title: Diagnostic yield and optimal duration of continuous-loop event monitoring for the diagnosis of palpitations. A cost-effectiveness analysis.
abstract: 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.
authors.affiliation: Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Zimetbaum
authors.forename: K Y
authors.initials: KY
authors.lastname: Kim
authors.forename: M E
authors.initials: ME
authors.lastname: Josephson
authors.forename: A L
authors.initials: AL
authors.lastname: Goldberger
authors.forename: D J
authors.initials: DJ
authors.lastname: Cohen
mesh_terms: 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