AMBULATORY ELECTROCARDIOGRAPHY - A COST PER MANAGEMENT DECISION-ANALYSIS

Background: This study evaluated the current clinical use and costs of ambulatory electrocardiographic (AECG) monitoring for arrhythmia dete ction based on a cost per management decision analysis. Methods: Conse cutive inpatient and outpatient 24-hour AECGs (n=650) performed during the calendar year 1991 were retrospectively reviewed for clinical ind ication, arrhythmia detection, diary information, and whether a manage ment decision that might alter patient outcome was derived from the da ta. The cost per management decision (based on a representative reimbu rsement of $550 per AECG) and the cost index (CI) (all tests divided b y useful tests) were calculated. Results: Although arrhythmias were id entified in 91% of the patients, management decisions were indicated i n only 18% (cost per decision, $2974; CI=5.4). Management decisions we re most often derived from the data in patients being evaluated for ar rhythmia therapy (37 of 37 patients; cast per decision, $550; CI=1). S ymptoms and arrhythmias were correlated in only 11 patients (2%). More often typical clinical symptoms were present (26 patients) in the abs ence 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 sam e symptoms in isolation (29% vs 7%; P<.05). No patient had central ner vous system symptoms correlated with an arrhythmia during the recordin g period or unsuspected ventricular tachycardia. Conclusion: Ambulator y electrocardiography has a highly variable and indication-dependent e ffectiveness and cost. The results suggest a strategy for improving th e use of AECG based on knowing what testing indications are more likel y to lead to useful clinical information.