Ambulatory Electrocardiography: A Cost per Management Decision Analysis

Danielle K. Kessler, Kenneth M. Kessler, Robert J. Myerburg

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: This study evaluated the current clinical use and costs of ambulatory electrocardiographic (AECG) monitoring for arrhythmia detection based on a cost per management decision analysis. Methods: Consecutive inpatient and outpatient 24-hour AECGs (n=650) performed during the calendar year 1991 were retrospectively reviewed for clinical indication, arrhythmia detection, diary information, and whether a management decision that might alter patient outcome was derived from the data. The cost per management decision (based on a representative reimbursement of $550 per AECG) and the cost index (CI) (all tests divided by useful tests) were calculated. Results: Although arrhythmias were identified in 91% of the patients, management decisions were indicated in only 18% (cost per decision, $2974; CI=5.4). Management decisions were most often derived from the data in patients being evaluated for arrhythmia therapy (37 of 37 patients; cost per decision, $550; CI=1). Symptoms and arrhythmias were correlated in only 11 patients (2%). More often typical clinical symptoms were present (26 patients) in the absence of an arrhythmia. Of 101 AECGs following a cerebrovascular event, four had unsuspected atrial fibrillation (cost per decision, $13 888; CI=25.0). Dizziness or lightheadedness associated with other cardiac symptoms was more likely to lead to a management decision than the same symptoms in isolation (29% vs 7%; P<.05). No patient had central nervous system symptoms correlated with an arrhythmia during the recording period or unsuspected ventricular tachycardia. Conclusions: Ambulatory electrocardiography has a highly variable and indication-dependent effectiveness and cost. The results suggest a strategy for improving the use of AECG based on knowing what testing indications are more likely to lead to useful clinical information.

Original languageEnglish (US)
Pages (from-to)165-169
Number of pages5
JournalArchives of internal medicine
Issue number2
StatePublished - Jan 23 1995

ASJC Scopus subject areas

  • Internal Medicine


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