Peter J. Zimetbaum, MD; Kelly Y. Kim, MD; Mark E. Josephson, MD; Ary L. Goldberger, MD; David J. Cohen, MD, MSc
Zimetbaum PJ, Kim KY, Josephson ME, Goldberger AL, Cohen DJ. Diagnostic Yield and Optimal Duration of Continuous-Loop Event Monitoring for the Diagnosis of Palpitations: A Cost-Effectiveness Analysis. Ann Intern Med. 1998;128:890-895. doi: 10.7326/0003-4819-128-11-199806010-00002
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Published: Ann Intern Med. 1998;128(11):890-895.
Continuous-loop event recorders are widely used for the evaluation of palpitations, but the optimal duration of monitoring is unknown.
To determine the yield, timing, and incremental cost-effectiveness of each week of event monitoring for palpitations.
Prospective cohort study.
105 consecutive outpatients referred for the placement of a continuous-loop event recorder for the evaluation of palpitations.
Diagnostic yield, incremental cost, and cost-effectiveness for each week of monitoring.
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.
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.
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