For CV service line and system leaders, these changes create both new expectations and new opportunities. As payers bring health systems into TCOC and specialty-focused value-based arrangements, healthcare executives are increasingly looking to cardiology leaders to identify sources of avoidable cost, improve care coordination, and support population health goals. Success in these models will depend on cardiology's ability to move beyond procedural care and play a more active role in managing CV risk across patient populations.

Early arrythmia detection is an underutilized tactic for meeting TCOC pressures. Advances in ambulatory ECG monitoring and wearable technologies are making earlier CV risk identification more scalable,^5,6 helping providers identify risk sooner and intervene earlier.⁶

Atrial Fibrillation (AF) frequently presents in acute-care settings; nearly half of AF-related ED visits in a nationwide analysis resulted in inpatient admission, and CDC reports more than 454,000 annual hospitalizations with AF as the primary diagnosis.^7,8 Earlier diagnosis may give providers time to intervene and manage risk before patients enter the system through a crisis event.

In a retrospective Medicare analysis, a long-term continuous monitoring strategy (of up to 14 days) was associated with higher odds of a new arrhythmia diagnosis within 90 days and lower incremental acute-care utilization, compared with other ambulatory cardiac monitoring modalities.⁹

By identifying patients before they present through a crisis event, these capabilities can help shift diagnosis and management from high-cost acute settings to more proactive outpatient care.

While earlier diagnosis can help move care upstream, it may also reduce the downstream costs associated with delayed arrhythmia identification. For example, undiagnosed atrial fibrillation alone is estimated to cost the U.S. healthcare system $3 billion annually, highlighting the potential value of earlier detection and intervention.¹⁰

The financial impact of arrhythmias often extends beyond initial diagnosis, with downstream events contributing to higher TCOC, avoidable utilization, and performance challenges in risk-based contracts.

Earlier diagnosis supports goals common to Medicare Advantage, accountable care organizations (ACOs), Medicare Shared Savings Program (MSSP), and other risk-based models by reducing avoidable utilization and improving management of high-risk populations.^4,11

Patients may be more likely to trust and return to the clinician who identifies the problem, guides next steps, and coordinates specialty care. Proactive diagnosis often allows primary care to serve as the "quarterback" of care, directing patients to specialty support when needed and bringing them back into longitudinal care afterward. Thoughtful workup before referral may reduce unnecessary specialty visits, improve specialist access, and help keep care within the organization.

Organizations should first determine whether arrhythmia represents a meaningful source of unmanaged risk within their population by asking themselves:

• Where do care gaps, avoidable utilization, or specialist access challenges create opportunities for earlier detection?
• How often are arrhythmias being diagnosed after an ED visit, hospitalization, stroke, or other acute event rather than through planned outpatient care?
• Which populations generate the highest CV utilization and may be at risk for delayed arrhythmia diagnosis?

Patients with diabetes, heart failure, chronic obstructive pulmonary disease, chronic kidney disease, coronary artery disease, and cardiovascular-kidney-metabolic syndrome represent key populations for earlier arrhythmia detection.¹²

Earlier detection only creates value when organizations have clear processes to act on the findings. While many PCPs are comfortable identifying potential concerns, they often need guidance on which patients should be monitored, how findings should be interpreted, and when specialty escalation is warranted.

Establishing PCP-cardiology workflows can provide that support while enabling PCPs to manage lower-acuity findings and preserving specialist capacity. Clear interpretation and routing protocols can further reduce uncertainty, inconsistent follow-up, redundant testing, and unnecessary referrals by ensuring abnormal findings receive appropriate follow-up without automatically generating a cardiology referral.

iRhythm is a leading digital health care company that creates solutions that detect, predict, and prevent disease. Combining wearable biosensors and cloud-based data analytics with powerful proprietary algorithms, iRhythm distills data from millions of heartbeats into clinically actionable information. Through a relentless focus on patient care, iRhythm’s vision is to deliver better data, better insights, and better health for all. Learn more about iRhythm’s Population Health Solutions for Arrhythmia Detection.

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