Reducing Review Burden with Key EGM Selection
The key EGM selection tool evaluated in this study reduced the total
number of EGMs to review for each arrhythmia type, and by 55.1% across
all arrhythmias. Looking at patient EGM rates per month, rather than
entire population totals, provides an informative view of how a minority
of patients can overwhelm the patient care system. Key EGM selection
resulted in a significant drop in median EGMs/pt/mo across the entire
population. As expected, this reduction was even greater for patients in
the top 25th percentile of EGMs/pt/mo, who accounted
for almost 90% of all EGMs to review. In these high EGM-volume
patients, the median EGMs/pt/mo dropped by 37.7%, 53.0%, 70.8%, and
48.1% for AF, tachycardia, bradycardia, and pause, respectively.
Resource Utilization
Benefit
In a recent study of 1,811 ICMs (over 90% Medtronic), with nearly 1,500
total transmissions over a 4-week period, 15 ± 6 min was spent by clinic
personnel and 1.5 ± 1 min by electrophysiologists per
transmission.11 Based on the number of EGMs per
transmission in that study, clinic personnel can be estimated to spend
0.6 min to review each EGM, plus a fixed time of 11.0 min per
transmission for pre-review preparation and post-review record/patient
processing, with an additional review time by electrophysiologists of
0.2 min per EGM. Applying these estimates to the current study, in which
the EGM burden was reduced by 55.1% while maintaining the number of
transmissions, the expected time saved per 100 patients in this cohort
would be 120 hours/year for clinic personnel (28.7% reduction) and 36
hours/year for electrophysiologists (55.1% reduction).