{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T02:08:12Z","timestamp":1792202892682,"version":"4.4.0"},"reference-count":67,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,8,30]],"date-time":"2025-08-30T00:00:00Z","timestamp":1756512000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006983","name":"iRhythm Technologies Inc.","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006983","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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 \u20ac17.49 to \u20ac939.78 and for ILR from \u20ac416.14 (provider reimbursement only) to \u20ac18,718 (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.<\/jats:p>","DOI":"10.1093\/ehjdh\/ztaf102","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T11:41:25Z","timestamp":1756467685000},"page":"1282-1292","source":"Crossref","is-referenced-by-count":6,"title":["Access and reimbursement of ambulatory cardiac monitoring across Europe"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9820-4815","authenticated-orcid":false,"given":"Giuseppe","family":"Boriani","sequence":"first","affiliation":[{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena , Via del Pozzo, 71, Modena 41124 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Brachmann","sequence":"additional","affiliation":[{"name":"Medical School Regiomed, Regiomed-Kliniken Coburg Germany and University of Split School of Medicine , Split ,","place":["Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4056-6696","authenticated-orcid":false,"given":"Thorsten","family":"Lewalter","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Intensive Unit Care, Hospital Munich South, Peter Osypka Heart Center , Munich ,","place":["Germany"]},{"name":"Department of Cardiology, University of Bonn , Bonn ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J","family":"Wright","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital , Liverpool ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9751-0557","authenticated-orcid":false,"given":"Patrick","family":"Badertscher","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Basel, University of Basel , Basel ,","place":["Switzerland"]},{"name":"Cardiovascular Research Institute Basel, University Hospital Basel , Basel ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4732-382X","authenticated-orcid":false,"given":"Chris P","family":"Gale","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Leeds Teaching Hospitals NHS Trust , Leeds ,","place":["UK"]},{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1737-1903","authenticated-orcid":false,"given":"Jos\u00e9 Luis","family":"Merino","sequence":"additional","affiliation":[{"name":"La Paz University Hospital, Universidad Aut\u00f3noma de Madrid, Idipaz , Madrid ,","place":["Spain"]},{"name":"Cardiology, Hospital Viamed Santa Elena , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helmut","family":"P\u00fcrerfellner","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology, Ordensklinikum Linz Elisabethinen , Linz ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory Y H","family":"Lip","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital , Liverpool ,","place":["UK"]},{"name":"Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University , Aalborg ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,8,30]]},"reference":[{"key":"2025111918512318100_ztaf102-B1","first-page":"1","article-title":"Long-term continuous ambulatory ECG monitors and external cardiac loop recorders for cardiac arrhythmia: a health technology assessment","volume":"17","author":"Health Quality Ontario","year":"2017","journal-title":"Ont Health Technol Assess Ser"},{"key":"2025111918512318100_ztaf102-B2","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1093\/europace\/euac144","article-title":"Searching for atrial fibrillation: looking harder, looking longer, and in increasingly sophisticated ways. An EHRA position paper","volume":"25","author":"Kalarus","year":"2023","journal-title":"Europace"},{"key":"2025111918512318100_ztaf102-B3","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1056\/NEJMra2301903","article-title":"Wearable digital health technologies for monitoring in cardiovascular medicine","volume":"390","author":"Spatz","year":"2024","journal-title":"N Engl J Med"},{"key":"2025111918512318100_ztaf102-B4","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1093\/europace\/euac038","article-title":"How to use digital devices to detect and manage arrhythmias: an EHRA practical guide","volume":"24","author":"Svennberg","year":"2022","journal-title":"Europace"},{"key":"2025111918512318100_ztaf102-B5","doi-asserted-by":"crossref","first-page":"1721","DOI":"10.1093\/europace\/euac088","article-title":"Clinical applications of heart rhythm monitoring tools in symptomatic patients and for screening in high-risk groups","volume":"24","author":"Carrington","year":"2022","journal-title":"Europace"},{"key":"2025111918512318100_ztaf102-B6","doi-asserted-by":"crossref","first-page":"e55","DOI":"10.1016\/j.hrthm.2017.03.038","article-title":"2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring\/telemetry","volume":"14","author":"Steinberg","year":"2017","journal-title":"Heart