Hoefman Emmy, van Weert Henk C P M, Reitsma Johannes B, Koster Rudolph W, Bindels Patrick J E
Division for Clinical Methods and Public Health, Department of General Practice, Academic Medical Center Amsterdam, The Netherlands.
Fam Pract. 2005 Oct;22(5):478-84. doi: 10.1093/fampra/cmi048. Epub 2005 Jun 17.
Because palpitations and light headedness often occur paroxysmally these complaints are difficult to diagnose. The hazards for a GP are too many diagnostic interventions for worried well and too few diagnostics for potentially life threatening complaints.
Patient-activated memo event recorders have proved to be successful in diagnosing episodes of cardiac arrythmias in secondary care. We tested the diagnostic yield of these devices in general practice.
A randomized clinical trial in general practice. Consecutive patients with complaints of palpitations or light-headedness were randomized to either usual care or usual care plus event-recorder. The main outcome was the difference in explained episodes. Secondary outcomes were the differences in the number and character of cardiac diagnoses and the feasibility of the event-recorder.
There were fewer patients without a diagnosis in the intervention group (17% vs 38%; RR = 0.5, 95% CI 0.3 to 0.7) and more patients with a cardiac diagnosis (67% vs. 27%: RR 2.5, CI 1.8 to 3,5). More relevant cardiac arrhythmias were detected (22% vs 7%) with event recording than with usual care (RR 3.2, 95% CI 1.5 to 6.8).
Patient-activated loop recorders are feasible and effective diagnostic tools in patients with palpitations or light-headedness in primary care. More research into patient characteristics and selection criteria is needed to fine-tune the use of these devices in primary care.
由于心悸和头晕通常呈发作性出现，这些症状难以诊断。对于全科医生来说，存在的风险是：对健康焦虑者进行过多的诊断性干预，而对潜在危及生命的症状诊断不足。
患者激活的记忆事件记录器已被证明在二级医疗中诊断心律失常发作方面是成功的。我们在全科医疗中测试了这些设备的诊断效能。
在全科医疗中进行一项随机临床试验。连续出现心悸或头晕症状的患者被随机分为接受常规治疗或常规治疗加事件记录器。主要结局是可解释发作的差异。次要结局是心脏诊断的数量和特征差异以及事件记录器的可行性。
干预组中未确诊的患者较少（17%对38%；RR = 0.5，95%CI 0.3至0.7），心脏诊断的患者较多（67%对27%：RR 2.5，CI 1.8至3.5）。与常规治疗相比，事件记录检测到更多相关的心律失常（22%对7%）（RR 3.2，95%CI 1.5至6.8）。
患者激活的环路记录器在基层医疗中对有心悸或头晕症状的患者是可行且有效的诊断工具。需要对患者特征和选择标准进行更多研究，以优化这些设备在基层医疗中的使用。
