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External Loop Recorders: Primary Care Placement Is Noninferior to Hospital-Based Cardiac Unit

Introduction: External loop recorders (ELRs) are recommended for the investigation of syncope and palpitations. This study aimed to compare rates of arrhythmia detection between primary care (PC) and hospital-based cardiac unit (HBCU) fitted ELRs. Methods: Data were captured from January to December...

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Autores principales: Callum, Kara J., Hall, Lynn, Jack, Sharon, Farman, Colin, Rushworth, Gordon F., Leslie, Stephen J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7391424/
https://www.ncbi.nlm.nih.gov/pubmed/32723141
http://dx.doi.org/10.1177/2150132720946147
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author Callum, Kara J.
Hall, Lynn
Jack, Sharon
Farman, Colin
Rushworth, Gordon F.
Leslie, Stephen J.
author_facet Callum, Kara J.
Hall, Lynn
Jack, Sharon
Farman, Colin
Rushworth, Gordon F.
Leslie, Stephen J.
author_sort Callum, Kara J.
collection PubMed
description Introduction: External loop recorders (ELRs) are recommended for the investigation of syncope and palpitations. This study aimed to compare rates of arrhythmia detection between primary care (PC) and hospital-based cardiac unit (HBCU) fitted ELRs. Methods: Data were captured from January to December 2015. Twenty-eight general practitioner practices and 1 hospital took part. Patients were divided into those with ELR fitted in PC or HBCU. All ELR data were analyzed by a cardiac physiologist. Results: A total of 560 ELR recordings were analyzed; 219 (PC) versus 341 (HBCU). There was no difference between the baseline characteristics (all Ps > .05). The predominant indication for ELR in each group were palpitations; between-group variation was observed for syncope (P = .0004). There were no significant between-group differences in the number of recordings per patient; however, PC group wore the ELR for less time (median 7 days vs median 14 days; P < .0001). There were no differences in arrhythmia detection between PC- and HBCU-fitted ELRs (16.2% [n = 39] vs 21.7% [n = 74], respectively; P = .28). PC placement of ELRs was highest in very remote rural communities (P = .005) and correlated with distance from HBCU (r = 0.39; P = .04). Conclusions: This study showed no difference in detection of arrhythmias between PC and HBCU fitted ELRs. This suggests adequate ELR recording can be completed by suitably trained staff in PC. Furthermore, ELRs were fitted for less time in PC without an adverse effect on diagnostic yield. ELR usage increased with increasing distance from the specialist center and rurality suggesting improved local access to arrhythmia detection services.
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spelling pubmed-73914242020-08-07 External Loop Recorders: Primary Care Placement Is Noninferior to Hospital-Based Cardiac Unit Callum, Kara J. Hall, Lynn Jack, Sharon Farman, Colin Rushworth, Gordon F. Leslie, Stephen J. J Prim Care Community Health Original Research Introduction: External loop recorders (ELRs) are recommended for the investigation of syncope and palpitations. This study aimed to compare rates of arrhythmia detection between primary care (PC) and hospital-based cardiac unit (HBCU) fitted ELRs. Methods: Data were captured from January to December 2015. Twenty-eight general practitioner practices and 1 hospital took part. Patients were divided into those with ELR fitted in PC or HBCU. All ELR data were analyzed by a cardiac physiologist. Results: A total of 560 ELR recordings were analyzed; 219 (PC) versus 341 (HBCU). There was no difference between the baseline characteristics (all Ps > .05). The predominant indication for ELR in each group were palpitations; between-group variation was observed for syncope (P = .0004). There were no significant between-group differences in the number of recordings per patient; however, PC group wore the ELR for less time (median 7 days vs median 14 days; P < .0001). There were no differences in arrhythmia detection between PC- and HBCU-fitted ELRs (16.2% [n = 39] vs 21.7% [n = 74], respectively; P = .28). PC placement of ELRs was highest in very remote rural communities (P = .005) and correlated with distance from HBCU (r = 0.39; P = .04). Conclusions: This study showed no difference in detection of arrhythmias between PC and HBCU fitted ELRs. This suggests adequate ELR recording can be completed by suitably trained staff in PC. Furthermore, ELRs were fitted for less time in PC without an adverse effect on diagnostic yield. ELR usage increased with increasing distance from the specialist center and rurality suggesting improved local access to arrhythmia detection services. SAGE Publications 2020-07-29 /pmc/articles/PMC7391424/ /pubmed/32723141 http://dx.doi.org/10.1177/2150132720946147 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Research
Callum, Kara J.
Hall, Lynn
Jack, Sharon
Farman, Colin
Rushworth, Gordon F.
Leslie, Stephen J.
External Loop Recorders: Primary Care Placement Is Noninferior to Hospital-Based Cardiac Unit
title External Loop Recorders: Primary Care Placement Is Noninferior to Hospital-Based Cardiac Unit
title_full External Loop Recorders: Primary Care Placement Is Noninferior to Hospital-Based Cardiac Unit
title_fullStr External Loop Recorders: Primary Care Placement Is Noninferior to Hospital-Based Cardiac Unit
title_full_unstemmed External Loop Recorders: Primary Care Placement Is Noninferior to Hospital-Based Cardiac Unit
title_short External Loop Recorders: Primary Care Placement Is Noninferior to Hospital-Based Cardiac Unit
title_sort external loop recorders: primary care placement is noninferior to hospital-based cardiac unit
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7391424/
https://www.ncbi.nlm.nih.gov/pubmed/32723141
http://dx.doi.org/10.1177/2150132720946147
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