Key result
Primary care loop recorder placement matches hospital placement for arrhythmia detection despite shorter wear times.
Why the study?
External loop recorders are recommended for syncope and palpitations investigation, but comparison of arrhythmia detection rates between primary care and hospital-based cardiac unit placement was lacking.
Does primary care placement of external loop recorders provide noninferior arrhythmia detection compared to hospital-based cardiac unit placement in patients with syncope and palpitations?
Observational (n=560)
Yes
Does primary care placement of external loop recorders provide noninferior arrhythmia detection compared to hospital-based cardiac unit placement in patients with syncope and palpitations?
Primary care placement of external loop recorders yields comparable arrhythmia detection rates to hospital-based placement, despite shorter wear times, improving local access for rural patients.
Answers are grounded in this paper and cite their sources.
PC-fitted ELRs yielded comparable arrhythmia detection; leaves open whether primary care placement can be safely scaled without randomized confirmation.
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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Callum et al. (2020) conducted an observational in Syncope and palpitations (n=560). Primary care placement of external loop recorders vs. Hospital-based cardiac unit placement was evaluated on Arrhythmia detection (p=0.28). Primary care placement of external loop recorders was noninferior to hospital-based placement for arrhythmia detection (16.2% vs 21.7%; P=0.28), despite shorter wear times.
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