The Dual Role of Implantable Loop Recorder in Patients with Potentially Arrhythmic Symptoms: A Retrospective Single‐Center Study

Kabra, Rajesh; Gopinathannair, Rakesh; Sandesara, Chirag; Messinger, Catherine; Olshansky, Brian

doi:10.1111/j.1540-8159.2009.02407.x

Cited by 15 publications

(9 citation statements)

References 13 publications

(13 reference statements)

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“…Forty-one (48%) did not have any arrhythmia during their symptoms. 16 The FRESH study further supported the contention that ICMs have a critical role in syncope evaluation. In this prospective, open-label, multicenter study, low-risk syncope patients who underwent conventional evaluation for the condition were compared with those who underwent ICM implantation.…”

supporting

confidence: 59%

Implantable Cardiac Monitors: Evolution Through Disruption

Sandesara

Gopinathannair

Olshansky

2017

J Innov Cardiac Rhythm Manage

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ABSTRACT. Syncope and stroke are commonly seen in clinical practice, and the diagnostic workup is often time-consuming and costly and may increase resource utilization in the health-care system. The use of implantable cardiac monitors (ICMs) in syncope evaluation has been well studied, but their use in cryptogenic stroke evaluation and anticoagulation management in patients with atrial fibrillation (AF) is still emerging. The standard workup of the syncope patient or those at risk for a possible cardioembolic stroke includes the utilization of external cardiac monitors; however, these devices cannot provide long-term arrhythmia assessment, whereas ICMs can now last up to three years, increasing the possibility of arriving at a diagnosis. Recent studies have shown that ICM use may shorten the time to diagnosis associated with AF, which may affect the prescribed treatment plan, thereby reducing the risks of further stroke. Long term and on a larger scale, this could potentially reduce overall health-care costs, but more studies are needed to confirm whether ICMs can positively decrease such costs and improve patient care. Still, these devices have become smaller and more reliable; additionally, they are now equipped with enhanced diagnostic capabilities, reducing the likelihood of physicians being confronted with an overwhelming amount of data, and supplying them with actionable items to improve patient care. With this growth, ICMs have in effect become a disruptive technology, as their applications in clinical practice continue to grow. Additional studies are warranted to investigate the safety and efficacy of their potential uses.

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supporting

confidence: 59%

Implantable Cardiac Monitors: Evolution Through Disruption

Sandesara

Gopinathannair

Olshansky

2017

J Innov Cardiac Rhythm Manage

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“…The invasive strategy achieved earlier, more diverse and more frequent (hazard ratio 8.93 95% CI 3.17–25.2, p < 0.0001) diagnosis, resulting in cost savings (mean difference of £809) [19]. Additionally, the diagnostic accuracy, safety, reliability and usefulness of the ILR has already been demonstrated in recent trials and in specific populations, such as patients with congenital heart disease [21,34,35] and patients undergoing magnetic resonance imaging [36]. …”

Section: Discussionmentioning

confidence: 99%

Financial impact of adopting implantable loop recorder diagnostic for unexplained syncope compared with conventional diagnostic pathway in Portugal

Providência

Candeias

Morais

et al. 2014

BMC Cardiovasc Disord

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BackgroundTo estimate the short- and long-term financial impact of early referral for implantable loop recorder diagnostic (ILR) versus conventional diagnostic pathway (CDP) in the management of unexplained syncope (US) in the Portuguese National Health Service (PNHS).MethodsA Markov model was developed to estimate the expected number of hospital admissions due to US and its respective financial impact in patients implanted with ILR versus CDP. The average cost of a syncope episode admission was estimated based on Portuguese cost data and landmark papers. The financial impact of ILR adoption was estimated for a total of 197 patients with US, based on the number of syncope admissions per year in the PNHS. Sensitivity analysis was performed to take into account the effect of uncertainty in the input parameters (hazard ratio of death; number of syncope events per year; probabilities and unit costs of each diagnostic test; probability of trauma and yield of diagnosis) over three-year and lifetime horizons.ResultsThe average cost of a syncope event was estimated to be between 1,760€ and 2,800€. Over a lifetime horizon, the total discounted costs of hospital admissions and syncope diagnosis for the entire cohort were 23% lower amongst patients in the ILR group compared with the CDP group (1,204,621€ for ILR, versus 1,571,332€ for CDP).ConclusionThe utilization of ILR leads to an earlier diagnosis and lower number of syncope hospital admissions and investigations, thus allowing significant cost offsets in the Portuguese setting. The result is robust to changes in the input parameter values, and cost savings become more pronounced over time.

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“…99 It would seem that the ILR should be considered earlier in the evaluation of syncope, 100,101 especially if syncope is recurrent, such that unnecessary and nondiagnostic tests can be avoided. 102 Furthermore, if syncope continues after ILR implantation, a negative result can exclude an arrhythmic cause such that other mechanisms can be investigated further, 103 including seizure disorder. 104 In a tertiary referral center in Poland, it was estimated that approximately 6% of syncope patients (including those with organic heart disease) had an indication for an ILR.…”

Section: Implantable Loop Recordersmentioning

confidence: 99%