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iRhythm: Providing solutions for arrhythmias

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iRhythm is a MedTech company that began in the United States to provide digital healthcare solutions for patients with suspected arrhythmias.

It launched its service, Zio XT, in the UK market, over 6 years ago to support the identification and clinical diagnosis of arrhythmias, such as atrial fibrillation (AF).

Here, iRhythm gives SR Times insight into the inspiration behind its founding and how its technology helps with stroke prevention.

What was the inspiration behind iRhythm?

Patients.  iRhythm Technologies puts the patient at the heart of everything they do.  From the patient centric design of the Zio device, to the streamlined service so patients get the answers they need fast.

iRhythm became the first organisation to go through NICE’s brand new Digital Health Tech Pilot scheme, receiving NICE guidance in 2020.  The programme aims to evaluate the clinical, operational and financial effectiveness of MedTech devices looking to become more widely adopted in the NHS,

In the same year, iRhythm applied for funding via the Government’s Artificial Intelligence (AI) in Health and Care Award. iRhythm was announced as a phase four winner of the Award to evaluate its Zio XT service at selected NHS sites, with the aim to collect real world evidence to inform commissioning decisions   

iRhythm’s primary objective is to support individuals with suspected cardiac arrhythmias, to prevent them from having potentially life-threatening future events, such as strokes. Considering that heart and circulatory diseases cause a quarter of all deaths in the UK (approximately 460 deaths every day in the UK).

We also have a mission in the UK; to support sites across the NHS to reduce cardiology backlogs. This is particularly important as, from February 2023, 361,293 people across England have been waiting for initial cardiology appointments; an increase of 137,640 people since before the Covid-19 pandemic in January 2020.  

iRhythm has real-world data which demonstrates the material impact it has had on NHS waiting times. One of the sites to have utilised Zio XT via the AI in Health and Care Award was Liverpool Heart and Chest Hospital, which has been able to reduce patient waiting lists from as high as eight weeks, to just a matter of days. This is despite concerns that this figure could have greatly increased during the Covid-19 pandemic.

Can you tell us about iRhythm’s technology and how it works?

Zio XT is an ambulatory electrocardiogram (ECG) monitor that provides a unique service to enable clinicians to diagnose arrhythmias more quickly and efficiently than traditional technologies, such as Holter devices. This reduces the need for multiple indeterminate tests, while enabling sufficient medical interventions.

The device is worn by patients for up to 14 days, recording heart rhythm data continuously whilst patients continue daily activities.  After the prescribed wear period, patients simply post the monitor back to iRhythm. iRhythm’s team of cardiac technicians use a highly advanced AI algorithm to analyse the heart rhythm data and curate this information into a clinically actionable report.  The Zio XT service streamlines clinical pathways to support a fast, accurate and efficient arrhythmia diagnosis.

Last year, data from trial funding of Zio XT at Liverpool Heart and Chest Hospital was revealed at the European Society of Cardiology’s 2022 Congress. This demonstrated the device’s efficiency compared to traditional Holter methods:

  • Zio was associated with a significant reduction in out-patient follow-up appointments, by 70.1 per cent vs. 87 per cent.
  • Results took 25 less days to produce a conclusive result with Zio XT compared to a Holter.

How does your technology help stroke survivors?

iRhythm’s technology, Zio XT, helps patients before extremely serious medical events take place, such as strokes. The service is a diagnostic tool to help clinical teams make a fast and accurate arrhythmia diagnosis, or rule out if an arrhythmia is present, meaning patients can be put on the right treatment path, fast.  Traditional methods of monitoring such a Holter can present challenges when making a clinical diagnosis.

A Holter is a portable ECG that records and monitors heart activity, typically for 24/48hrs. Electrodes, which are small patches that stick to the skin, are placed on the patient’s chest connected to a bulky monitor via leads and wires.  As you can imagine, this can be clunky, burdensome and noticeable, making it more challenging for patients to continue with daily activities.  The typically short monitoring period also restricts the available data to make an accurate diagnosis, resulting in inconclusive results or the need to repeat test. This is the standard heart monitoring device which is ordinarily used across NHS hospitals, despite evidence suggesting they can be 37.9 per cent less effective in detecting arrhythmias than with Zio XT.  

The longer monitoring period of a Zio XT device (up to 14 days), compared to that of a Holter (up to 48 hours), provides a fuller, more accurate picture of patients’ heart rhythm, considering it is certainly possible for conditions to be picked up after two days of wearing a monitor.

For example, one of iRhythm’s patients had a heart condition picked up by Zio XT on day 10 of continuous monitoring. They were fitted with a Zio XT monitor as part of the AI in Health and Care Award, and the AI algorithm detected a 28 second period in which the patient’s heart had stopped beating while they were sleeping. This is known as ventricular asystole, and can lead to a sudden cardiac arrest if left untreated. It is more likely for patients who have suffered from an acute stroke to be vulnerable to sudden cardiac death.

The data was reviewed by one of iRhythm’s physiologists, and the patient’s physician was notified of the issue. This patient was brought into hospital, where they were fitted with a pacemaker and the condition was treated effectively.

Without iRhythm’s unique ability to monitor a patient for up to 14 uninterrupted days, their condition would have remained undiagnosed and untreated.

[The green line above shows the Zio XT’s AI algorithm detecting the 28 second period where the patient’s heart stopped beating] 

Is machine learning, artificial intelligence and a more digitised environment the answer to crack rising healthcare costs?

MedTech is certainly a solution to counteracting rising costs within the health industry, particularly cardiology.

2022 research has indicated that AF is expected to directly cost the NHS a minimum of £1.435 billion, and a maximum of £2.548 billion per year, accounting for approximately 1.6 per cent of all NHS expenditure. What’s for certain is that, over the coming years, AF is highly likely to impose a growing cost on NHS budgets and the wider UK healthcare system, unless hospitalisations are reduced.

As mentioned previously, an AF diagnosis makes it five times more likely that individuals will suffer from a stroke, which also costs the NHS considerable time and resources let alone the impact to patients and their families. In fact, the NHS has estimated that strokes cost the entire UK healthcare system approximately £3 billion every single year, in addition to a further £4 billion in lost productivity, disability and informal care.

MedTech and devices such as Zio XT have been proven time and time again to be able to improve detection, reduce waiting times and repeat testing while improving the utilisation of clinician time and resources.

What is next for iRhythm?

Having secured funding via the AI in Health and Care Award, iRhythm has been able to support patients at sites across England, including in East Kent, Barts, Liverpool Heart and Chest, Gloucester and Southampton.  The real world evidence this has generated, proving Zio XT to be a scalable and consistently reliable service that improves clinical, operational and financial efficiencies will support wider adoption.

Our objective is to secure long-term commissioning of Zio XT across these sites, as well as in other parts of the UK. We want to be able to support those with suspected arrhythmias on a nationwide basis, improving patient access to monitoring so that faster and more accurate diagnoses can be made.

However, the journey to long-term funding is not straightforward.  We will therefore continue to liaise with healthcare decision makers, and navigate all appropriate ways to ensure patient across the UK have access to Zio XT and the faster and more accurate arrhythmia diagnosis it supports.

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