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iRhythm Technologies (NASDAQ: IRTC) this week announced a landmark publication in
*Heart Rhythm* and unveiled new data at the AHA Scientific Sessions 2025, underscoring
the growing importance of long-term continuous monitoring in cardiac care.
The *Heart Rhythm* study, analyzing data from over 1.1 million patients utilizing iRhythm’s
Zio long-term continuous monitoring (LTCM) system, revealed critical shortcomings in
traditional 24–48 hour monitoring. The data demonstrated that a significant proportion
(64%) of daily-symptom patients with actionable arrhythmias were not detected within the
initial 48 hours. Furthermore, the average time required to detect the first arrhythmia
exceeded 48 hours across all arrhythmia types, while symptom–rhythm correlation stood at
a mere 20%, raising questions about the efficacy of symptom-guided monitoring.
The AHA presentations offered supporting evidence for the adoption of LTCM. Data from over
742,000 Zio devices showed that patients were highly compliant with at-home
self-application, achieving median wear times exceeding 13.8 days and maintaining analyzable
ECG time exceeding 98%. Further, CKM/CKD analyses spanning over 10 million patients
indicated that arrhythmia emergence often precedes or coincides with the onset of chronic
kidney disease, suggesting the need for earlier cardiac monitoring in at-risk populations.
Positive
- 1.1M-patient study demonstrating LTCM detection advantage
- 64% of daily-symptom patients with actionable arrhythmias undetected in first 48 hours
- Home enrollment: median wear time >13.8 days and >98% analyzable ECG time (742,268
devices) - CKM/CKD analyses across >10M patients reveal arrhythmia risk emerging earlier
Negative
- Symptom–Rhythm Correlation 20%, limiting symptom-guided monitoring
- Short-duration (24–48h) monitors missed actionable arrhythmias in a majority of
daily-symptom patients
Insights
Large real-world studies reinforce longer ambulatory ECG monitoring
value and show scalable home deployment with high data quality.
The publication reports data from >1.1 million Zio users showing that 24–48-hour
monitoring missed actionable arrhythmias in many patients: 64% of daily-symptom
patients with actionable arrhythmias were undetected within 48 hours and mean
time to first arrhythmia exceeded 48 hours across arrhythmia types; symptom–rhythm
correlation was 20% for most arrhythmias. These results directly support the
clinical mechanism that longer continuous monitoring up to 14 days increases
diagnostic yield versus short Holter windows.
Operationally, the AHA data on 2025 demonstrate home enrollment scale: analysis of
742,268 Zio devices showed median wear >13.8 days, analyzable ECG time >98%,
early terminations ≤2%, higher MyZio app use in home-enrolled patients (52% vs 17%)
and better device return/compliance (return within 45 days 93% vs 80%). Separate
CKM/CKD analyses across >10 million patients found arrhythmias often precede or
coincide with CKD diagnosis (arrhythmias before CKD in 58% of >8 million CKD
patients) and rising arrhythmia incidence across CKM stages (from 6.3% to 12.5% by
Stage 3).
Dependencies and risks are explicit in the data: diagnostic advantage depends on
actual extended wear (median >13.8 days reported) and analyzable signal quality
(> 98%), and payer/clinical practice must accept longer monitoring to realize
benefit. Watchable, concrete milestones include regulatory/guideline or payer policy
changes and any published replication studies or guideline citations in the next
6–18 months that reference the Nov. 11, 2025 Heart Rhythm paper and the AHA
presentations; these will determine whether the evidence alters standard monitoring
duration and reimbursement pathways.
11/11/2025 – 08:05 AM
- *Real-world data across more than 1 million patients published in Heart Rhythm show that 24–48-hour
monitoring can miss actionable arrhythmias and highlights the value of iRhythm’s Zio® long-term
continuous monitoring (LTCM)– even in patients with frequent (i.e., daily) symptoms*1 - *Data from more than 742,000 patients presented at the American Heart
Association (AHA) Scientific Sessions 2025 confirm that at-home self-application and activation of Zio
14-day patch-based LTCM devices achieve high compliance, strong engagement, and data quality comparable to
in-clinic application*2 - *Additional large-scale real-world analyses also presented at AHA 2025
provide expanded insights into CKM/CKD risk and reveal earlier arrhythmia detection supporting proactive
monitoring in at-risk populations*3,4,5
SAN FRANCISCO, Nov. 11, 2025 — iRhythm Technologies, Inc. (NASDAQ: IRTC) announced the publication of
“Relationship of Symptom Frequency and Symptom-Rhythm Correlation to Arrhythmia Type and Time to Detection:
Insights from Ambulatory ECG Monitoring in Over 1 Million Patients,”1 in *Heart Rhythm*, the journal
of the Heart Rhythm Society, featuring real-world insights from more than one million patients monitored with
iRhythm’s Zio® long-term continuous monitoring (LTCM) service. The study examined how symptom
frequency influences time to arrhythmia detection and the correlation between symptoms and arrhythmia events,
underscoring the advantages of long-term continuous monitoring with the Zio LTCM service.
