Ambulatory electrocardiography. A cost per management decision analysis.
Arch Intern Med
; 155(2): 165-9, 1995 Jan 23.
Article
em En
| MEDLINE
| ID: mdl-7811125
ABSTRACT
BACKGROUND:
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.METHODS:
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.RESULTS:
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 in patients being evaluated for arrhythmia therapy (37 of 37 patients; cost per decision, $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). No patient had central nervous system symptoms correlated with an arrhythmia during the recording period or unsuspected ventricular tachycardia.CONCLUSION:
Ambulatory electrocardiography has a highly variable and indication-dependent effectiveness and cost. The results suggest a strategy for improving the use of AECG based on knowing what testing indications are more likely to lead to useful clinical information.
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Base de dados:
MEDLINE
Assunto principal:
Arritmias Cardíacas
/
Eletrocardiografia Ambulatorial
/
Custos Hospitalares
Tipo de estudo:
Diagnostic_studies
/
Evaluation_studies
/
Health_economic_evaluation
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
1995
Tipo de documento:
Article