Rhythm"},{"key":"2025111918512318100_ztaf102-B7","doi-asserted-by":"crossref","first-page":"49","DOI":"10.33963\/KP.a2021.0182","article-title":"Diagnostic yield is dependent on monitoring duration. Insights from a full-disclosure mobile cardiac telemetry system","volume":"80","author":"Dziubi\u0144ski","year":"2022","journal-title":"Kardiol Pol"},{"key":"2025111918512318100_ztaf102-B8","doi-asserted-by":"crossref","first-page":"95.e11","DOI":"10.1016\/j.amjmed.2013.10.003","article-title":"Comparison of 24-hour Holter monitoring with 14-day novel adhesive patch electrocardiographic monitoring","volume":"127","author":"Barrett","year":"2014","journal-title":"Am J Med"},{"key":"2025111918512318100_ztaf102-B9","first-page":"251","article-title":"Comparison of arrhythmia detection by 24-hour Holter and 14-day continuous electrocardiography patch monitoring","volume":"36","author":"Chua","year":"2020","journal-title":"Acta Cardiol Sin"},{"key":"2025111918512318100_ztaf102-B10","doi-asserted-by":"crossref","first-page":"14","DOI":"10.33963\/KP.a2022.0202","article-title":"Prevalence of atrial fibrillation in the 65 or over Polish population. Report of cross-sectional NOMED-AF study","volume":"81","author":"Kalarus","year":"2023","journal-title":"Kardiol Pol"},{"key":"2025111918512318100_ztaf102-B11","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1016\/j.amjcard.2013.04.017","article-title":"Diagnostic utility of a novel leadless arrhythmia monitoring device","volume":"112","author":"Turakhia","year":"2013","journal-title":"Am J Cardiol"},{"key":"2025111918512318100_ztaf102-B12","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.amjcard.2021.11.027","article-title":"Diagnostic yield, outcomes, and resource utilization with different ambulatory electrocardiographic monitoring strategies","volume":"166","author":"Gupta","year":"2022","journal-title":"Am J Cardiol"},{"key":"2025111918512318100_ztaf102-B13","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.ahj.2023.12.002","article-title":"Comparative effectiveness and healthcare utilization for ambulatory cardiac monitoring strategies in medicare beneficiaries","volume":"269","author":"Reynolds","year":"2024","journal-title":"Am Heart J"},{"key":"2025111918512318100_ztaf102-B14","author":"NHS England"},{"key":"2025111918512318100_ztaf102-B15"},{"key":"2025111918512318100_ztaf102-B16"},{"key":"2025111918512318100_ztaf102-B17","author":"Federal Statistical Office (Bundesamt f\u00fcr Statistik [BFS])"},{"key":"2025111918512318100_ztaf102-B18","author":"Dutch Healthcare Institute (Zorg Instituut Nederland [ZIN])"},{"key":"2025111918512318100_ztaf102-B19","author":"Federal Institute for Drugs and Medical Devices (Bundesinstitut f\u00fcr Arzneimittel und Medizinprodukte [BfArM])"},{"key":"2025111918512318100_ztaf102-B20","author":"Technical Agency for Information on Hospital Care (Agence technique de l'information sur l'hospitalisation [ATIH])"},{"key":"2025111918512318100_ztaf102-B21","author":"The National Board of Health and Welfare (Socialstyrelsen)"},{"key":"2025111918512318100_ztaf102-B22","author":"NHS England"},{"key":"2025111918512318100_ztaf102-B23","author":"Italian Portal of Health Classifications (Portale Italiano delle Classificazioni Sanitarie)"},{"key":"2025111918512318100_ztaf102-B24","author":"Federal Statistical Office (Bundesamt f\u00fcr Statistik [BFS])"},{"key":"2025111918512318100_ztaf102-B25"},{"key":"2025111918512318100_ztaf102-B26"},{"key":"2025111918512318100_ztaf102-B27","author":"Federal Institute for Drugs and Medical Devices (Bundesinstitut f\u00fcr Arzneimittel und Medizinprodukte [BfArM])"},{"key":"2025111918512318100_ztaf102-B28","year":"2025"},{"key":"2025111918512318100_ztaf102-B29","year":"2025"},{"key":"2025111918512318100_ztaf102-B30","author":"The National Board of Health and Welfare (Socialstyrelsen)"},{"key":"2025111918512318100_ztaf102-B31","author":"NHS England"},{"key":"2025111918512318100_ztaf102-B32","author":"Swiss DRG"},{"key":"2025111918512318100_ztaf102-B33","author":"Swiss DRG"},{"key":"2025111918512318100_ztaf102-B34","author":"Dutch Healthcare Authority (Nederlandse Zorgautoriteit [NZA])"},{"key":"2025111918512318100_ztaf102-B35","author":"Dutch Healthcare Authority (Nederlandse Zorgautoriteit [NZA])"},{"key":"2025111918512318100_ztaf102-B36","author":"Institute for the Hospital Remuneration System (Institut f\u00fcr das Entgeltsystem im Krankenhaus [InEK])"},{"key":"2025111918512318100_ztaf102-B37","author":"Institute for the Hospital Remuneration System (Institut f\u00fcr das Entgeltsystem im Krankenhaus [InEK])"},{"key":"2025111918512318100_ztaf102-B38","author":"The National Board of Health and Welfare (Socialstyrelsen)"},{"key":"2025111918512318100_ztaf102-B39","author":"NHS England"},{"key":"2025111918512318100_ztaf102-B40","author":"Ministry of Health (Ministero della Salute)"},{"key":"2025111918512318100_ztaf102-B41","author":"Emilia-Romagna Region"},{"key":"2025111918512318100_ztaf102-B42","author":"Region of Venice"},{"key":"2025111918512318100_ztaf102-B43","author":"Lombardy Region"},{"key":"2025111918512318100_ztaf102-B44","author":"French National Authority for Health (Haute Autorit\u00e9 de Sant\u00e9 [HAS])"},{"key":"2025111918512318100_ztaf102-B45","author":"French State Healthcare (L'Assurance Maladie)"},{"key":"2025111918512318100_ztaf102-B46","author":"French State Healthcare (L'Assurance Maladie)"},{"key":"2025111918512318100_ztaf102-B47","author":"Technical Agency for Information on Hospital Care (Agence technique de l'information sur l'hospitalisation [ATIH])"},{"key":"2025111918512318100_ztaf102-B48","author":"Technical Agency for Information on Hospital Care (Agence technique de l'information sur l'hospitalisation [ATIH])"},{"key":"2025111918512318100_ztaf102-B49","author":"Emilia-Romagna Region"},{"key":"2025111918512318100_ztaf102-B50","author":"Region of Venice"},{"key":"2025111918512318100_ztaf102-B51","author":"Lombardy Region"},{"key":"2025111918512318100_ztaf102-B52","author":"Swedish Association of Local Authorities and Regions (Sveriges Kommuner och Regioner S. Swedish Association of Local Authorities and Regions"},{"key":"2025111918512318100_ztaf102-B53","author":"The National Board of Health and Welfare (Socialstyrelsen)"},{"key":"2025111918512318100_ztaf102-B54"},{"key":"2025111918512318100_ztaf102-B55","author":"Amsterdam University Medical Center"},{"key":"2025111918512318100_ztaf102-B56","author":"Leiden University Medical Center"},{"key":"2025111918512318100_ztaf102-B57","author":"Maastricht University Medical Center"},{"key":"2025111918512318100_ztaf102-B58","author":"National Association of Statutory Health Insurance Physicians (Gemeinsame Einrichtung [KVG])"},{"key":"2025111918512318100_ztaf102-B59","author":"Organisation of outpatient medical tariffs (Organisation ambulante \u00c4rztetarife [OAAT AG])"},{"key":"2025111918512318100_ztaf102-B60","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.1093\/eurheartj\/eht031","article-title":"Health technology assessment in interventional electrophysiology and device therapy: a position paper of the European heart rhythm association","volume":"34","author":"Boriani","year":"2013","journal-title":"Eur Heart J"},{"key":"2025111918512318100_ztaf102-B61","doi-asserted-by":"crossref","first-page":"euae031","DOI":"10.1093\/europace\/euae031","article-title":"Economic analyses in cardiac electrophysiology: from clinical efficacy to cost utility","volume":"26","author":"Frausing","year":"2024","journal-title":"Europace"},{"key":"2025111918512318100_ztaf102-B62","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1007\/s41669-021-00311-5","article-title":"Similarities and differences in health technology assessment systems and implications for coverage decisions: evidence from 32 countries","volume":"6","author":"Fontrier","year":"2022","journal-title":"Pharmacoecon Open"},{"key":"2025111918512318100_ztaf102-B63","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1136\/emermed-2018-207570","article-title":"Diagnostic yield of an ambulatory patch monitor in patients with unexplained syncope after initial evaluation in the emergency department: the PATCH-ED study","volume":"35","author":"Reed","year":"2018","journal-title":"Emerg Med J"},{"key":"2025111918512318100_ztaf102-B64","doi-asserted-by":"crossref","first-page":"euad297","DOI":"10.1093\/europace\/euad297","article-title":"Length of hospital stay for elective electrophysiological procedures: a survey from the European heart rhythm association","volume":"25","author":"Boriani","year":"2023","journal-title":"Europace"},{"key":"2025111918512318100_ztaf102-B65","doi-asserted-by":"crossref","first-page":"1834","DOI":"10.1093\/europace\/euac142","article-title":"Reimbursement practices for use of digital devices in atrial fibrillation and other arrhythmias: a European heart rhythm association survey","volume":"24","author":"Boriani","year":"2022","journal-title":"Europace"},{"key":"2025111918512318100_ztaf102-B66","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1093\/europace\/euac062","article-title":"Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation: the 8th AFNET\/EHRA consensus conference","volume":"25","author":"Schnabel","year":"2023","journal-title":"Europace"},{"key":"2025111918512318100_ztaf102-B67","author":"Institute for the Hospital Remuneration System (Institut f\u00fcr das Entgeltsystem im Krankenhaus [InEK])"}],"container-title":["European Heart Journal - Digital Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjdh\/advance-article-pdf\/doi\/10.1093\/ehjdh\/ztaf102\/64165053\/ztaf102.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjdh\/article-pdf\/6\/6\/1282\/64165053\/ztaf102.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjdh\/article-pdf\/6\/6\/1282\/64165053\/ztaf102.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T23:51:31Z","timestamp":1763596291000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjdh\/article\/6\/6\/1282\/8244473"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,30]]},"references-count":67,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,8,30]]},"published-print":{"date-parts":[[2025,11,20]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjdh\/ztaf102","relation":{},"ISSN":["2634-3916"],"issn-type":[{"value":"2634-3916","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,11]]},"published":{"date-parts":[[2025,8,30]]}}}