Abstract
BackgroundPractice guidelines provide clinicians direction for the selection of ambulatory ECG (AECG) monitors in the evaluation of syncope/collapse. However, whether patients’ understand differences among AECG systems is unknown.Methods and ResultsA survey was conducted of USA (n = 99), United Kingdom (UK)/Germany (D) (n = 75) and Japan (n = 40) syncope/collapse patients who underwent diagnostic AECG monitoring. Responses were quantitated using a Likert‐like 7‐point scale (mean ± SD) or percent of patients indicating a Top 2 box (T2B) for a particular AECG attribute. Patient ages and diagnosed etiologies of syncope/collapse were similar across geographies. Patients were queried on AECG attributes including the ability to detect arrhythmic/cardiac causes of collapse, instructions received, ease of use, and cost. Patient perception of the diagnostic capabilities and ease of use did not differ significantly among the AECG technologies; however, USA patients had a more favorable overall view of ICM/ILRs (T2B: 42.4%) than did UK/D (T2B: 28%) or Japan (T2B: 17.5%) patients. Similarly, US patient rankings for education received regarding device choice and operation tended to be higher than UK/D or Japan patients; nevertheless, at their best, the Likert scores were low (approximately 4.7‐6.0) suggesting need for education improvement. Finally, both US and UK/D patients were similarly concerned with ICM costs (T2B, 31% vs 20% for Japan).ConclusionsPatients across several geographies have a similar but imperfect understanding of AECG technologies. Given more detailed education the patient is likely to be a more effective partner with the clinician in establishing a potential symptom‐arrhythmia correlation.
Highlights
Establishing the cause of syncope and collapse remains a challenge.[1,2] In this regard, practice guidelines and consensus statements provide practitioners with appropriate diagnostic direction.3-7 In particular, it is agreed that the first steps should comprise a medical history detailing overall health, past medical history, and current symptoms; thereafter, physical examination and selected laboratory tests based on the clinical history are appropriate
If the diagnosis continues to be unclear and an arrhythmic cause remains a concern, practice guidelines provide strategies for appropriate use of shorter- and longer-term ambulatory ECG (AECG) monitoring devices in an attempt to document subsequent symptomatic episodes or potentially causal arrhythmias.3-7 In brief, while the guidelines cannot specify specific values for sensitivity and specificity of monitoring device types since clinical circumstances vary widely, they do teach that for maximum diagnostic sensitivity, the monitoring duration should be selected based on the expected event frequency; low event frequencies require longer monitoring technologies
The extent to which patients understand differences among the AECG options selected for their care, and the basis for practitioner recommendations is unclear; greater patient understanding of prescribed technology may be expected to lead to greater acceptance and enhanced compliance with a provider-proposed AECG monitoring strategy
Summary
Establishing the cause of syncope and collapse remains a challenge.[1,2] In this regard, practice guidelines and consensus statements provide practitioners with appropriate diagnostic direction.3-7 In particular, it is agreed that the first steps should comprise a medical history detailing overall health, past medical history, and current symptoms; thereafter, physical examination and selected laboratory tests based on the clinical history (eg, ECG, echocardiogram) are appropriate. US patient rankings for education received regarding device choice and operation tended to be higher than UK/D or Japan patients; at their best, the Likert scores were low (approximately 4.7-6.0) suggesting need for education improvement Both US and UK/D patients were concerned with ICM costs (T2B, 31% vs 20% for Japan). Given more detailed education the patient is likely to be a more effective partner with the clinician in establishing a potential symptom- arrhythmia correlation
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