Background: This paper describes the clinical outcomes from a novel direct access arrhythmia
monitoring service.
Methods: The study was carried out in the north of Scotland. Data was collected over
a 29 month period between 18 June 2008 and 8 November 2010 from consecutive cases from
two groups of patients, general practitioner (GP) direct access and ‘redirected’ consultant
referrals. Monitor test results, frequency of arrhythmias requiring further care and clinic
attendances were recorded. Statistical differences were analyzed using Χ2, Fisher’s and Student’s
t-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%) referrals
through 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 and
the remaining 112 (46.9%) had Holter monitoring. Of the 239 patients, only nine (3.8%) cases
required referral to a consultant cardiologist. Of these, three were directly returned to GP care
without consultant clinic review. Six patients with significant arrhythmias were reviewed at
cardiology clinic. There were no adverse events.
Conclusions: Direct access for cardiac arrhythmia monitoring seems to provide an effective
mechanism for diverting inappropriate or non-essential referrals away from the cardiology
clinic. (Cardiol J 2012; 19, 1: 70–75
