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Differences in the yield of the implantable loop recorder between secondary and tertiary centers
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Abstract
Background: The implantable loop recorder (ILR) is a useful tool for diagnosis of syncope or palpitations. Its easy use and safety have extended its use to secondary hospitals (those without an Electrophysiology Lab). The aim of the study was to compare results between secondary and tertiary hospitals.
Methods: National prospective and multicenter registry of patients with an ILR inserted for clinical reasons. Data were collected in an online database. The follow-up ended when the first diagnostic clinical event occurred, or 1 year after implantation. Data were analyzed according to the center of reference; hospitals with Electrophysiology Lab were considered Tertiary Hospitals, while those hospitals without a lab were considered Secondary Hospitals.
Results: Seven hundred and forty-three patients (413 [55.6%] men; 65 ± 16 year-old): 655 (88.2%) from Tertiary Centers (TC) and 88 (11.8%) from Secondary Centers (SC). No differences in clinical characteristics between both groups were found. The electrophysiologic study and the tilt table test were conducted more frequently in Tertiary Centers. Follow-up was conducted for 680 (91.5%) patients: 91% in TC and 94% in SC. There was a higher rate of final diagnosis among SC patients (55.4% vs. 30.8%; p < 0.001). Tertiary Hospital patients showed a trend towards a higher rate of neurally mediated events (20% vs. 4%), while bradyarrhythmias were more frequent in SC (74% vs. 60%; p = 0.055). The rate of deaths and adverse events was similar in both populations.
Conclusions: Patients with an ILR in SC and TC have differences in terms of the use of complementary tests, but not in clinical characteristics. There was a higher rate of diagnosis in Secondary Hospital patients.
Abstract
Background: The implantable loop recorder (ILR) is a useful tool for diagnosis of syncope or palpitations. Its easy use and safety have extended its use to secondary hospitals (those without an Electrophysiology Lab). The aim of the study was to compare results between secondary and tertiary hospitals.
Methods: National prospective and multicenter registry of patients with an ILR inserted for clinical reasons. Data were collected in an online database. The follow-up ended when the first diagnostic clinical event occurred, or 1 year after implantation. Data were analyzed according to the center of reference; hospitals with Electrophysiology Lab were considered Tertiary Hospitals, while those hospitals without a lab were considered Secondary Hospitals.
Results: Seven hundred and forty-three patients (413 [55.6%] men; 65 ± 16 year-old): 655 (88.2%) from Tertiary Centers (TC) and 88 (11.8%) from Secondary Centers (SC). No differences in clinical characteristics between both groups were found. The electrophysiologic study and the tilt table test were conducted more frequently in Tertiary Centers. Follow-up was conducted for 680 (91.5%) patients: 91% in TC and 94% in SC. There was a higher rate of final diagnosis among SC patients (55.4% vs. 30.8%; p < 0.001). Tertiary Hospital patients showed a trend towards a higher rate of neurally mediated events (20% vs. 4%), while bradyarrhythmias were more frequent in SC (74% vs. 60%; p = 0.055). The rate of deaths and adverse events was similar in both populations.
Conclusions: Patients with an ILR in SC and TC have differences in terms of the use of complementary tests, but not in clinical characteristics. There was a higher rate of diagnosis in Secondary Hospital patients.
Keywords
implantable loop recorder, registry, secondary centers, tertiary centers
About this articleTitle
Differences in the yield of the implantable loop recorder between secondary and tertiary centers
Journal
Issue
Pages
241-246
Published online
2015-06-19
Page views
1820
Article views/downloads
1969
DOI
10.5603/CJ.a2014.0088
Pubmed
Bibliographic record
Cardiol J 2015;22(3):241-246.
Keywords
implantable loop recorder
registry
secondary centers
tertiary centers
Authors
Francisco Javier Lacunza-Ruiz
Angel Moya-Mitjans
Jesús Martínez-Alday
Gonzalo Barón-Esquivias
Ricardo Ruiz-Granell
Nuria Rivas-Gándara
Susana González-Enríquez
Juan Leal-del-Ojo
Natalie García-Heil
Arcadi García-Alberola
