Ann Intern Med. 1998 Jun 1;128(11):890-5.  

Diagnostic yield and optimal duration of continuous-loop event monitoring for
the diagnosis of palpitations. A cost-effectiveness analysis.

Zimetbaum PJ, Kim KY, Josephson ME, Goldberger AL, Cohen DJ.

Beth Israel Deaconess Medical Center and Harvard Medical School, Boston,
Massachusetts 02115, USA.

BACKGROUND: Continuous-loop event recorders are widely used for the evaluation
of palpitations, but the optimal duration of monitoring is unknown. OBJECTIVE:
To determine the yield, timing, and incremental cost-effectiveness of each week
of event monitoring for palpitations. DESIGN: Prospective cohort study.
PATIENTS: 105 consecutive outpatients referred for the placement of a
continuous-loop event recorder for the evaluation of palpitations. MEASUREMENTS:
Diagnostic yield, incremental cost, and cost-effectiveness for each week of
monitoring. RESULTS: The diagnostic yield of continuous-loop event recorders was
1.04 diagnoses per patient in week 1, 0.15 diagnoses per patient in week 2, and
0.01 diagnoses per patient in week 3 and beyond. Over time, the
cost-effectiveness ratio increased from $98 per new diagnosis in week 1 to $576
per new diagnosis in week 2 and $5832 per new diagnosis in week 3. CONCLUSIONS:
In patients referred for evaluation of palpitations, the diagnostic yield of
continuous-loop event recording decreases rapidly after 2 weeks of monitoring. A
2-week monitoring period is reasonably cost-effective for most patients and
should be the standard period for continuous-loop event recording for the
evaluation of palpitations.

PMID: 9634426 [PubMed - indexed for MEDLINE]