title: Diagnostic yield of patient-activated loop recorders for detecting heart rhythm abnormalities in general practice: a randomised clinical trial.
abstract: BACKGROUND
  Because palpitations and light headedness often occur paroxysmally these complaints are difficult to diagnose. The hazards for a GP are too many diagnostic interventions for worried well and too few diagnostics for potentially life threatening complaints.
  
  
  OBJECTIVE
  Patient-activated memo event recorders have proved to be successful in diagnosing episodes of cardiac arrythmias in secondary care. We tested the diagnostic yield of these devices in general practice.
  
  
  METHODS
  A randomized clinical trial in general practice. Consecutive patients with complaints of palpitations or light-headedness were randomized to either usual care or usual care plus event-recorder. The main outcome was the difference in explained episodes. Secondary outcomes were the differences in the number and character of cardiac diagnoses and the feasibility of the event-recorder.
  
  
  RESULTS
  There were fewer patients without a diagnosis in the intervention group (17% vs 38%; RR = 0.5, 95% CI 0.3 to 0.7) and more patients with a cardiac diagnosis (67% vs. 27%: RR 2.5, CI 1.8 to 3,5). More relevant cardiac arrhythmias were detected (22% vs 7%) with event recording than with usual care (RR 3.2, 95% CI 1.5 to 6.8).
  
  
  CONCLUSIONS
  Patient-activated loop recorders are feasible and effective diagnostic tools in patients with palpitations or light-headedness in primary care. More research into patient characteristics and selection criteria is needed to fine-tune the use of these devices in primary care.
authors.affiliation: Division for Clinical Methods and Public Health, Department of General Practice, Academic Medical Center Amsterdam, The Netherlands.
authors.forename: Emmy
authors.initials: E
authors.lastname: Hoefman
authors.forename: Henk C P M
authors.initials: HC
authors.lastname: van Weert
authors.forename: Johannes B
authors.initials: JB
authors.lastname: Reitsma
authors.forename: Rudolph W
authors.initials: RW
authors.lastname: Koster
authors.forename: Patrick J E
authors.initials: PJ
authors.lastname: Bindels
mesh_terms: D001145:Arrhythmias, Cardiac / Q000175:diagnosis*; D001281:Atrial Fibrillation / Q000175:diagnosis; D004244:Dizziness / Q000209:etiology; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation*; D005194:Family Practice; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013617:Tachycardia, Supraventricular / Q000175:diagnosis