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Ambulatory electrocardiography. A cost per management decision analysis
D K Kessler1, K M Kessler, R J Myerburg
1Department of Medicine, University of Miami Fla School of Medicine.
Archives of Internal Medicine
|January 23, 1995
Summary
Ambulatory electrocardiographic (AECG) monitoring for arrhythmia detection shows variable effectiveness. Focusing on specific indications improves the clinical utility and cost-effectiveness of AECG testing.
Area of Science:
- Cardiology
- Medical Informatics
Background:
- Ambulatory electrocardiographic (AECG) monitoring is widely used for arrhythmia detection.
- The clinical utility and cost-effectiveness of AECG require evaluation.
Purpose of the Study:
- To evaluate the clinical use and costs of AECG monitoring for arrhythmia detection.
- To analyze AECG effectiveness based on a cost per management decision.
Main Methods:
- Retrospective review of 650 inpatient and outpatient 24-hour AECGs from 1991.
- Analysis of clinical indication, arrhythmia detection, and management decisions derived from AECG data.
- Calculation of cost per management decision and cost index (CI).
Main Results:
- Arrhythmias detected in 91% of patients, but management decisions in only 18% (cost per decision: $2974; CI: 5.4).
- Highest utility in patients evaluated for arrhythmia therapy (cost per decision: $550; CI: 1).
- Low correlation between symptoms and arrhythmias (2%); symptoms often present without arrhythmia (26 patients).
- High cost per decision for unsuspected atrial fibrillation post-cerebrovascular event ($13,888; CI: 25.0).
- Dizziness with cardiac symptoms more likely to yield management decisions than isolated symptoms (29% vs 7%).
Conclusions:
- AECG effectiveness and cost are highly variable and indication-dependent.
- A strategy for improving AECG use is suggested by identifying indications yielding useful clinical information.
- Optimizing AECG testing indications can enhance clinical decision-making and resource allocation.