A nurse-led implantable loop recorder service is safe and cost effective

J Cardiovasc Electrophysiol. 2019 Dec;30(12):2900-2906. doi: 10.1111/jce.14206. Epub 2019 Oct 9.


Introduction: Implantable loop recorders (ILR) are predominantly implanted by cardiologists in the catheter laboratory. We developed a nurse-delivered service for the implantation of LINQ (Medtronic; Minnesota) ILRs in the outpatient setting. This study compared the safety and cost-effectiveness of the introduction of this nurse-delivered ILR service with contemporaneous physician-led procedures.

Methods: Consecutive patients undergoing an ILR at our institution between 1st July 2016 and 4th June 2018 were included. Data were prospectively entered into a computerized database, which was retrospectively analyzed.

Results: A total of 475 patients underwent ILR implantation, 271 (57%) of these were implanted by physicians in the catheter laboratory and 204 (43%) by nurses in the outpatient setting. Six complications occurred in physician-implants and two in nurse-implants (P = .3). Procedural time for physician-implants (13.4 ± 8.0 minutes) and nurse-implants (14.2 ± 10.1 minutes) were comparable (P = .98). The procedural cost was estimated as £576.02 for physician-implants against £279.95 with nurse-implants, equating to a 57.3% cost reduction. In our center, the total cost of ILR implantation in the catheter laboratory by physicians was £10 513.13 p.a. vs £6661.55 p.a. with a nurse-delivered model. When overheads for running, cleaning, and maintaining were accounted for, we estimated a saving of £68 685.75 was performed by moving to a nurse-delivered model for ILR implants. Over 133 catheter laboratory and implanting physician hours were saved and utilized for other more complex procedures.

Conclusion: ILR implantation in the outpatient setting by suitably trained nurses is safe and leads to significant financial savings.

Keywords: arrhythmias; implantable loop recorder; syncope.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Ambulatory Care / economics*
  • Clinical Competence / economics
  • Cost Savings
  • Cost-Benefit Analysis
  • Databases, Factual
  • Female
  • Health Care Costs*
  • Humans
  • Male
  • Middle Aged
  • Monitoring, Ambulatory / economics*
  • Monitoring, Ambulatory / instrumentation
  • Monitoring, Ambulatory / nursing*
  • Nurse's Role*
  • Physician's Role*
  • Predictive Value of Tests
  • Remote Sensing Technology / economics*
  • Remote Sensing Technology / instrumentation
  • Remote Sensing Technology / nursing*
  • Retrospective Studies
  • Workflow