24 Hour ECG Monitoring Pathway
Author: Dr Andrew McCoye - GP
Date published: March 2018
Date to review: April 2024
The following Providers were successful in securing contracts with the CCG for the provision of Cardiology Diagnostic Services (ambulatory ECG) via an AQP procurement process.
Ecclesfield Group Practice
Firth Park Surgery
Manor Park Medical Centre
Primary Care Sheffield Ltd
Rivelin Healthcare Ltd
The Healthcare Surgery
Referrals will need to be made via e-RS and copies of the Referral Forms will be included on PRESS as they are made available from Providers.
Clinical Management Pathway
Stage 1 – The consultation
It is up to the patients GP to determine whether the patient has a level of risk which requires specialist assessment.
Patients will be included in this diagnostic pathway (a subset of the overall cardiac pathway) by their GP if they report symptoms of:
feelings of dizziness,
“fainting or falls” (note these patients require a careful assessment of risk of significant problems warranting urgent specialist assessment.)
Patients experiencing palpitations less frequently than daily should be considered by their GP for loop event recorder investigation.
The patients GP should take a history and perform any necessary examination. If this reveals any high risk factors (see below) then there should be a referral to an appropriate specialist service. Patients who at clinical interview or examination have severe symptoms or have high risk (eg FHx, sudden death under 40 years) should be excluded from this pathway and be referred to a specialist service. Other symptoms which raise clinical concern, should be discussed with an appropriate clinician to decide if a 24 hour ECG would be helpful or not.
Before referral to a 24 hour ECG Service, a resting 12-lead ECG and appropriate blood tests should be carried out.
Patients with significant abnormalities detected in the 12-lead ECG should be referred to secondary care.
Low Risk group
Patients who fulfil the following criteria should initially be treated conservatively:
· No history of sustained tachycardia or loss of consciousness AND
· Good exercise capacity AND
· No family history of Sudden Cardiac Death < 40 years AND
· Normal cardiac examination AND
· Normal 12 lead ECG
Stage 2 – referral to local service provider for 24-hour ECG investigation
Referrals to the Service will be made using ERS for the patient to attend for a fitting of a device to a local provider.
The Provider will fit the patient with the device and provide the patient with a patient information leaflet and their contact details should any problems/concerns arise. The Provider will give the patient an appointment to return with the device the following day.
At the patients next day follow-up appointment the Provider will remove the device and download the recordings and transmit for interpretation in PDF format using a secure electronic method along with the original referral form.
Should a patient fail to attend an appointment and does not contact the Provider to re-book, the Provider should inform the referring GP within 1 working day.
The Provider of this service transmits a report back to the patients registered GP electronically by NHS.net.
The patient is informed of the results by their registered practice and managed as appropriate.
Note – the Provider should aim to not undertake any repeat scanning of patients unless there is clinical rationale for the repeat scan.
To download the Information Pathway for 24 Hour ECG recording in Primary Care click on the downward arrow below.