Device clinics that customize the settings of subcutaneous cardiac rhythm monitors (SCRM) would save time and money from having to analyze fewer false positives in continuous rhythm monitoring alerts, one center suggested.
Judging by hourly pay rates, the total compensation to adjudicate data transmitted from 1,811 subcutaneous cardiac rhythm monitors over 4 weeks was approximately $12,000 for technicians and device nurses, who reviewed all transmissions by logging into individual web-based systems for each device maker, and another $9,600 for an electrophysiologist to provide input, according to Muhammad Afzal, MD, of Ohio State University Medical Center in Columbus, and colleagues.
Half of the 1,457 consecutive transmissions were false positives, however, and seemed to have been driven by standard device settings where atrial fibrillation (Afib) episodes as short as 30 seconds had been recorded and transmitted, they reported online in JACC: Clinical Electrophysiology.
In April 2019, Afzal’s clinic stopped using device programming straight out of the box and opted for a custom protocol for arrhythmia detection:
- Threshold of Afib detection raised to 6 minutes of episode duration in most people
- For those with cryptogenic stroke, the detection cutoff was at least 2 minutes, with pause detection turned off
- For those with Afib, pause was set to the maximum allowable duration (usually 4.5 or 5 seconds)
As a result, the 55% false-positive rate in devices with standard settings dropped to 16% in rhythm monitors given custom settings (P=0.01), translating into a 34% reduction in resource use, or a $7,300 drop in salary cost to the clinic every month, the authors reported.
“Resource use in the present study did not include the overhead cost, cost for personnel required for scheduling, and billing, and so on. Thus, overall estimation of resource use was likely more than what was calculated in the present study,” Afzal and colleagues suggested.
Moreover, they found that 35% of data transmissions analyzed in the study were repeats from the same patient. In these cases, the clinic received no additional reimbursement because billing rules allow providers to bill just once a 31-day monitoring period.
“Compared with other implantable cardiac devices, ambulatory monitoring with SCRM requires significant additional work that does not yield additional payment. This reimbursement limitation warrants further consideration and will become even more relevant with the fast growing wearable device market,” the investigators said.
The study included people with 1,811 rhythm monitors implanted from January 2017 to September 2019. Of these monitors, 205 had custom programming due to the intervention.
Alerts and full downloads alike were considered among device transmissions.
The single-center study may have limited generalizability, and resource use is dependent on staff expertise, the investigators acknowledged.
Notably, there was no information reported on whether patient outcomes changed after the clinic’s switch to a custom arrhythmia detection algorithm.
Ultimately, if device makers find ways to sufficiently cut down on unnecessary transmissions from rhythm monitors, clinics would not even have to resort to custom programming.
“As the issue of FP [false-positive] episodes continues to exist, as shown by this and previous studies, there is a potential to improve the efficacy of detection algorithms. The existing algorithms for arrhythmia detection do not incorporate total duration or rate characteristics (median or maximum rate during an Afib episode) for Afib diagnosis,” according to Afzal’s group.
“It is anticipated that inclusion of heart rate and duration characteristics in the existing algorithms may improve the specificity of Afib diagnosis and reduce FP episodes,” they stated.
Disclosures
Afzal disclosed no relevant relationships with industry.
Source: MedicalNewsToday.com
