Evaluation of a direct access cardiac arrhythmia monitoring service

Background: This paper describes the clinical outcomes from a novel direct access arrhythmiamonitoring service.Methods: The study was carried out in the north of Scotland. Data was collected overa 29 month period between 18 June 2008 and 8 November 2010 from consecutive cases fromtwo groups of patients, general practitioner (GP) direct access and ‘redirected’ consultantreferrals. Monitor test results, frequency of arrhythmias requiring further care and clinicattendances were recorded. Statistical differences were analyzed using c2, Fisher’s and Student’st-test as appropriate with the significance taken at the 0.05 level.Results: 239 patients were referred from 47 GP practices. There were 165 (69%) referralsthrough the ‘direct’ and 72 (31%) through the ‘redirected’ route. The average age was 55.5 ±± 16.7 years with 84 (35.1%) males. 127 (53.1%) had a patient activated event recording andthe remaining 112 (46.9%) had Holter monitoring. Of the 239 patients, only nine (3.8%) casesrequired referral to a consultant cardiologist. Of these, three were directly returned to GP carewithout consultant clinic review. Six patients with significant arrhythmias were reviewed atcardiology clinic. There were no adverse events.Conclusions: Direct access for cardiac arrhythmia monitoring seems to provide an effectivemechanism for diverting inappropriate or non-essential referrals away from the cardiologyclinic.