Key result
Alternative ambulatory monitors linked to up to ~50% lower odds of arrhythmia diagnosis versus iRhythm.
Why the study?
Comparative effectiveness data across ambulatory cardiac monitoring modalities and vendors in diverse insured populations were limited.
Do different ambulatory cardiac monitoring modalities compared to a specific LTCM (iRhythm) affect arrhythmia diagnosis rates, repeat monitoring, and healthcare utilization in adults without prior arrhythmia?
Cohort (n=352,782)
Yes
Do different ambulatory cardiac monitoring modalities compared to a specific LTCM (iRhythm) affect arrhythmia diagnosis rates, repeat monitoring, and healthcare utilization in adults without prior arrhythmia?
Effect estimate: OR 0.50-0.95
p-value: p=<0.01
A specific long-term continuous monitor (iRhythm) demonstrated higher claims-based arrhythmia yield, lower repeat monitoring, and reduced downstream healthcare utilization compared to most alternative ambulatory cardiac monitoring modalities.
BACKGROUND: Comparative effectiveness data across ambulatory cardiac monitoring (ACM) modalities are limited. OBJECTIVE: To confirm and extend comparative findings across ACM modalities and vendors in commercially insured and Medicare Advantage beneficiaries without prior arrhythmia. METHODS: Retrospective study using Optum Research Database. Adults ≥ 18 years with first ACM use between January 1, 2017 and June 30, 2022 were categorized as long-term continuous monitors (LTCM), Holter, external ambulatory event monitors (AEM), or mobile cardiac telemetry (MCT). Outcomes were arrhythmia diagnosis (90 days), repeat monitoring (180 days), cardiovascular events, hospitalization, emergency department [ED] visits, and costs (365 days). Inverse probability of treatment weighting used a specific LTCM (iRhythm Technologies, San Francisco, CA) as reference. RESULTS: Among 352,782 patients (mean age 62.0 ± 17.1 years; 61% female), 25% received LTCM, 37% Holter, 20% AEM, and 18% MCT. Among LTCM users, 58% received iRhythm LTCM. Compared with this LTCM, Holter, MCT, and other LTCM had lower odds of arrhythmia diagnosis (IPTW-weighted ORs 0.50-0.95; p < 0.01); AEM did not differ. Repeat monitoring was higher for other LTCM, AEM, and Holter (IPTW-weighted ORs 1.99-2.77; p < 0.001); MCT did not differ. All other modalities had higher IPTW-weighted odds of cardiovascular events (ORs 1.10-1.66; p < 0.001), hospitalization (ORs 1.12-2.04; p < 0.001), ED visits (ORs 1.09-2.08; p < 0.001), and costs (IPTW-weighted cost ratios 1.03-1.28; p < 0.01). CONCLUSIONS: Outcomes differed across ACM modalities and vendors, confirming observations in other payer populations. A specific LTCM was associated with higher claims-based arrhythmia yield and lower repeat monitoring than most alternatives, and with lower hospitalization, health care utilization, and costs.
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Mittal et al. (2026) conducted a cohort in Patients without prior arrhythmia requiring ambulatory cardiac monitoring (n=352,782). Other ambulatory cardiac monitoring modalities (Holter, MCT, other LTCM, AEM) vs. iRhythm long-term continuous monitors (LTCM) was evaluated on Arrhythmia diagnosis (90 days) (OR 0.50-0.95, p=<0.01). Compared with iRhythm LTCM, other ambulatory monitors (Holter, MCT, other LTCM) were associated with lower odds of arrhythmia diagnosis (OR 0.50-0.95; P<0.01) and higher healthcare utilization.
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