A survey of patients selected by general practitioners for home care of suspected myocardial infarction: arrhythmia detection using Holter monitoring.
From the Lancaster district (pop. 50 000) 101 patients were selected for home care of suspected acute myocardial infarction (AMI) by their general practitioners (GPs) and 78% were seen within 6 h (44% within 2 h). Infarction was confirmed in 54 cases compared with 203 in the coronary case unit over the same period. Reasons given for home management were stable condition (48%), diagnostic doubt (34%), patient preference (18%), good home (15%), age (14%). Holter ECGs from 97 patients were analysed to see if arrhythmias were undetected clinically and recordings of at least 20 h were obtained in 88 (91%). Symptoms drew attention to atrial arrhythmias in 5 patients. Ventricular premature beats were recorded in 96% of the AMI group (84% of the non-MI), ventricular tachycardia in 21% of the AMI patients (5% non-MI), atrial fibrillation in 25% of AMI (7% non-MI) and complex ventricular ectopic activity (Lown 3-5) was found in 81% of the AMI (58% of the non-MI). We conclude that the GPs in the Lancaster district select patients for home care of AMI on clinical and social grounds rather than time after onset. Holter ECG recordings reveal major arrhythmias which are usually undetected clinically and are at least as common as those found in CCU treated patients. Further studies involving larger numbers of home treated patients monitored early are required to identify criteria for home care.
D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis*; D004562:Electrocardiography / Q000379:methods*; D005194:Family Practice; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*