Virtual enrollment for ambulatory ECG patch monitors: trends in the real world

U.S. Veterans experience transportation-related healthcare barriers due to rurality, longer travel distances, and limited transportation options, that are worsened by older age, poor health status and financial burden. Large digital health trials have used 100% virtual / home enrollment (VHE) that included mailed, self-applied ambulatory ECG patch monitors. The adoption of VHE of ambulatory ECG patch monitors has not been examined in a real-world population.

To understand the trends of virtual / home enrollment for ambulatory ECG patch monitors in a real-world setting.

Administrative data at a tertiary care Veterans Administration Healthcare System was queried for numbers of ambulatory ECG patch monitors over time between 2011 and 2024, as well as for VHE from inception of the ambulatory ECG patch monitor VHE program in April 2020 (start of the COVID-19 pandemic) through end of fiscal year (FY) 2024. Chi-square was used to determine statistical significance.

Between FY2011-FY2024 there were a total of 21,953 ambulatory ECGs placed; by FY2020 >90% were ambulatory ECG patch monitors (panel A). After VHE began there has been a total of 9,658 ambulatory ECG patch monitors placed, 4,995 (51.7%) of which were VHE. Highest VHE was January 2021 (82%) during the 2nd wave of the COVID-19 pandemic and the lowest VHE was May 2024 (30%). There appeared to be a plateau between March 2021 through October 2023, with possible seasonal fluctuation thereafter (Panel B). VHE was 72% (624 of 861) in FY 2020, decreased significantly to 59% (1216 of 2049) in FY 2021 (p<0.001), to 49% (973 of 1987) in FY 2022 (p<0.001), remained at 50% (1145 of 2290) in FY 2023, and decreased further to 42% (1039 of 2471) in FY 2024 (p<0.001) (Panel C).

Virtual / home enrollment and self-application of ambulatory patch ECG monitoring has been highly adopted by a real-world Veteran population, with >50% choosing virtual enrollment with self-application at home over in-clinic application of devices since the inception of the VHE program. While trends show a significant decrease of VHE over time, >40% still choose VHE despite the end of the COVID-19 pandemic. Future studies of VHE should be performed to evaluate its potential impact on transportation-related healthcare inequities.

Trends Ambulatory ECG VHE