External Loop Recorders: Primary Care Placement Is Noninferior to Hospital-Based Cardiac Unit

Area of Science:

• Cardiology
• Primary Care Medicine
• Medical Device Technology

Background:

• External loop recorders (ELRs) are crucial for diagnosing syncope and palpitations.
• Comparing arrhythmia detection rates between primary care (PC) and hospital-based cardiac unit (HBCU) settings is important for optimizing patient care.
• Understanding the impact of ELR fitting location on diagnostic yield and patient access is essential.

Purpose of the Study:

• To compare the rates of arrhythmia detection between ELRs fitted in primary care and hospital-based cardiac units.
• To evaluate if ELR wear time and diagnostic yield differ based on the fitting location.
• To explore the relationship between ELR placement, geographical factors, and proximity to specialist centers.

Main Methods:

• A comparative study analyzing 560 external loop recorder (ELR) recordings from January to December 2015.
• Patients were stratified into two groups: those who had ELRs fitted in primary care (PC) versus a hospital-based cardiac unit (HBCU).
• Data on baseline characteristics, indications for ELR use, wear time, and arrhythmia detection were collected and analyzed by cardiac physiologists.

Main Results:

• No significant difference in arrhythmia detection rates was found between PC-fitted (16.2%) and HBCU-fitted (21.7%) ELRs (P = .28).
• Patients in the PC group wore ELRs for a shorter median duration (7 days vs. 14 days; P < .0001) without compromising diagnostic yield.
• ELR placement in PC was more frequent in remote rural areas and correlated with increased distance from the HBCU (r = 0.39; P = .04).

Conclusions:

• External loop recorders fitted in primary care demonstrate comparable arrhythmia detection efficacy to those fitted in hospital-based cardiac units.
• Suitability trained primary care staff can effectively manage ELR fitting, reducing the need for hospital visits.
• Increased use of ELRs in remote areas suggests improved local access to arrhythmia detection services, particularly benefiting patients distant from specialist centers.