Impact of ambulatory electrocardiogram monitoring program in detecting atrial arrhythmia – a virtual cardiology programme

Background Ambulatory electrocardiogram (ECG) monitoring can facilitate early detection of atrial fibrillation (AF) and initiation of anticoagulation in high-risk populations; however, optimal implementation strategies at the population level remain uncertain. Purpose To evaluate the effectiveness of a real-world, protocol-driven virtual cardiology ambulatory ECG monitoring program in detecting atrial arrhythmia among Medicare beneficiaries. Methods The study included a cohort of 31,644 Medicare beneficiaries who participated in an ambulatory ECG monitoring program between March 2024 and August 2025. Participants aged 65-75 were included if they had a prior diagnosis of unspecified arrhythmia. Participants aged 75 and above were included if they had one or more cardiovascular risk factors and symptoms concerning for arrhythmia (Figure). Those with wear time of less than 48 hours were excluded. Logistic regression model was fit to assess association between clinical predictors and risk of atrial arrhythmia (atrial fibrillation and/or atrial flutter). Results The final cohort included 29562 individuals (78.1 [IQR 74.2, 82.5] years old, 39.8% male). Wear time was 312 (IQR 172, 334) hours. The most prevalent cardiovascular risk factors included hypertension (93.7%), obesity (61.3%), diabetes (52.2%), prediabetes (26.2%), heart failure (23.6%) and chronic obstructive pulmonary disease (COPD) (24.4%). Atrial fibrillation/flutter were diagnosed in 568 (1.9%) individuals. Among those with atrial arrhythmia, median CHA₂DS₂-VASc score was 5 (IQR 3,7), and 99.8% met guideline criteria for anticoagulation. Independent predictors of atrial arrhythmia included male sex, older age, longer wear time, hypertension, heart failure, and diabetes (Table). Conclusion In a large real-world Medicare population, a protocol-driven virtual cardiology ambulatory cECG monitoring program identified atrial arrhythmia in nearly 2% of participants despite a relatively short monitoring duration. Individuals with detected atrial fibrillation had very high thromboembolic risk, with nearly all meeting criteria for anticoagulation. These findings suggest that structured, remotely delivered monitoring programs can enable scalable detection of clinically actionable atrial arrhythmia among high-risk older adults and may represent an effective population health strategy for stroke prevention. Integration of virtual cardiology pathways with standardized triage and management protocols may allow earlier diagnosis and treatment initiation outside traditional specialty clinic settings.cECG flow chartcECG table