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Evidence to Improve Care

Long-Term Continuous Ambulatory ECG Monitors and External Cardiac Loop Recorders for Cardiac Arrhythmia

Ontario Health Technology Advisory Committee Recommendations

  • The Ontario Health Technology Advisory Committee recommends continuing to publicly fund (1) long-term continuous ambulatory electrocardiography (ECG) monitors and (2) external cardiac loop recorders that can detect abnormal heart rhythm without the patient initiating the recording of the event

  • The Ontario Health Technology Advisory Committee recommends discontinuing public funding for external cardiac loop recorders that rely solely on patient-initiated recording of the event

Read the full OHTAC Recommendation report

Cardiac arrhythmia means that the heartbeat is erratic, too fast, or too slow. An arrhythmia can increase the risk of stroke, heart attack, or sudden cardiac death. To diagnose the specific problem, doctors often initially use an electrocardiograph (ECG). Patients whose symptoms occur too infrequently to be detected by this test in the hospital may be asked to wear a device called an ambulatory ECG monitor for several days or weeks while at home.

Health Quality Ontario Reviews Long-Term Ambulatory ECG Monitors

Our review looked at two types of devices used for long-term ECG monitoring. They are equally effective at detecting arrhythmia based on a patient’s symptoms. Combined, about 85,000 of these two types of tests were done in Ontario in 2014. In recent years, use of one type, called long-term continuous ambulatory ECG monitors, has grown steadily in this province. At the same time, use of the other type, called external cardiac loop recorders, has decreased but still accounts for about half of these tests.

Doing ambulatory ECG tests by long-term continuous monitor currently costs the health care system somewhat more but has advantages over external cardiac loop recorders. The long- term continuous monitors can record for longer periods, store more information about the heartbeat, and are often easier for patients to use.

Long-Term Continuous Ambulatory ECG Monitors and External Cardiac Loop Recorders for Cardiac Arrhythmia: A Health Technology Assessment (PDF)
January 2017

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The Ministry of Health and Long-Term Care is currently reviewing this recommendation.

The Ministry of Health and Long-Term Care has provided the following response: The Ministry has a standardized process in place to review Health Quality Ontario recommendations. This takes into consideration Ministry priorities, implementation options, the need for consultation with impacted stakeholders, and funding considerations.

Health Technology Assessment at Health Quality Ontario

As part of our core function to promote health care supported by the best available evidence, we use established scientific methods to analyze the evidence for a wide range of health interventions, including diagnostic tests, medical devices, interventional and surgical procedures, health care programs and models of care. These analyses are informed by input from a range of individuals, including patients and clinical experts. The Ontario Health Technology Advisory Committee — a committee of the Health Quality Ontario board of directors — reviews the evidence and makes recommendations about whether health care interventions should be publicly funded or not. Draft recommendations are posted on the Health Quality Ontario website for feedback. Final recommendations are approved by our board of directors and then shared with the Ministry of Health and Long-Term Care. For more detailed information, visit our Evidence to Improve Care pages.


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