The DOI matches its Crossref record.
Cardiac Event Recorders Yield More Diagnoses and Are More Cost-effective than 48-Hour Holter Monitoring in Patients with Palpitations: A Controlled Clinical Trial
Abstract
OBJECTIVE: To compare the diagnostic yield and cost-effectiveness of transtelephonic event monitors with those of Holter monitoring in patients with intermittent palpitations. DESIGN: Randomized crossover trial. SETTING: Diagnostic service of a teaching hospital and surrounding primary care practices. PATIENTS: 43 patients with previously uninvestigated palpitations who were referred for Holter monitoring. MEASUREMENTS: Patients were randomly allocated to receive an event monitor or 48-hour Holter monitor and then to receive the other device. Event monitors were used for 3 months or until two recordings were obtained while symptoms occurred. The main end point was an electrogram recorded during symptoms. The incremental cost-effectiveness of obtaining a diagnostic rhythm strip from event monitors was compared with that of Holter monitoring. RESULTS: The mean (+/- SD) patient age was 45 +/- 19 years; 37 patients (88%) were women. Event monitors were twice as likely to provide a diagnostic rhythm strip electrocardiogram during symptoms as 48-hour Holter monitoring (29 patients [67%] and 15 patients [35%], respectively; P < 0.001). Event monitors detected 8 patients (19%) with clinically important arrhythmias (6 patients with supraventricular tachycardia and 2 with atrial fibrillation or flutter), whereas the Holter monitors detected no significant arrhythmia (P < 0.005). With the event monitors, most patients transmitted an electrocardiogram recording by 6 weeks. Event monitors were dominant and therefore more cost-effective than 48-hour Holter monitoring, resulting in a cost savings of $213 for each additional diagnostic rhythm strip obtained during symptoms. CONCLUSIONS: Holter monitoring is a poor diagnostic test for intermittent palpitations. Event recorders provide better data and are more cost-effective.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Whereas these recorders can be useful in the investigation of palpitations, 163 they have a marginal role in the evaluation of syncope.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [163]
In the citing paper
“Recent studies have shown that patient-triggered cardiac event recorders (CER) have an increased diagnostic yield and are more cost effective than conventional 24h-Holter electrocardiograms (ECGs) for the evaluation of sporadic, potentially arrhythmia-related symptoms.”
In the citing paper
“Recent studies have shown that patient-triggered cardiac event recorders (CER) have an increased diagnostic yield and are more cost effective than conventional 24h-Holter electrocardiograms (ECGs) for the evaluation of sporadic, potentially arrhythmia-related symptoms.”
In the citing paper
“and provide a significantly higher yield than standard patient-activated loop recorders in patients with infrequent palpitations.49,73 -79”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [76]
In the citing paper
“The external and implantable loop recorders, mobile cardiac outpatient telemetry, and pacemakers and ICDs can detect asymptomatic clinically significant arrhythmias automatically (i.e. with no activation by the patient)”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [76]
Citations
Cited by
Sorted by citations
Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), societies, E. B. T. F., European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp298 · Cited by 2,040
2018 ESC Guidelines for the diagnosis and management of syncope
Brignole, M., Moya, A., de Lange, F. J., Deharo, J.-C., Elliott, P. M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R. A., Martín, A., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy037 · Cited by 1,951
Kusumoto, F. M., Schoenfeld, M. H., Barrett, C., Edgerton, J. R., Ellenbogen, K. A., Gold, M. R., Goldschlager, N. F., Hamilton, R. M., Joglar, J. A., Kim, R. J., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.10.044 · Cited by 1,008
Kusumoto, F. M., Schoenfeld, M. H., Barrett, C., Edgerton, J. R., Ellenbogen, K. A., Gold, M. R., Goldschlager, N. F., Hamilton, R. M., Joglar, J. A., Kim, R. J., et al. (2019) · Circulation · doi:10.1161/cir.0000000000000628 · Cited by 603
Barrett, P. M., Komatireddy, R., Haaser, S., Topol, S., Sheard, J., Encinas, J., Fought, A. J., & Topol, E. J. (2014) · The American Journal of Medicine · doi:10.1016/j.amjmed.2013.10.003 · Cited by 498
Metadata
- Authors
- Kinlay, S., Leitch, J. W., Neil, A., Chapman, B. L., Hardy, D. B., & Fletcher, P. J.
- Affiliations
- John Hunter Hospital (AU)
- Corresponding author
- Kinlay, Scott
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 1996-01-01
- Volume
- 124
- Issue
- 1_Part_1
- Pages
- 16-20
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2028013985
- Cited by
- 245
- References
- 0
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 3 · 2023: 5 · 2022: 2 · 2021: 9 · 2020: 7 · 2019: 4 · 2018: 9 · 2017: 7 · 2016: 6 · 2015: 9 · 2014: 9 · 2013: 14 · 2012: 8
- FWCI
- 6.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- Holter monitoring, cost-effectiveness, diagnostic yield, supraventricular tachycardia, atrial fibrillation, arrhythmia detection, transtelephonic monitoring, electrocardiogram
- MeSH terms
- Adult, Arrhythmias, Cardiac, Atrial Fibrillation, Cost-Benefit Analysis, Electrocardiography, Female, Humans, Male, Middle Aged, Electrocardiography, Ambulatory, Cross-Over Studies
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
