Clinical Utility of a Single 24-Hour Electrocardiogram in theInvestigation of Patients with Suspected Cardiac Dysrhythm
Bibliographic record
Abstract
Despite the widespread use of ambulatory electrocardiography in cardiology practise, its clinical efficacy has not been extensively investigated. The purpose of this study was to evaluate the screening test performance of a single, continuous 24-hour electrocardiogram in 150 patients referred to a tertiary care center with clinical suspicion of cardiac dysrhythm. We found the incidence of symptoms during the test period to be significantly higher (29/50) among patients referred because of prior palpitations (group 1) relative to patients referred because of complaints of dizziness/presyncope (group 2; 10/50, p < 0.001) or patients referred because of non-specified clinical suspicion of dysrhythm, particularly ventricular dysrhythm (group 3; 17/50, p < 0.005). In contrast, abnormal cardiac rhythm was detected more frequently in group 3 (38/50) than in group 1 (24/50, p < 0.001) or group 2 (30/50, NS). The incidence of symptoms or detected dysrhythm, or both, which we defined as the maximal clinical utility of a single 24-hour test, was not different (NS) among the three referral groups, ranging from 68 % in group 2 to 84% in group 3. Only in group 3, however, did patients have a high temporal concordance of symptoms and dysrhythm (12/17); in group 1 the symptom-dysrhythm concordance was 10/29 (p < 0.025) and only 2/10 (p < 0.025) in group 2. Overall, the data support the use of ambulatory electrocardiographic monitoring as a non-invasive diagnostic test for patients suspected to have abnormal cardiac rhythm. A single 24-hour recording appears most useful in the investigation of patients with palpitations because of a high incidence of palpitations during the test interval. Whatever the initial clinical stimulus for referral, a high proportion of tertiary care patients have symptoms in temporal concordance with sinus rhythm.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.002 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".