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Diagnostic Yield and Optimal Duration of Continuous-Loop Event Monitoring for the Diagnosis of Palpitations: A Cost-Effectiveness Analysis

Peter J. Zimetbaum, MD; Kelly Y. Kim, MD; Mark E. Josephson, MD; Ary L. Goldberger, MD; and David J. Cohen, MD, MSc
[+] Article and Author Information

From Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts. For current author addresses, see end of text. Grant Support: In part by grants from the G. Harold and Leila Y. Mathers Charitable Foundation, Mount Kisko, New York, and the National Aeronautics and Space Administration, Washington, D.C. Dr. Cohen was supported in part by a Clinician-Scientist award from the American Heart Association. Requests for Reprints: David J. Cohen, MD, MSc, Cardiovascular Division (GZ-435), Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115. Current Author Addresses: Drs. Zimetbaum, Josephson, Goldberger, and Cohen: Division of Cardiology (GZ-435), Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1998;128(11):890-895. doi:10.7326/0003-4819-128-11-199806010-00002
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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.

Design: Prospective cohort study.

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

Measurements: 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.

Figures

Grahic Jump Location
Figure 1.
Cumulative diagnostic yield of the continuous-loop event recorder for all diagnoses associated with palpitations as a function of duration of monitoring. Top.Bottom.

Diagnostic yield for first diagnoses. Diagnostic yield for second diagnoses. The numbers beneath the x-axis are the numbers of patients at risk (monitored patients without a diagnosis) at each time point.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Cumulative diagnostic yield of the continuous-loop event recorder for serious diagnoses associated with palpitations as a function of duration of monitoring. Top.Bottom.

Diagnostic yield for first serious diagnoses. Diagnostic yield for second serious diagnoses. The numbers beneath the x-axis are the numbers of patients at risk (monitored patients without a diagnosis) at each time point.

Grahic Jump Location

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