Do Heart Tests in the ER Actually Help Patients Who Faint? | Research

The takeaway

Systematic review finds limited evidence that troponin, BNP, echocardiography, and cardiac monitoring improve 30-day outcomes for ER patients presenting with fainting.

Limited diagnostic utility
Troponin, BNP, echo, and cardiac monitoring show unclear benefit for 30-day syncope outcomes

What the researchers found

Evidence supporting the routine use of troponin, BNP, echocardiography, and outpatient cardiac monitoring in ER syncope patients is limited, with unclear benefit for 30-day outcomes.

Why it matters

Millions of ER visits for fainting result in expensive cardiac testing. Evidence-based guidance on which tests are actually useful could reduce unnecessary costs and patient anxiety.

How the study worked

Systematic review of diagnostic accuracy studies evaluating cardiac biomarkers, echocardiography, and outpatient monitoring in adult ED patients with syncope, following SAEM GRACE methodology.

What this study cannot tell us

Systematic review quality depends on available primary studies, which were often small or retrospective. Different syncope etiologies may respond differently to testing.

How to read the evidence

Systematic review of diagnostic accuracy studies — rigorous methodology but limited by the quality of underlying primary studies.

When this study was published

Published in 2026; represents current SAEM GRACE guideline evidence.

The bigger picture

This reflects a broader movement in emergency medicine toward evidence-based testing — avoiding reflexive ordering of tests that may not change clinical management or improve outcomes.

Questions still open

Should ER fainting protocols be redesigned to reduce routine cardiac testing?
Which specific syncope risk factors should trigger cardiac workup versus reassurance and discharge?

Common questions

Should I get heart tests after fainting?

It depends on your risk factors. This review suggests routine cardiac testing may not benefit most fainting patients, but those with concerning symptoms (chest pain, abnormal ECG, history of heart disease) should still be evaluated.

What is BNP?

BNP (B-type natriuretic peptide) is a hormone released by the heart when it is under stress. It is commonly measured in blood tests to evaluate heart failure, but its role in evaluating fainting is less clear.

Read the original research

Cardiac Biomarkers, Echocardiography, and Outpatient Cardiac Monitoring for Evaluation of Emergency Department Patients With Syncope: A Systematic Review and Analysis of Direct Evidence for SAEM GRACE.

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 33(2), e70175

View on PubMed ↗Publisher’s paper ↗

Citation

Benabbas, Roshanak; Zehtabchi, Shahriar; Wakai, Abel; Allen, Robert; deSouza, Ian S; Richards, Rebekah J; Curley, David; Dunne, Eric; Sinert, Richard. (2026). Cardiac Biomarkers, Echocardiography, and Outpatient Cardiac Monitoring for Evaluation of Emergency Department Patients With Syncope: A Systematic Review and Analysis of Direct Evidence for SAEM GRACE.. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 33(2), e70175. https://doi.org/10.1111/acem.70175