Year: 2025
Type: article
Study design: Systematic Review
Abstract: Ambulatory cardiac monitoring (ACM) allows long-term electrocardiogram (ECG) monitoring to detect arrhythmias with different modalities, ranging from short-term Holter monitoring (up to 48 h) to long-term continuous patch ECG monitors (up to 14 days), external event recorders (up to 30 days), and implantable loop recorders (ILRs). Access and reimbursement for ACM across Europe are not well understood. We performed a systematic review and analysis to understand ACM reimbursement across Europe, including a review of the reimbursement systems in each country and a detailed inspection of clinical coding and provider reimbursement. Level of reimbursement is dependent on many factors, including clinical setting (inpatient, outpatient, and day case), hospital length of stay, diagnosis, complications/severity, geographical location, hospital type, and device model and manufacturer. In most countries, reimbursement is performed for the monitoring procedure itself, without considering the time extension of monitoring and the specific type of device used for monitoring. The monetary value of reimbursement varies by country for both ACM and ILR [for Holter from €17.49 to €939.78 and for ILR from €416.14 (provider reimbursement only) to €18,718 (provider reimbursement bundled with ILR device)]. Holter and ILR are universally reimbursed, but newer ACM technologies with extended duration of monitoring, including long-term continuous monitoring and event recorders, are not. Across Europe, we found large variation in monetary values for reimbursement for ACM and ILR. We also found limited reimbursement and access to longer-duration ACM technologies. These findings suggest heterogeneous and problematic access to evidence-based tools for longer-duration monitoring.
Institutions: University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Klinikum Coburg, University of Split, University of Bonn, München Klinik, University of Liverpool, Liverpool Heart and Chest Hospital, University of Basel, University Hospital of Basel, University of Leeds, Leeds Teaching Hospitals NHS Trust, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Krankenhaus der Elisabethinen, Liverpool John Moores University, Aalborg University
Language: English
Topic: ECG Monitoring and Analysis
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,725
OpenAlex ID: W4413852753