Cardiac arrhythmia is a group of conditions in which the heart is beating too fast, too slow, or erratically. Symptoms of arrhythmia may include chest pain, fainting, dizziness, or a racing or thumping heart. To diagnose an arrhythmia, doctors often use an electrocardiograph (ECG). For patients whose symptoms occur too infrequently to be detected by an ECG, doctors frequently ask them to use a device called an ambulatory ECG monitor (often called a Holter monitor). The patient wears the device at home to record their heart’s electrical signals while they are ambulatory (walking around), doing normal activities.
For many years, the standard devices used for this test were able to store data for up to 24 or 48 hours. Patients who needed monitoring beyond 48 hours could use a device known as an external cardiac loop recorder. But due to their limited data storage capacity, these devices automatically erase normal signals after a few minutes and only keep the abnormal signals. Newer devices, known as long-term continuous ambulatory ECG monitors, with more data storage capacity are now available. Their use in Ontario has grown steadily since they became publicly funded in 2006—and particularly since 2011, when funding was extended to models that can record for two weeks or longer. At the same time, the use of external cardiac loop recorders has decreased.
This health technology assessment looked at the effectiveness and costs of long-term continuous ECG monitors, compared with loop recorders. In our review of published research, we found that the two types of devices were equally effective in their ability to detect symptomatic cardiac arrhythmias. Assuming that the use of long-term continuous ECG monitors continues to grow in Ontario, we estimated that the added costs to the province’s health care system would be between $130,000 and $370,000 per year for the next 5 years. However, this estimate relies on several assumptions, including that there will be no change in the fees associated with the use of each test.