Journal of Health & Medical Economics

Cardiac Ambulatory Monitoring and Hospital Quality (CAMELOT IQ): Strategies for Reducing Length of Stay and Readmissions

Importance: Early and accurate detection of cardiac arrhythmias via Ambulatory Cardiac Monitoring (ACM) may reduce hospital Length Of Stay (LOS) and 30-day readmissions, yet the differences in monitoring modality on key inpatient quality indicators remains poorly characterized. Objective: To evaluate variation in hospital LOS and 30-day readmission rates among Medicare fee-for-service beneficiaries undergoing first-time ACM, comparing different monitor types and manufacturers. Design: Retrospective cohort analysis of administrative claims data. We compared absolute values and adjusted Incidence Rate Ratios (aIRRs) for acute inpatient days and 30-day readmissions during a 12-month baseline period vs. annualized follow-up, using generalized linear models with log-link and negative-binomial distribution. Settings: U.S. Medicare fee-for-service claims, 2016–2023. Participants: 287,789 diagnostic-naïve Medicare beneficiaries aged ≥65 years receiving a first ACM, categorized by monitor type: Holter (53.8%), mobile continuous telemetry (MCT; 22.5%), long-term continuous monitor (LTCM; 13.3%), and external event monitor (AEM; 10.3%). The largest manufacturerspecific cohort was an LTCM device (10.8%). Exposures: First-time use of ACM, stratified by monitoring modality and manufacturer; iRhythm LTCM served as the reference. Main outcome: (1) Hospital LOS in days; (2) 30-day readmission counts. Secondary economic implications were estimated, assuming $3,000 per hospital day and $16,037 per readmission. Conclusions and relevance: Hospital length of stay and 30-day readmission rates differed significantly across monitoring modalities and manufacturers. Use of iRhythm Long-Term Continuous Monitoring (LTCM) was associated with shorter hospitalizations and fewer readmissions compared with other ACM strategies. These findings suggest that strategic selection of ACM may influence inpatient quality outcomes. Value-based care programs and guideline committees should consider incorporating such real-world evidence when developing recommendations for arrhythmia monitoring.

Author(s): Erik Hendrickson*, Iman Mohammadi, Brent Wright, Kenneth Boyle

Abstract | PDF

Share this