Clin Cardiol. 2026 Oct;49(10):e70500. doi: 10.1002/clc.70500.
ABSTRACT
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.
PMID:42886071 | DOI:10.1002/clc.70500