Objective data comparing the diagnostic performance of different ambulatory cardiac monitors (ACMs) are lacking. To assess variation in monitoring strategy, clinical outcomes and healthcare utilization in patients undergoing ambulatory monitoring without a pre-existing arrhythmia diagnosis. 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. 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). 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.

中文翻译：

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医疗保险受益人动态心脏监测策略的比较有效性和医疗保健利用率

缺乏比较不同动态心脏监护仪（ACM）诊断性能的客观数据。评估在没有预先存在心律失常诊断的情况下接受门诊监测的患者的监测策略、临床结果和医疗保健利用的变化。使用医疗保险索赔数据的完整样本 (100%)，我们对 2017 年至 2018 年首次接受 ACM 诊断的患者进行了一项回顾性队列研究，并在 3 个月时评估心律失常遭遇诊断，在 6 个月时重复 ACM 测试、全因 90 天急诊科 (ED) 和住院患者的利用率，以及不同策略的成本：动态心电图；长期连续监测（LTCM）；非连续、基于事件的外部动态事件监测器 (AEM)；和移动心脏遥测（MCT）。其次，我们对制造商进行了特定于设备的分析，通过独特的声明修饰符代码进行识别。 287,789 名患者使用了 ACM（AEM = 10.3%；Holter = 53.8%；LTCM = 13.3%；MCT = 22.5%）。针对特定设备的分析表明，与 Holter、AEM、MCT 或其他 LTCM 制造商相比，特定 LTCM（Zio XT 14 天补丁，iRhythm Technologies，旧金山，加利福尼亚州）的调整后诊断几率最高，调整后诊断几率最低。 ACM 重新测试。室性心动过速、房室传导阻滞和阵发性心房颤动等特定心律失常诊断的结果是一致的。作为一个类别，LTCM 与 1 年增量医疗保健支出最低相关（平均 Δ$10,159），其次是 Holter（10,755 美元）、AEM（11,462 美元）和 MCT（12,532 美元）。诊断监测策略存在很大差异。特定的 LTCM 与新心律失常诊断的最高调整赔率和重复 ACM 测试的最低调整赔率相关。 LTCM 作为一个类别，急性护理利用率增量最低。不同的监测策略可能会在诊断和护理方面产生不同的结果。