1. Comparative effectiveness and healthcare utilization for ambulatory cardiac monitoring strategies in Medicare beneficiaries.
- Author
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Reynolds MR, Passman R, Swindle J, Mohammadi I, Wright B, Boyle K, Turakhia MP, and Mittal S
- Subjects
- United States, Humans, Aged, Retrospective Studies, Medicare, Health Expenditures, Patient Acceptance of Health Care, Electrocardiography, Ambulatory, Atrial Fibrillation diagnosis, Methacrylates
- Abstract
Background: Objective data comparing the diagnostic performance of different ambulatory cardiac monitors (ACMs) are lacking., Objectives: To assess variation in monitoring strategy, clinical outcomes and healthcare utilization in patients undergoing ambulatory monitoring without a pre-existing arrhythmia diagnosis., Methods: Using the full sample (100%) of Medicare claims data, we performed a retrospective cohort study of diagnostic-naïve patients who received first-time ACM in 2017 to 2018 and evaluated arrhythmia encounter diagnosis at 3-months, repeat ACM testing at 6 months, all-cause 90-day emergency department (ED) and inpatient utilization, and cost of different strategies: Holter; long-term continuous monitor (LTCM); non-continuous, event-based external ambulatory event monitor (AEM); and mobile cardiac telemetry (MCT). We secondarily performed a device-specific analysis by manufacturer, identified from unique claim modifier codes., Results: ACMs were used in 287,789 patients (AEM = 10.3%; Holter = 53.8%; LTCM = 13.3%; MCT = 22.5%). Device-specific analysis showed that compared to Holter, AEM, MCT, or other LTCM manufacturers, a specific LTCM (Zio
Ⓡ XT 14-day patch, iRhythm Technologies, San Francisco, CA) had the highest adjusted odds of diagnosis and lowest adjusted odds of ACM retesting. Findings were consistent for specific arrhythmia diagnoses of ventricular tachycardia, atrioventricular block, and paroxysmal atrial fibrillation. As a category, LTCM was associated with the lowest 1-year incremental health care expenditures (mean Δ$10,159), followed by Holter ($10,755), AEM ($11,462), and MCT ($12,532)., Conclusions: There was large variation in diagnostic monitoring strategy. A specific LTCM was associated with the highest adjusted odds of a new arrhythmia diagnosis and lowest adjusted odds of repeat ACM testing. LTCM as a category had the lowest incremental acute care utilization. Different monitoring strategies may produce different results with respect to diagnosis and care., Competing Interests: Disclosures Dr. Reynolds is a consultant for Medtronic, Philips, Edwards Lifesciences, and iRhythm and serves on a data safety and monitoring board for Affera. Dr Passman receives research support from the American Heart Association (#18SFRN34250013), research support and speaker fees from Medtronic, research support from Abbott, royalties from UpToDate, and is a consultant for iRhythm. Dr. Swindle and Dr. Mohammadi have no conflict of interest to disclose. Brent Wright is an employee of iRhythm Technologies. Dr. Boyle is an employee of iRhythm Technologies. Dr. Turakhia is an employee of iRhythm Technologies. Outside of the submitted work, Dr. Turakhia reports research grants from Bristol Myers Squibb, American Heart Association, Bayer, Gilead Sciences, and the Food and Drug Administration, consulting fees from Medtronic, Pfizer, Johnson & Johnson, Alivecor, and equity from iRhythm, Connect America, Forward, and Evidently. Dr. Mittal is a consultant for Boston Scientific and iRhythm Technologies., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)- Published
- 2024
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