This study evaluated the current clinical use and costs of ambulatory electrocardiographic (AECG) monitoring for arrhythmia detection based on a cost per management decision analysis.
Consecutive inpatient and outpatient 24-hour AECGs (n=650) performed during the calendar year 1991 were retrospectively reviewed for clinical indication, arrhythmia detection, diary information, and whether a management decision that might alter patient outcome was derived from the data.
The cost per management decision (based on a representative reimbursement of $550 per AECG) and the cost index (CI) (all tests divided by useful tests) were calculated.
Although arrhythmias were identified in 91% of the patients, management decisions were indicated in only 18% (cost per decision, $2974 ; CI=5.4).
Management decisions were most often derived from the data inpatientsbeing evaluated for arrhythmia therapy (37 of 37 patients ; cost perdecision, $550 ; CI=1).
Symptoms and arrhythmias were correlated in only 11 patients (2%). More often typical clinical symptoms were present (26 patients) in the absence of an arrhythmia.
Of 101 AECGs following a cerebrovascular event, four had unsuspected atrial fibrillation (cost per decision, $13 888 ; CI=25.0).
Dizziness or lightheadedness associated with other cardiac symptoms was more likely to lead to a management decision than the same symptoms in isolation (29% vs 7% ; P<. 05).
Mots-clés Pascal : Electrocardiographie, Ambulatoire, Analyse coût efficacité, Economie santé, Exploration, Homme, Electrodiagnostic
Mots-clés Pascal anglais : Electrocardiography, Ambulatory, Cost efficiency analysis, Health economy, Exploration, Human, Electrodiagnosis
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0264564
Code Inist : 002B24D01. Création : 01/03/1996.