DIAGNOSTIC YIELD AND OPTIMAL DURATION OF CONTINUOUS-LOOP EVENT MONITORING FOR THE DIAGNOSIS OF PALPITATIONS - A COST-EFFECTIVENESS ANALYSIS

Background: Continuous-loop event recorders are widely used for the ev aluation of palpitations, but the optimal duration of monitoring is un known. Objective: To determine the yield, timing, and incremental cost -effectiveness of each week of event monitoring for palpitations. Desi gn: Prospective cohort study. Patients: 105 consecutive outpatients re ferred for the placement of a continuous-loop event recorder for the e valuation of palpitations. Measurements: Diagnostic yield, incremental cost, and cost-effectiveness for each week of monitoring. Results: Th e diagnostic yield of continuous-loop event recorders was 1.04 diagnos es 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 eff ectiveness ratio increased from $98 per new diagnosis in week 1 to $57 6 per new diagnosis in week 2 and $5832 per new diagnosis in week 3. C onclusions: In patients referred for evaluation of palpitations, the d iagnostic yield of continuous-loop event recording decreases rapidly a fter 2 weeks of monitoring. A 2-week monitoring period is reasonably c ost-effective for most patients and should be the standard period for continuous-loop event recording for the evaluation of palpitations.