Comparative effectiveness and healthcare utilization for ambulatory cardiac monitoring strategies in Medicare beneficiaries
Authors: Matthew R. Reynolds, MD, Rod Passman, MD, Jason Swindle, PhD, Iman Mohammadi, PhD, Brent Wright, DrPHc, Kenneth Boyle, DC Mintu P. Turakhia, MD and Suneet Mittal, MD.
Summary:
Real World Evidence study on 287,789 Medicare patients comparing diagnostic performance of different ambulatory cardiac monitors.
Key Findings:
- Usage breakdown: LTCM 13.3%, Holter 53.8%, MCT 22.5%, Event 10.3%.
- LTCM was associated with the highest diagnostic yield, lowest retest rate, and lowest 1 year incremental health care costs with Zio outperforming all other LTCM monitors (identified by NPI#).
- Diagnostic yield adjusted odds ratios at 90 days with Zio XT being reference (based on arrhythmias part of
HCC 96; PACs, PVCs, unspecified bradycardia or tachycardia are not included): LTCM (non-iRhythm) 0.77,
MCT 0.67, Event 0.58, Holter 0.5.
HCC 96; PACs, PVCs, unspecified bradycardia or tachycardia are not included): LTCM (non-iRhythm) 0.77,
MCT 0.67, Event 0.58, Holter 0.5.
- Retest rates compared to Zio XT at 180 days: Non-Zio LTCM 3.66 x more likely, Holter 1.35 x more likely,
Event 4.27 x more likely, MCT 3 x more likely.
Event 4.27 x more likely, MCT 3 x more likely.
- HCRU difference-in-differences between LTCM and other cohorts from baseline to follow-up at 1 year:, Holter,
External AEM, and MCT all had higher mean hospitalizations (0.08, 0.10, 0.09, respectively);
ED visits (0.18, 0.04, 0.08, respectively); and outpatient visits (0.92, 0.89, 1.17, respectively).
External AEM, and MCT all had higher mean hospitalizations (0.08, 0.10, 0.09, respectively);
ED visits (0.18, 0.04, 0.08, respectively); and outpatient visits (0.92, 0.89, 1.17, respectively).
