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Surveys and registries are needed to verify that real-life daily practice is in keeping with what is recommended in the guidelines, thus completing the loop between clinical research, writing of guidelines, disseminating them and implementing them into clinical practice.

Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies. However, the ESC Guidelines do not override in any way whatsoever the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient or the patient's caregiver where appropriate and/or necessary. It is also the health professional's responsibility to verify the rules and regulations applicable to drugs and devices at the time of prescription.

The first ESC Guidelines for the management of syncope were published in 2001, with subsequent versions in 2004 and 2009. In March 2015, the ESC CPG considered that there were enough new data to justify the production of new Guidelines.

The most important aspect characterizing this document is the composition of the Task Force, which is truly multidisciplinary. Cardiologists form a minority of the panel; experts in emergency medicine, internal medicine and physiology, neurology and autonomic diseases, geriatric medicine, and nursing cover all aspects of management of the various forms of syncope and transient loss of consciousness (TLOC).

Compared with the previous versions of these Guidelines, the 2018 document contains Supplementary Data as an integral part. While the print text mainly aims to give formal evidence-based recommendations according to the standardized rules of the ESC, this new web-only feature allows expansion of the content to practical issues, and aims to fill the gap between the best available scientific evidence and the need for dissemination of these concepts into clinical practice (‘We have the knowledge, we need to teach it’). Thanks to the Supplementary Data further explanation on specific points is given, and thanks to the Web Practical Instructions advice is given on how to evaluate patients with loss of consciousness (LOC), and how to perform and interpret tests properly; whenever possible, we provide tracings, videos, flow charts, and checklists.

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