De opbrengst van eventrecorders bij de diagnostiek van hartritmestoornissen in de huisartsenpraktijk: een gerandomiseerd effectonderzoek

Abstract

Hoefman E, Van Weert HCPM, Reitsma JB, Koster RW, Bindels PJE. Diagnostic yield of patient-activated loop recorders for detecting heart rhythm abnormalities in general practice: a randomised clinical trial. Huisarts Wet 2005;48(12):597-602. Background Palpitations and light-headedness often occur paroxysmally and are therefore difficult to diagnose. The problems for the GP lie in: (a) too many diagnostic interventions in cases of worried but well patients, and (b) shortcomings in diagnosis for potentially life-threatening complaints. Objectives Patient-activated continuous loop event recorders (CERs) have proved successful in the diagnosis of cardiac arrhythmia episodes in secondary care. We tested the diagnostic yield of these devices in general practice. Method A randomised clinical trial in general practice. Consecutive patients with complaints of palpitations or light-headedness were randomised either to usual care or to usual care plus CER. The main outcome was the difference in the number of explained episodes. Secondary outcomes were the differences in the number and character of cardiac diagnoses and the user-friendliness of the CER. Results There were fewer patients without a diagnosis in the intervention group than in the control group (17% v. 38%; RR = 0.5; 95%-CI 0.3 to 0.7) and more patients with a cardiac diagnosis (67% v. 27%: RR = 2.5, 95%-CI 1.8 to 3.5). More relevant cardiac arrhythmias were detected (22% v. 7%) with event recording than with usual care (RR = 3.2; 95%-CI = 1.5 to 6.8). Conclusion Patient-activated CERs are useful and effective diagnostic tools in primary care patients with palpitations or light-headedness. More research is required into patient characteristics and selection criteria in order to fine-tune the use of these devices in primary care.