Benefits of monitoring patients with mobile cardiac telemetry (MCT) compared with the Event or Holter monitors

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Abstract

Introduction

This research is meant to establish if a patient monitored with mobile cardiac telemetry (MCT) sees different outcomes regarding diagnostic yield of arrhythmia, therapeutic management through the use of antiarrhythmic drugs, and cardiovascular costs incurred in the hospital setting when compared with more traditional monitoring devices, such as the Holter or the Event monitor.

Materials and methods

We conducted a retrospective analysis spanning 57 months of claims data from January 2007 to September 2011 pertaining to 200,000+ patients, of whom 14,000 used MCT only, 54,000 an Event monitor only, and 163,000 a Holter monitor only. Those claims came from the Truven database, an employer database that counts 2.8 million cardiovascular patients from an insured population of about 10 million members. We employed a pair-wise pre/post test-control methodology, and ensured that control patients were similar to test patients along the following dimensions: age, geographic location, type of cardiovascular diagnosis both in the inpatient and outpatient settings, and the cardiovascular drug class the patient uses.

Results

First, the diagnostic yield of patients monitored with MCT is 61%, that is significantly higher than that of patients that use the Event monitor (23%) or the Holter monitor (24%). Second, patients naive to antiarrhythmic drugs initiate drug therapy after monitoring at the following rates: 61% for patients that use MCT compared with 39% for patients that use the Event and 43% for patients that use the Holter. Third, there are very significant inpatient cardiovascular savings (in the tens of thousands of dollars) for patients that undergo ablation, coronary artery bypass graft (CABG) and valve septa. Savings are more modest but nonetheless significant when it comes to the heart/pericardium procedure.

Conclusion

Given the superior outcome of MCT regarding both patient care and hospital savings, hospitals only stand to gain by enforcing protocols that favor the MCT system over the Event or the Holter monitor.

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Most cited references 10

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Comparison of autotriggered memory loop recorders versus standard loop recorders versus 24-hour Holter monitors for arrhythmia detection.

V M Murry, Robert Schwarzberg, James A. Reiffel (2005)

To determine the relative yields of Holter monitoring (HM), memory loop recording (MLR), and autotriggered MLR (AT-MLR), we retrospectively interrogated the very large database of Lifewatch (a Card Guard company and a commercial monitoring company) and compared the results obtained by each method. From among a total database of approximately 100,000 patients, records of 1,800 patients from 2003 were randomly selected and examined, 600 from each of the 3 different monitoring groups. Each session of MLR and AT-MLR was applied for 30 days. For each patient we determined the symptomatic and asymptomatic events that were documented, including those that met predefined immediate physician notification criteria and the time to first notification event. The groups were identical in age and symptoms that necessitated monitoring; fewer women had HM. Information on the type of underlying structural heart disease, if present, and medications taken, if any, was not available to us in this database. The AT-MLR approach provided a higher yield of diagnostic events (e.g., 37, 108, and 216 total patients who had events; 37, 212, and 524 total events; and 6.2%, 17%, and 36% with a diagnostic yield for HM, MLR, and AT-MLR, respectively) and an earlier diagnosis. AT-MLR was also the most effective technique for capturing asymptomatic significant events, such as atrial fibrillation (52 with AT-MLR vs 1 for standard MLR). AT-MLR detected more than half as many asymptomatic episodes of atrial fibrillation (n = 52) as the total number of symptomatic episodes detected by patient activated recording (n = 94), thus confirming the common presence of asymptomatic atrial fibrillation. AT-MLR provided electrocardiographic documentation of tachyarrhythmias (n = 392) more often than MLR (n = 47) or HM (n = 44) and bradyarrhythmias/pauses/atrioventricular block (n = 38) more often than MLR (n = 13) or HM (n = 18). Thus, MLR and AT-MLR provide a diagnosis more often than does HM, thus confirming the benefit of prolonged monitoring. Further, the higher yield of AT-MLR versus MLR demonstrates the significantly enhanced benefit of autotriggered programmable recording.

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The inpatient experience and predictors of length of stay for patients hospitalized with systolic heart failure: comparison by commercial, Medicaid, and Medicare payer type.

