Clinical logistics in 24-hour ambulatory electrocardiographic monitoring
1Northeast Cardiovascular Clinic and Research Center, Wilkes-Barre, PA, USA.
Insights
Ambulatory ECG recordings reveal frequent abnormalities, yet few correlate with patient complaints or clinical significance. Most tests were requested by general practitioners, highlighting potential overutilization of electrocardiogram diagnostics.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Ambulatory electrocardiogram (ECG) monitoring is a common diagnostic tool.
- Understanding the prevalence and clinical significance of ECG abnormalities is crucial for appropriate test utilization.
Purpose of the Study:
- To analyze the findings of 493 ambulatory ECG recordings.
- To assess the correlation between ECG abnormalities, patient symptoms, and clinical necessity.
- To identify patterns in test requests by healthcare providers.
Main Methods:
- Retrospective analysis of 493 ambulatory ECG recordings.
- Review of patient demographics, ECG findings, and reported subjective complaints.
- Evaluation of cardiologist's assessment of test necessity and clinical significance.
Main Results:
- 71.4% of ECGs showed abnormalities, with 1.4% urgent and 14.6% significant.
- Only 1.2% of abnormalities correlated with patient complaints; 55.4% of abnormal ECGs were clinically insignificant.
- 23.9% of tests were deemed necessary; general practitioners requested 59.8% of the tests.
Conclusions:
- Ambulatory ECGs frequently detect abnormalities, but a large proportion lack clinical significance or correlation with symptoms.
- The study suggests potential overutilization of ambulatory ECGs, particularly when requested by general practitioners.
- Further research is needed to refine indications for ambulatory ECG testing to improve diagnostic yield and resource allocation.
Abstract:
In total, 493 ambulatory ECG recordings were studied. Women were preponderant (62.3% vs 37.7%). The average age of women and men patients was 66.9 and 64.7 years, respectively. Of the ECGs studied, 71.4% showed abnormalities and 28.6% appeared completely normal. Urgent abnormalities were noted in 1.4% of the recordings and significant abnormalities were present in 14.6%. Subjective complaints were noted in their logbooks by 18.8% of patients, but correlation of complaints with the electrocardiographic abnormalities was noted in only 1.2% of cases. The attending cardiologist concluded that 23.9% of the tests supported reasons of valid necessity for performance. Two hundred seventy-three recordings were classified as electrocardiographically abnormal (55.4%) but were clinically insignificant. General practitioners requested 59.8% of the tests versus 40.2% by specialists. Preponderant abnormalities included premature atrial and ventricular contractions, supraventricular tachycardia, and atrial fibrillation. Less frequent abnormalities included ventricular tachycardia (4.6%), atrial flutter, atrioventricular block, artificial pacemaker rhythm, nodal rhythm, and intermittent bundle branch block.
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