Abstract Body: Introduction: Ambulatory continuous electrocardiographic (ECG) monitoring is commonly used to diagnose cardiac arrhythmias, assess arrhythmia burden, and evaluate cardiovascular therapeutic effectiveness. Novel ‘patch’ ECG monitors and mobile cardiac telemetry (MCT) facilitate long-term monitoring for 3 to 14 and 30 days respectively with greater user convenience compared to traditional lead-based Holter devices (<72 hours), although it is debated whether longer monitoring is cost-effective and improves health outcomes in different patients. We aimed to describe temporal trends and patterns of ambulatory continuous ECG monitor use in the United States.

Methods: We conducted a retrospective cohort study with integrated longitudinal electronic health record data from individuals in the general population who received health care across 340 sites in the All of Us Research Program in the United States. We examined trends in the utilization of ambulatory continuous ECG monitors and characteristics of incident users by device type between 2009 and 2022.

Results: Among 393,451 persons (mean age 52 years, 61% female, 53% White adults), the proportion with long-term 3-14-day monitor use following a clinical visit occurrence increased from 0 in 2009 to 6.6‰ in 2022 (p_trend<0.001), a trend that was consistent but more pronounced in those following incident arrhythmia diagnoses (up to 38‰ in 2022; n=71,703) compared to those without (Figure 1). The use of 24-48-hour monitors and MCTs was relatively unchanged during this time. Comparing between 13,886, 7,568, and 386 incident users of 24-48-hour, 3-14-day, and MCT monitors, respectively, 24-48-hour and 3-14-day monitor users more frequently had preceding palpitations, while MCT users more frequently had a history of cerebrovascular accident (Table 1). In subsets of patients with specific cardiovascular diseases, the increase in 3-14-day monitor use was most substantial following diagnoses of supraventricular tachyarrhythmias (up to 48‰ in 2022; Figure 2A). The use of 24-48-hour monitors decreased but was most common following diagnoses of premature beats (66‰ in 2009 to 41‰ in 2022; Figure 2B).

Conclusions: Long-term ambulatory ECG monitor use increased substantially from 0 in 2009 to 6.6‰ in 2022 in the United States general population due to the growth of 3-14-day monitoring likely from patch ECG device use. These findings highlight the importance of studies to further optimize long-term ambulatory ECG monitor use.