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Family Practice Advance Access first published online on June 17, 2005
This version published online on August 22, 2005
Family Practice, doi:10.1093/fampra/cmi048
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© The Author (2005). Published by Oxford University Press. All rights reserved.
Received November 2, 2004
Accepted April 21, 2005

Article

Diagnostic yield of patient-activated loop recorders for detecting heart rhythm abnormalities in general practice: a randomised clinical trial

Emmy Hoefman 1, Henk C. P. M. van Weert 1*, Johannes B. Reitsma 2, Rudolph W. Koster 3, and Patrick J. E. Bindels 1

1 Division of Clinical Methods and Public Health, Department of General Practice, Academic Medical Center Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
2 Department of Clinical Epidemiology and Biostatistics, Academic Medical Center Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
3 Division for Internal Medicine, Department of Cardiology, Academic Medical Center Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands

* To whom correspondence should be addressed.
Henk C. P. M. van Weert, E-mail: h.c.vanweert{at}amc.uva.nl


  Abstract

Background. Because palpitations and light headedness often occur paroxysmally these complaints are difficult to diagnose. The hazards for a GP are too many diagnostic interventions for worried well and too few diagnostics for potentially life threatening complaints.

Objectives. Patient-activated memo event recorders have proved to be successful in diagnosing episodes of cardiac arrythmias in secondary care. We tested the diagnostic yield of these devices in general practice.

Methods. A randomized clinical trial in general practice. Consecutive patients with complaints of palpitations or light-headedness were randomized to either usual care or usual care plus event-recorder. The main outcome was the difference in explained episodes. Secondary outcomes were the differences in the number and character of cardiac diagnoses and the feasibility of the event-recorder.

Results. There were fewer patients without a diagnosis in the intervention group (17% vs 38%; RR = 0.5, 95% CI 0.3 to 0.7) and more patients with a cardiac diagnosis (67% vs. 27%: RR 2.5, CI 1.8 to 3,5). More relevant cardiac arrhythmias were detected (22% vs 7%) with event recording than with usual care (RR 3.2, 95% CI 1.5 to 6.8).

Conclusion. Patient-activated loop recorders are feasible and effective diagnostic tools in patients with palpitations or light-headedness in primary care. More research into patient characteristics and selection criteria is needed to fine-tune the use of these devices in primary care.

Keywords: Arrythmia; diagnosis; light-headedness; palpitations; randomized controlled trials.
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