Ambulatory electrocardiography. A cost per management decision analysis.
BACKGROUND
This study evaluated the current clinical use and costs of ambulatory electrocardiographic (AECG) monitoring for arrhythmia detection based on a cost per management decision analysis.


METHODS
Consecutive inpatient and outpatient 24-hour AECGs (n = 650) performed during the calendar year 1991 were retrospectively reviewed for clinical indication, arrhythmia detection, diary information, and whether a management decision that might alter patient outcome was derived from the data. The cost per management decision (based on a representative reimbursement of $550 per AECG) and the cost index (CI) (all tests divided by useful tests) were calculated.


RESULTS
Although arrhythmias were identified in 91% of the patients, management decisions were indicated in only 18% (cost per decision, $2974; CI = 5.4). Management decisions were most often derived from the data in patients being evaluated for arrhythmia therapy (37 of 37 patients; cost per decision, $550; CI = 1). Symptoms and arrhythmias were correlated in only 11 patients (2%). More often typical clinical symptoms were present (26 patients) in the absence of an arrhythmia. Of 101 AECGs following a cerebrovascular event, four had unsuspected atrial fibrillation (cost per decision, $13,888; CI = 25.0). Dizziness or lightheadedness associated with other cardiac symptoms was more likely to lead to a management decision than the same symptoms in isolation (29% vs 7%; P < .05). No patient had central nervous system symptoms correlated with an arrhythmia during the recording period or unsuspected ventricular tachycardia.


CONCLUSIONS
Ambulatory electrocardiography has a highly variable and indication-dependent effectiveness and cost. The results suggest a strategy for improving the use of AECG based on knowing what testing indications are more likely to lead to useful clinical information.
Kessler
D K
DK
Department of Medicine, University of Miami Fla School of Medicine.
Kessler
K M
KM
Myerburg
R J
RJ
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis*; D003362:Cost-Benefit Analysis; D015716:Electrocardiography, Ambulatory / Q000191:economics*; D005069:Evaluation Studies as Topic; D005260:Female; D005431:Florida; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies