Why is it important for health plans to prioritize arrhythmia detection when managing members with potential cardiovascular disease?

In my five years at iRhythm, I've been struck by the impact of heart disease in the U.S. As the leading cause of death and disability in the U.S., cardiovascular conditions encompass conditions like stroke, heart failure, and atrial fibrillation (AFib). Projections show that AFib could affect up to 12 million Americans by 2030,² yet monitoring doesn’t always happen early enough. This not only has dire consequences for patient health, but also significantly drives up costs, with AFib alone costing the U.S. between $6–26 billion annually.³ Late arrythmia detection can necessitate expensive treatments for escalating conditions, burdening the healthcare system and health plans alike.

What are the different types of arrythmia monitoring and the benefits/drawbacks of each?

Traditional arrhythmia monitoring typically involved three main types: Holter monitors, event monitors, and in-clinic, 12-lead electrocardiograms (ECGs). In recent years, long-term continuous monitoring (LTCM) has also entered the ambulatory cardiac monitoring market.

A Holter monitor is a device that records a patient’s heartbeat. It contains electrodes, which attach to the chest, connected by wires to a monitoring device worn on a belt or shoulder strap. The device provides an overview of the heart's activity throughout the day and night but can be slightly uncomfortable due to the electrodes attached to the skin. The primary drawback is that it may not capture infrequent arrhythmias given the limited monitoring timeframe, which is typically up to 48 hours.

A cardiac event recorder is a portable device that the patient wears or carries to record their heart’s electrical activity as they go about their normal activities. There are multiple types of event recorders: external loop memory monitors, symptom event monitors, and patch recorders.

However, the recorders may depend on patient activation, rely on patient-triggered symptom logging, and provide only intermittent heartbeat data.

An ECG is a quick, in-clinic test that captures the heart's electrical activity at a specific point in time through electrodes placed on the body. While ECGs are the standard for diagnosing heart rhythm issues, they typically provide only 10 seconds of the heart’s rhythm and can miss arrhythmias that do not present during the test.

Long-term continuous monitoring (LTCM), in contrast, uses patches that record heart activity over extended periods of up to two weeks. Often, in this category, there are several components, including extended monitoring and reading services. This type of monitoring offers a more comprehensive picture of the heart's rhythm, increasing the likelihood of detecting intermittent arrhythmias.

According to the 2024 CAMELOT study published in the American Heart Journal, LTCM stands out for its effectiveness at utilizing healthcare resources compared to other services. Specifically, compared to LTCM services, for every 1,000 patients, Holter monitoring services were associated with, on average:

• 180 more emergency department visits
• 80 more inpatient hospitalizations
• 920 more outpatient visits
• Higher healthcare resource utilization^4-7

From my perspective, as a nurse, the message is clear: The right service not only cuts costs but also eases patient stress, facilitating a swifter and more precise diagnosis while enhancing the efficiency of healthcare resources.

What challenges do health plans face in setting policy around arrhythmia detection?

Health plans often struggle with a lack of awareness and urgency when it comes to treating arrhythmias. A key point of confusion is the term "modality," which simply refers to the kind of diagnostic service being used. It's important to understand that not all services are the same, nor do they yield the same results.

For instance, the traditional in-clinic, 12-lead ECG test, which has been the go-to test for arrhythmias, often fails to catch the intermittent nature of some heart events. Compared to Zio LTCM service, Holter monitoring services had a 50% lower likelihood of a specified arrhythmia diagnosis.^4-7 Surprisingly, even a 30-day event monitor, which collects data intermittently over a longer period, may not be as effective as expected. Undetected arrythmias can have significant economic risks, such as unnecessary inpatient hospitalizations and emergency department visits.

In advocating for LTCM, I've even had to clarify why our Zio monitoring service provides more value with 14-day monitoring than a 24 to 48-hour Holter monitor. The Zio monitoring service uses advanced AI, expert certified cardiographic technicians (CCTs), and up to 14-day wear times, to improve the chances of capturing an arrhythmic event.^8-11 As such, it's essential to dispel common misconceptions and ensure the most suitable monitoring tool is selected for each patient's needs.

What financial risks are associated with delaying arrhythmia treatment or letting it go undiagnosed?

Repeated hospital visits before a proper diagnosis can lead to inpatient expenses of up to $20,000 each, on top of emergency room and ambulance costs.¹² These expenses impact the entire healthcare ecosystem — straining healthcare systems, challenging patients with access issues and lost workdays, and stretching the resources of insurance providers. It’s estimated that undiagnosed AFib costs the U.S. $3 billion per year.¹³ The total cost of heart failure in the U.S. is expected to reach $70 billion by 2030.¹⁴ With patients at a five times greater risk of developing heart failure if AFib is a comorbidity,¹⁵ it’s more important than ever to raise awareness of early detection, using services with higher diagnostic yield and less retesting.

How does the early detection of arrhythmia contribute to cost savings and improved patient outcomes within a value-based care framework?

It's exciting to see healthcare systems embracing a new approach as we move away from fee-for-service models. For too long, the focus has been on productivity rather than value-based care, which didn't always prioritize patient outcomes. Instead, focusing on productivity often drives up costs, repeat testing, and unnecessary use of healthcare resources. And that's exactly what iRhythm is aiming to change.

