AMBULATORY CARDIAC MONITORING UTILIZATION AND GUIDELINE ALIGNMENT AMONG SYMPTOMATIC ARRHYTHMIA-NAIVE PATIENTS IN ENGLAND: A REAL-WORLD EVIDENCE STUDY
Author(s)
Pierantonio Russo, MD1, Ramaa Nathan, PhD1, Jake Clements, MPH2, Erik M. Hendrickson, PhD3, Angelina Irizari Policarpio, MBA, RN3, Genevieve Bean, PhD4.
1Eversana, Overland Park, KS, USA, 2IQVIA, London, United Kingdom, 3iRhythm Technologies, San Francisco, CA, USA, 4iRhythm Technologies, Bagshot, United Kingdom.
1Eversana, Overland Park, KS, USA, 2IQVIA, London, United Kingdom, 3iRhythm Technologies, San Francisco, CA, USA, 4iRhythm Technologies, Bagshot, United Kingdom.
OBJECTIVES: Ambulatory cardiac monitoring in England includes short-term Holter, extended Holter, event recorders, and implantable loop recorders (ILRs), with NICE/BHRS/ESC guidance informing device selection by symptom type. Evidence on monitoring patterns among newly symptomatic, arrhythmia-naive patients remains limited. This study assessed contemporary practice and guideline alignment across England.
METHODS: We conducted a retrospective cohort study using Hospital Episode Statistics (HES) from NHS England, accessed via IQVIA, covering April 2020 to February 2026. Eligible adults (≥18 years) had a qualifying cardiac symptom, at least one cardiovascular or metabolic risk factor, and no prior use of ambulatory cardiac monitors or arrhythmia diagnosis. We assessed monitoring rates by symptom cluster, modality distribution, major arrhythmia types, geographic variation across England regions and Integrated Care Boards, and alignment with NICE guideline recommendations.
RESULTS: Among 729,520 eligible patients, 32.9% were monitored and 105,185 (14.4%) had major arrhythmias. Breathing disorders (Cluster 3) were the largest cluster (n=301,605); among monitored patients, 35.7% received short-term and 8.7% extended Holter. For palpitations (Cluster 2), despite NICE NG196 supporting longer monitoring for less-frequent symptoms, 54.5% received only short-term Holter; 15.5% received extended Holter and 4.6% event monitoring. For syncope (Cluster 5), despite NICE CG109 recommending external or implantable event recording for infrequent episodes, 43.6% received short-term Holter, 11.6% extended Holter, and 12.1% ILR. Bradycardia (Cluster 1) was best aligned with 24-48-hour Holter guidance: 48.0% received short-term Holter. Among patients with major arrhythmias (105,185), monitoring ranged from 57.8% in London (9,070/15,685) to 32.7% in North East and Yorkshire (5,305/15,180), a 25.1 percentage-point gap. ICB rates ranged from 67.9% in South East London to 16.3% in Leicester, Leicestershire and Rutland.
CONCLUSIONS: Most symptomatic, arrhythmia-naive patients were not monitored, while short-term Holter predominated despite guideline support for longer monitoring. Substantial regional and ICB variation suggests inequities in access and guideline-concordant care across England.
METHODS: We conducted a retrospective cohort study using Hospital Episode Statistics (HES) from NHS England, accessed via IQVIA, covering April 2020 to February 2026. Eligible adults (≥18 years) had a qualifying cardiac symptom, at least one cardiovascular or metabolic risk factor, and no prior use of ambulatory cardiac monitors or arrhythmia diagnosis. We assessed monitoring rates by symptom cluster, modality distribution, major arrhythmia types, geographic variation across England regions and Integrated Care Boards, and alignment with NICE guideline recommendations.
RESULTS: Among 729,520 eligible patients, 32.9% were monitored and 105,185 (14.4%) had major arrhythmias. Breathing disorders (Cluster 3) were the largest cluster (n=301,605); among monitored patients, 35.7% received short-term and 8.7% extended Holter. For palpitations (Cluster 2), despite NICE NG196 supporting longer monitoring for less-frequent symptoms, 54.5% received only short-term Holter; 15.5% received extended Holter and 4.6% event monitoring. For syncope (Cluster 5), despite NICE CG109 recommending external or implantable event recording for infrequent episodes, 43.6% received short-term Holter, 11.6% extended Holter, and 12.1% ILR. Bradycardia (Cluster 1) was best aligned with 24-48-hour Holter guidance: 48.0% received short-term Holter. Among patients with major arrhythmias (105,185), monitoring ranged from 57.8% in London (9,070/15,685) to 32.7% in North East and Yorkshire (5,305/15,180), a 25.1 percentage-point gap. ICB rates ranged from 67.9% in South East London to 16.3% in Leicester, Leicestershire and Rutland.
CONCLUSIONS: Most symptomatic, arrhythmia-naive patients were not monitored, while short-term Holter predominated despite guideline support for longer monitoring. Substantial regional and ICB variation suggests inequities in access and guideline-concordant care across England.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
RWD157
Topic
Epidemiology & Public Health, Medical Technologies, Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)