Appropriateness of ECG Holter requests in an outpatient service: a prospective study
Stefano Piccirilli1, Mark M Gallagher, Marina Vellini
1Dipartimento di Cardiologia, Policlinico Universitario Tor Vergata, Viale Oxford 81, Rome 00133, Italy.
Insights
Ambulatory ECG Holter monitoring is often appropriate for diagnosing cardiac arrhythmias. While cardiologists prescribe fewer tests, their Holter recordings show higher appropriateness rates.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Medical Device Technology
Background:
- Ambulatory electrocardiographic (ECG) monitoring, specifically Holter recordings, is crucial for diagnosing cardiac arrhythmias.
- The study aimed to assess the appropriateness of Holter recording prescriptions at a specific center.
Purpose of the Study:
- To evaluate the appropriateness of prescribing Holter recordings for ambulatory ECG monitoring.
- To identify factors influencing the appropriateness of Holter test indications.
Main Methods:
- A prospective analysis of 2489 consecutive patients undergoing Holter monitoring.
- Data collection included the indication for the test, patient clinical characteristics, and the prescribing physician's specialty.
- Appropriateness was categorized into class I (clearly appropriate), class II (probably/possibly appropriate), and class III (inappropriate).
Main Results:
- 52% of Holter recordings were class I (appropriate), 13% class II, and 35% class III (inappropriate).
- Cardiologists requested 31% of tests, with 56.2% being class I, compared to 50% class I for non-cardiologists.
- Inappropriate prescriptions (class III) were more frequently associated with supraventricular tachycardia (57.6%) than appropriate ones (33.4%).
Conclusions:
- The majority of prescribed Holter recordings are appropriate for diagnosing cardiac arrhythmias.
- While cardiologists represent a smaller proportion of prescribers, their Holter tests demonstrate a higher rate of appropriate indication.
Background:
Electrocardiographic ambulatory ECG monitoring plays a central role in the diagnostic evaluation of patients with cardiac arrhythmias. We sought to evaluate the appropriateness of the prescription of ECG Holter recordings performed at our centre.
Methods:
We interviewed 2489 consecutive patients (49% male, aged 61 +/- 32 years) undergoing ECG Holter. We recorded the indication for the examination, the clinical characteristics of the patient and the speciality of the prescribing physician. The appropriateness of the test was evaluated.
Results:
We evaluated 2489 consecutive Holter recordings, of which 1298 (52%) were found to have been clearly appropriate (class I), 311 (13%) as probably or possibly appropriate (class II), and 880 (35%) as inappropriate (class III). The test was requested by a cardiologist in 776 cases (31%), of which 56.2% had a class I indication, 13.4% class II, and 30.4% class III. Tests requested by a non-cardiologist were clearly appropriate (class I) in 50% of cases, whereas 12% had a class II indication, and 38% were in class III. Supraventricular tachycardia was present in 33.4% of recordings with a class I indication, 9% of those in class II, and 57.6% of those in class III. Non-sustained ventricular tachycardia was present in 6% of those with class I indications, 2.6% of those in class II, and 7.4% of those in class III.
Conclusion:
Our data showed that the majority of Holter recordings prescribed in our region are appropriate. Tests prescribed by cardiologists constitute only 31% of the total volume, but are more often appropriately prescribed.
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