QI-452785-3 CARDIAC MONITORING PATHWAYS AND RATES OF THERAPEUTIC INTERVENTION IN AN UNEXPLAINED SYNCOPE POPULATION
نویسندگان
چکیده
Guidelines recommend insertable cardiac monitoring (ICM) early in the evaluation of unexplained syncope. This increases rate establishing a formal diagnosis and instituting directed treatment compared to conventional care. Little is known about short-term usage prior ICM this population how pathways may impact patient outcomes. To characterize external monitor (ECM) U.S. Medicare fee-for-service (FFS) syncope test relationship between ECM use time insertion related therapeutic interventions. We used 2010-2020 de-identified 5% FFS claims identify patients with first event an emergency department (ED) or inpatient hospitalization who received during after event. Patients diagnoses for specific syncopal were excluded (e.g., anemia, diabetes, drug intoxication, orthostatic hypotension), as history cardiovascular implantable electronic devices (CIEDs), dementia, severe brain injury, mental illness, metastatic cancer, cerebral palsy. ECMs identified. costs estimated using national average payments. Time from arrhythmia (CIED implant, ablation, medication initiation) characterized. Of 1,323 acute monitored by ICM, 56.7% female mean age was 75.1±9.1 years. Before insertion, 20.6% 1 ECM, 17 days monitoring, while 23.3% ≥2 43 monitoring. In placement, cost averaged $792 per patient. delayed ECMs: median 18 post-syncope no 310 those (Figure), p<0.0001. Median also increased, 148 588 (p<0.0001). ultimately associated significant delays definitive treatment, indicating potential loss follow-up. Future work could focus on optimizing ensure timely access
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ژورنال
عنوان ژورنال: Heart Rhythm
سال: 2023
ISSN: ['1556-3871', '1547-5271']
DOI: https://doi.org/10.1016/j.hrthm.2023.03.337