Melanie Ferguson, William E. Smoyer, Irene Agodoa … (2012)

Descriptions of the inpatient experience for patients hospitalized with systolic heart failure (HF) are limited and lack a cross-sectional representation of the US population. While length of stay (LOS) is a primary determinant of resource use and post-discharge events, few models exist for estimating LOS. MarketScan(®) administrative claims data from 1/1/2005-6/30/2008 were used to select hospitalized patients aged ≥18 years with discharge diagnoses for both HF (primary diagnosis) and systolic HF (any diagnostic position) without prior HF hospitalization or undergoing transplantation. Among 17,597 patients with systolic HF; 4109 had commercial; 2118 had Medicaid; and 11,370 had Medicare payer type. Medicaid patients had longer mean LOS (7.1 days) than commercial (6.3 days) or Medicare (6.7 days). In-hospital mortality was highest for patients with Medicaid (2.4%), followed by Medicare (1.3%) and commercial (0.6%). Commercial patients were more likely to receive inpatient procedures. Renal failure, pressure ulcer, malnutrition, a non-circulatory index admission DRG, receipt of a coronary artery bypass procedure or cardiac catheterization, or need for mechanical ventilation during the index admission were associated with increased LOS; receipt of a pacemaker device at index was associated with shorter LOS. Selection of patients with systolic HF is limited by completeness and accuracy of medical coding, and results may not be generalizable to patients with diastolic HF or to international populations. Inpatient care, LOS, and in-hospital survival differ by payer among patients hospitalized with systolic HF, although co-morbidity and inpatient procedures consistently influence LOS across payer types. These findings may refine risk stratification, allowing for targeted intensive inpatient management and/or aggressive transitional care to improve outcomes and increase the efficiency of care.

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A novel pacing maneuver to localize focal atrial tachycardia.

Rajesh Subbiah, J. Klein, Peter Leong-Sit … (2006)

Although focal atrial tachycardias cannot be entrained, we hypothesized that atrial overdrive pacing (AOP) can be an effective adjunct to localize the focus of these tachycardias at the site where the post-pacing interval (PPI) is closest to the tachycardia cycle length (TCL). Overdrive pacing was performed in nine patients during atrial tachycardia, and in a comparison group of 15 patients during sinus rhythm. Pacing at a rate slightly faster than atrial tachycardia in group 1 and sinus rhythm in group 2 was performed from five standardized sites in the right atrium and coronary sinus. The difference between the PPI and tachycardia or sinus cycle length (SCL) was recorded at each site. The tachycardia focus was then located and ablated in group 1, and the atrial site with earliest activation was mapped in group 2. In both groups the PPI-TCL at the five pacing sites reflected the distance from the AT focus or sinus node. In group 1, PPI-TCL at the successful ablation site was 11 +/- 8 msec. In group 2, PPI-SCL at the site of earliest atrial activation was 131 +/- 37 msec (P < 0.001 for comparison). In groups 1 and 2, calculated values at the five pacing sites were proportional to the distance from the AT focus or sinus node, respectively. The PPI-TCL after-AOP of focal atrial tachycardia has a direct relationship to proximity of the pacing site to the focus, and may be clinically useful in finding a successful ablation site.

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Author and article information

Journal

Journal ID (nlm-ta): Med Devices (Auckl)

Journal ID (iso-abbrev): Med Devices (Auckl)

Journal ID (publisher-id): Medical Devices: Evidence and Research

Title: Medical Devices (Auckland, N.Z.)

Publisher: Dove Medical Press

ISSN (Electronic): 1179-1470

Publication date Collection: 2014

Publication date (Electronic): 09 December 2013

Volume: 7

Pages: 1-5

Affiliations

Bayser Consulting, Skokie, IL, USA

Author notes

Correspondence: Jean-Patrick Tsang, Bayser Consulting, 4709 Golf Road – Suite 803, Skokie, IL 60076, USA, Tel +1 847 920 1000, Fax +1 847 679 8285, Email bayser@ 123456bayser.com

Article

Publisher ID: mder-7-001

DOI: 10.2147/MDER.S54038

PMC ID: 3862588

SO-VID: 69fea45c-5f96-4cd2-b94a-009b09223519

License:

The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

Benefits of monitoring patients with mobile cardiac telemetry (MCT) compared with the Event or Holter monitors

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Abstract

Introduction

Materials and methods

Results

Conclusion

Related collections

BIO Integration

Most cited references 10

Comparison of autotriggered memory loop recorders versus standard loop recorders versus 24-hour Holter monitors for arrhythmia detection.

The inpatient experience and predictors of length of stay for patients hospitalized with systolic heart failure: comparison by commercial, Medicaid, and Medicare payer type.

A novel pacing maneuver to localize focal atrial tachycardia.

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