Leaders of health systems, especially those in risk models, accountable care organizations, and clinically integrated networks, are starting to recognize the impact of LTCM over other monitors. Recently, we've been collaborating with health systems that are invested in value-based models. They're ready to integrate early arrythmia detection into primary care settings to ensure broad access and allow cardiologists and electrophysiologists to focus on more complex cases — a huge step forward for patient care.

How are new arrhythmia detection technologies helping to achieve the Quintuple Aim?

iRhythm is committed to partnering with healthcare providers, health systems, and health plans to work toward improving patient experience and outcomes, improving population health, reducing healthcare costs, improving clinical experience and satisfaction, and achieving health equity. With the Zio service, we've provided services for over 9.5 million patients and collected 2 billion hours of heartbeat data.⁸ This robust monitoring can shorten the journey to an often too-long diagnostic odyssey, which is frustrating and frightening for patients who are experiencing unexplained symptoms.

From a provider's perspective, getting a detailed report with all clinically actionable arrhythmias, including when they occurred, is incredibly valuable. The Zio service also includes a survey to gauge the member experience and ensure patient satisfaction, a key Medicare Stars measure. The Zio service provides healthcare professionals with highly accurate data they can trust, so patients get the right diagnosis the first time.⁸

Another crucial aspect we're focusing on is health equity. We're addressing the “cardiology deserts” where patients face challenges in accessing care. More than 46% of all U.S. counties, comprising 22 million residents, do not have a practicing cardiologist. These counties tend to be more rural and socioeconomically disadvantaged, with a greater burden of cardiovascular disease.¹⁶

By partnering with health plans and healthcare providers, we're expanding access so everyone, regardless of location, can receive accurate diagnoses.

What are the 2–3 things you think everybody in healthcare needs to know about arrhythmia detection?

First, it's crucial to understand that the technology we use for arrhythmia detection has a significant impact on patient outcomes and healthcare costs. Event and Holter monitoring can waste not only patient time and money but also the resources of health plans.^4-7 We need to embrace modern technologies that offer LTCM, which can last up to 14 days and is in a class of its own. This kind of monitoring is essential for effective screening and early detection of arrhythmias.

Another critical aspect to consider is the connectivity of monitoring. It's not always apparent how early monitoring can affect the progression of diseases like congestive heart failure, AFib, and stroke. But, if we can draw clearer connections between monitoring modalities and these conditions, we might be able to predict and prevent many unwanted health events.

What should health plan leaders focus on now to stay ahead in arrhythmia detection?

Arrhythmias are often overlooked by health plan leaders, yet they are a critical health concern. AFib is up to three times more prevalent than previously thought, with at least 10.55 million American adults diagnosed with AFib.¹⁷ Given this high prevalence, it's clear that arrythmias require more attention. Despite this, there are no screening guidelines for arrhythmias, unlike annual mammograms for breast cancer, for example.

Health plan leaders should focus on creating policy without barriers to early detection and treatment of arrhythmias. Leaders should offer education around the latest technology, with emphasis on clinical results, time to diagnosis, and the utilization of healthcare resources. With U.S. healthcare payment models transitioning from volume to value, we can't afford to keep spinning our wheels with unproductive practices that don't improve patient outcomes.

Long-term continuous monitoring (LTCM) is a tool that can help us achieve the goals set by the Quintuple Aim, including reducing the total cost of care. It’s time for health plan leaders to overcome trepidation and start standardizing effective solutions that save money and lives. By partnering with the right brands and technologies, health plan leaders can significantly impact patient health outcomes and overall healthcare costs.

iRhythm is a leading digital healthcare company that creates trusted solutions that detect, predict, and prevent disease. iRhythm combines wearable biosensors and cloud-based data analytics with powerful proprietary algorithms that distill data from millions of heartbeats into clinically actionable information.

We focus on our people and our innovative technologies. We are passionate about improving and enhancing lives through better data and insights. At iRhythm, we are continually developing a diverse and engaged workforce. We believe in the richness and quality of a working environment that is informed by people from all walks of life.

iRhythm’s Zio^® service has an FDA-cleared deep learned (DL) algorithm that detects 13 types of arrhythmia classes as well as beat, beat types, and beat runs. This algorithm has also been evaluated as part of the CPT code validation process. The collected heartbeat data is analyzed by our algorithm and then reviewed by certified cardiographic technicians (CCTs), who help identify potential arrhythmia events, generate reports for medical review, and notify physicians of clinically actionable arrhythmias according to the ordering physician’s prescribed protocol.^8-11 Importantly, the Zio service aids physicians in accurately diagnosing cardiac heart rhythm disorders by bringing data, analysis, and clinical decision support together, to generate actionable data and reports. The value of the Zio service has been demonstrated in over 100 original scientific research manuscripts.⁸ A recent analysis of Medicare claims has demonstrated that LTCM is associated with the highest diagnostic yield and lowest rate of resting among ambulatory monitors, including Holter, AEM, and MCT.^4-7