Diagnostic yield and optimal duration of continuous-loop event monitoring for the diagnosis of palpitations. A cost-effectiveness analysis.
BACKGROUND
Continuous-loop event recorders are widely used for the evaluation of palpitations, but the optimal duration of monitoring is unknown.


OBJECTIVE
To determine the yield, timing, and incremental cost-effectiveness of each week of event monitoring for palpitations.


METHODS
Prospective cohort study.


METHODS
105 consecutive outpatients referred for the placement of a continuous-loop event recorder for the evaluation of palpitations.


METHODS
Diagnostic yield, incremental cost, and cost-effectiveness for each week of monitoring.


RESULTS
The diagnostic yield of continuous-loop event recorders was 1.04 diagnoses per patient in week 1, 0.15 diagnoses per patient in week 2, and 0.01 diagnoses per patient in week 3 and beyond. Over time, the cost-effectiveness ratio increased from $98 per new diagnosis in week 1 to $576 per new diagnosis in week 2 and $5832 per new diagnosis in week 3.


CONCLUSIONS
In patients referred for evaluation of palpitations, the diagnostic yield of continuous-loop event recording decreases rapidly after 2 weeks of monitoring. A 2-week monitoring period is reasonably cost-effective for most patients and should be the standard period for continuous-loop event recording for the evaluation of palpitations.
Zimetbaum
P J
PJ
Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02115, USA.
Kim
K Y
KY
Josephson
M E
ME
Goldberger
A L
AL
Cohen
D J
DJ
D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D015716:Electrocardiography, Ambulatory / Q000191:economics* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors