GPs often omit screening for the red flags in syncope that help to detect cardiac syncope
  • Misdiagnosis affects up to 30% of patients with epilepsy; cardiovascular syncope is the most common misdiagnosis in epilepsy
  • Syncope presents to the GP or A&E six times more often than epilepsy
  • Syncope is an under-recognised cause of recurrent falls and older patients commonly experience amnesia for events before the syncope or fall
  • Cardiovascular events cause 45% of unexplained falls in people with dementia
  • Orthostatic intolerance syndromes (mainly due to orthostatic hypotension and postural tachycardia syndrome) cause chronic debility in the young and old.

Patient information



  • Prof Lesley Kavi (Syncope Clinical Champion)
  • Dr Harjeevan Gill (Syncope Clinical Fellow)
  • Dr Morwenna Opie-Moran
  • Dr Nick Gall


  • Prof Richard Sutton
  • Prof Robert Sheldon
  • Prof Rose Anne Kenny
  • Prof William Whitehouse
  • Mrs Trudie Lobban MBE and STARS team
  • Dr Dharini Shanmugabavan
  • Dr Jit Solanki
  • Dr James White
  • Prof Catherine Nelson-Piercy


  • Prof  Wouter Wieling
  • Dr Dean Jenkins
  • Dr Alexander Breitenstein
  • Syncope Unit at Hammersmith Hospital


Medtronic unrestricted educational grant


Download Syncope toolkit references (19 KB PDF)