First large-scale studies of wearable ambulatory cardiac monitoring shed light on usage
The first large-scale studies on the usage of wearable ambulatory cardiac monitors (ACM) in electrophysiology were recently presented from the EXCALIBER and CAMELOT studies at the Heart Rhythm Society (HRS) 2024 meeting. These studies analyzed the performance and impact of ACM devices across more than 300,000 patients.
Cardiovascular Business spoke with Matthew Reynolds, MD, cardiac electrophysiologist at Lahey Hospital and Medical Center, professor of medicine at the Tufts University School of Medicine, who was involved in the trials to find out more details.
Reynolds explained that the CAMELOT study, using Medicare data from 2017 to 2018, tracked nearly 300,000 patients who were prescribed ACM without a prior arrhythmia diagnosis. Key findings indicated that long-term continuous monitors (LTCMs), performed the best in diagnosing new arrhythmias, had the lowest repeat test rates, and incurred less additional healthcare costs compared to other types of monitors.
"The rise in healthcare costs post-monitoring is likely due to the treatment of newly diagnosed conditions. However, LTCMs showed a smaller cost increase, suggesting they are more efficient in early and accurate diagnosis," Reynolds explained.
The follow-up EXCALIBER study expanded on these findings using more recent data from 2017 to 2022, sourced from Optum, encompassing private payers and Medicare Advantage patients. This study included newer devices such as the Zio mobile continuous telemetry monitor (MCT), further validating the superior performance of LTCMs over traditional Holter monitors and event recorders.
Reynolds highlighted a significant shift in the types of monitors used. From 2017 to 2022, the use of Holter monitors decreased from 25% to around 10-15%, while the use of LTCMs surged.
"The newer monitors are replacing older types, leading to better patient compliance and more accurate diagnoses," he noted.
Despite these advancements, Reynolds emphasized that further research is needed to directly correlate these findings with patient outcomes.
"Our studies show an efficiency case for LTCMs, but we need more data to connect these findings to improved long-term health results."
The EXCALIBER study also reported on the distribution of different monitor types, with LTCMs making up 40% of the monitors used in recent years, MCTs accounting for 20%, and traditional event recorders and loop recorders shrinking to 10-15%.
"The adoption of wearable ACM technologies has increased dramatically," Reynolds said. "This trend is promising, suggesting that the medical community is moving towards more efficient and patient-friendly monitoring solutions."
Use of ambulatory monitors actually appear to increase costs
The usual goals of new healthcare technologies is to improve patient outcomes and to lower costs. Reynolds said there appears to be much better assessment of patient conditions using these monitors, as they catch many more events and much more data than older event recorders and Holter monitors with wired leads. While they likely led to improved outcomes for patients, capturing more cardiac events patients were sent on for more therapy, which translated into increased costs.
"What we observed in CAMELOT after the monitors are ordered, if you compare overall healthcare spending from some interval of time before the monitor to some interval of time after the monitor, healthcare spending looks like it trends upwards," Reynolds said.
He said investigators could only speculate as to why that is, but they think it's because more things are getting diagnosed and then the patients are coming back for treatment that include, prescriptions of medications, pacemakers or some other kind of intervention.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com