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Specialist society warns: guidelines cannot be implemented
The oldest and largest cardiological society in Europe recently drew attention to a dramatic care gap in patients with cardiac arrhythmias. Apparently, the guidelines for treatment cannot be implemented in part because the health insurance companies block funding.
The German Society for Cardiology - Cardiovascular Research e.V. (DGK) recently criticized the current state in the diagnosis of cardiac arrhythmias. According to the DGK, ineffective diagnostic methods are used for people with cardiac arrhythmia who suffer from occasional fainting spells (syncope) for cost reasons. There would have been more efficient options available for a long time, which are also recommended in the guideline. However, it fails to finance through the health insurance companies.
Every second person is potentially affected
According to the DGK, around every second person suffers at least one syncope in the course of their life. Syncope is a brief fainting spell, which is often based on an irregular heartbeat. Such short interruptions in consciousness are not necessarily dangerous, but can indicate serious to life-threatening underlying diseases. "Today's syncope can be the sudden cardiac death of tomorrow," emphasizes Professor Dr. Wolfgang von Scheidt, who contributed to the European guideline "Diagnostics and Management of Syncope".
Current diagnostic methods are not effective
If such a syncope occurs, a long-term ECG is usually used to identify a possible rhythm disorder. According to current evaluations, this only makes sense in four percent of the cases, warns the DGK. A long-term ECG is only helpful if the fainting fits occur several times a week. But that is not the case with most of those affected.
It can also be done better
Instead, the guideline recommends the use of so-called implantable event recorders. In a few minutes, a small chip is placed under the skin that records the heart rate of the patients over three years. If a syncope occurs during this period, the chip can be read out. According to the DGK, this makes it easier and more reliable to determine whether an underlying cardiac arrhythmia is the cause. "So if the next fainting occurs weeks or months after the implantation, the event recorder can be read out and reveals the heart rhythm at the time of the syncope," explains von Scheidt.
Strokes can also be better identified
No cause can be identified in around every third stroke. In medicine, one speaks of a cryptogenic stroke in such cases. In 2014, a large study already showed that in the run-up to a cryptogenic stroke, occasional seizure-like atrial fibrillation takes place, which are only rarely recognized by ECG and long-term ECG. Here, too, an event recorder could detect over six times more cases than the diagnostic methods currently used. "Early detection of atrial fibrillation with event recorders allows timely initiation of anticoagulant therapy and thus prevention of strokes," comments the DGK.
Doctors' hands are tied
In a current statement, the DGK reports an unbearable situation for doctors and patients. Because although the benefits of such recorders have been proven by numerous studies, the use of the guideline is recommended and the chip can be used cost-effectively, the statutory health insurance funds block financing. "Unfortunately, the implantation of an event recorder has so far been viewed by health insurance companies as the last step in diagnostics," reports the professor. Affected people would first have to go through a real diagnostic cascade before the health insurance companies agree to funding. "Outpatient implantation is currently not even paid for, although the outpatient procedure can be performed very well and safely," von Scheidt said.
Contradiction to the guidelines
"The requirements of the health insurance companies contradict the guideline recommendation," emphasizes Professor Dr. Thomas Deneke, spokesman for the DGK's Rhythmology group. A lot of money is spent in syncope diagnostics for measures that are useless. The DGK experts summarize that this money should be put into the supply of event recorders. "In our opinion, health insurance companies urgently need to rethink their stance on implantable event recorders," said von Scheidt. (vb)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Graduate editor (FH) Volker Blasek
- Press text DGK 07/2019: Dramatic supply gap in patients with cardiac arrhythmia and syncope (accessed: June 28, 2019), dgk.org
- German Society for Cardiology - Cardiovascular Research: ESC Pocket Guidelines, Diagnosis and Management of Syncope, Version 2018, leitlinien.dgk.org