Seven-day ECG Holter vs. 14-day event Holter in the detection of life-threatening ventricular arrhythmias, new atrial fibrillation, and silent ischemia among heart failure patients from social exclusion regions.

BACKGROUND

It was sought to compare the effectiveness of two methods 7-day ECG Holter or 14-day event-Holter monitoring in detection of arrythmias and ischemia in a heart failure (HF) population far from academic centers treated by a primary care physician under cardiologist supervision.

METHODS

In the prospective, non-randomized, 3-month pilot program carried out between June and December 2023 recruited were 429 HF patients from villages and small cities in 14 primary care units, far from academic centers. Of them, 124 (28.9%) patients were additionally monitored by either 7-day ECG Holter (7H-group) or 14-day event Holter (14eH-group). The cumulative percentage of patients with non-sustained ventricular tachycardia, new atrial fibrillation or ischemic changes was a primary composite endpoint.

RESULTS

Of 126 patients, 54 (43.5%) were monitored by 7-day ECG Holter while 70 (56.5%) by 14-day event Holter. At baseline, there were no significant differences between 7H- vs. 14eH-group in terms of demographics and cardiovascular risk factors. A history of PCI was more frequent in 7H- vs. 14eH-group (33 vs. 15%, p = 0.039). The cumulative percentage of the primary composite endpoint was significantly higher in 7H- vs. 14eH-group (24 vs. 2.9%, p < 0.001) and was driven by silent ischemia. The number of therapeutic interventions, including introduction of an oral anticoagulant or coronary angioplasty was numerically higher in 7H- vs. 14eH-group (11.1 vs. 4.3%, p = 0.27).

CONCLUSIONS

In this pilot study, 7-day ECG Holter was more effective in detection of non-sustained ventricular tachycardia, new atrial fibrillation or ischemic changes than 14-day event-Holter in HF patients in social exclusion regions.