Separately, new data presented at the American Heart Association (AHA) Scientific Sessions 2025 include
real-world evidence demonstrating successful at-home patient application and activation of the Zio LTCM
device,2 and independent large-scale analyses across cardio-kidney-metabolic (CKM) and chronic kidney
disease (CKD) populations highlighting earlier arrhythmia detection and risk emergence across the disease
continuum.3-5
**Real-World Evidence Published in *Heart Rhythm* Journal**
The newly published findings in *Heart Rhythm* draws on data from more than 1.1 million patients who used
iRhythm’s Zio LTCM and revealed that short-term (24–48-hour) monitoring, such as with Holter, can miss
actionable arrhythmias—even in patients reporting daily symptoms—and that patient-reported symptoms were
infrequently associated with arrhythmia events.1 Although prior studies including CAMELOT6
and AVALON7 have shown that LTCM yields greater arrhythmia diagnosis and less retesting, 24-48-hour
Holter monitoring is often preferred by clinicians and payors for frequent symptoms despite limited evidence
linking symptom frequency to optimal monitoring duration.
In this new retrospective cohort study of 1.1 million patients who used iRhythm’s Zio LTCM, 20.8% had reported
symptoms more than once per day. Nearly two-thirds (64%) of daily-symptom patients with actionable
arrhythmias were undetected in the first 48 hours, and the mean time to first detected arrhythmia exceeded 48
hours for all arrhythmia types, regardless of symptom frequency. Symptom–Rhythm Correlation (SRC) was notably
low for most arrhythmias, with less than 20% of patients documenting a symptom coinciding with an arrhythmic
episode. These findings highlight the clinical value of Zio LTCM up to 14 days for identification of
arrhythmias, challenging the limitations of short-duration Holter monitoring still prevalent in clinical
practice and payer policy.
“These findings challenge the long-held clinical assumptions and payor guidelines that frequent symptoms justify
short-duration monitoring,” said Mintu Turakhia, MD, Chief Medical and Scientific Officer and EVP of Advanced
Technologies at iRhythm. “They reinforce the limitations of 24–48-hour Holter monitoring, even if patients
report symptoms multiple times a day during wear, and highlight the value of Zio long-term continuous
monitoring up to 14 days. iRhythm’s real-world data are contributing evidence that can help guide both
clinical practice and payer policy.”
**Data Presented at AHA 2025**
**Patient Home Enrollment Pathway for Ambulatory Cardiac Monitoring** (*“Compliance, ECG Quality, and Engagement
With a Smartphone App in Patients With In-Clinic Compared With Home-Based, Self-Applied Long-Term Continuous
ECG Patch Monitors”* 2 study)
Presented at the American Heart Association (AHA) Scientific Sessions 2025, this analysis evaluated iRhythm’s
patient home enrollment pathway for its Zio® monitoring service, demonstrating that patients can
successfully self-apply and activate the Zio 14-day patch-based LTCM device shipped directly to their home,
achieving high compliance with the prescribed wear duration and data quality comparable to in-clinic
application.
Among the analysis of 742,268 Zio LTCM devices, researchers compared in-clinic and home-based applications
using iRhythm’s home enrollment (HE) pathway where monitoring devices are shipped directly to their home.
Median wear time and percent analyzable ECG time were high and comparable across groups (>13.8 days and
>98%, respectively), and early wear terminations were infrequent (≤2% for both groups). MyZio mobile app use
was more common among HE patients (52% vs. 17%) and associated with fewer early terminations, greater
analyzable time, and higher rate of compliance with return of devices for analysis within 45 days (93% vs.
80%).
**Earlier Arrhythmia Risk Across the CKM Syndrome Continuum**
In 2023, the AHA introduced the cardiovascular-kidney-metabolic (CKM) framework to describe how metabolic
dysfunction, kidney disease, and cardiovascular disease interact as stages of a single syndrome, emphasizing
early intervention to prevent progression to advanced organ failure.8
Three large-scale real-world analyses presented at AHA 2025 provide new insights and reveal arrhythmia risk
emerging earlier across the CKM syndrome continuum.3-5 The analyses, encompassing data from more than
10 million patients, provide new insights into how and when arrhythmias develop across the CKM syndrome
continuum. The data show that arrhythmias can occur before or during early CKM syndrome stages, with risk
accelerating as metabolic or kidney disease progresses. While arrhythmias including atrial fibrillation are
well recognized as complications after development or progression to advanced CKD,9 these findings
identify arrhythmias as a clinically measurable signal of elevated CKM syndrome risk and strengthen the case
for earlier rhythm assessment to identify at-risk patients before advanced complications occur.
- **Arrhythmias as Early Predictors of Chronic Kidney Disease (CKD)** (“*Arrhythmias as Early Predictors of CKD:
Real-World Evidence from a National Cardio-Kidney-Metabolic Cohort”*5 *study*)
Among more than 8 million CKD patients, arrhythmias—primarily atrial fibrillation (AF)—occurred before CKD
diagnosis in 58 percent of patients, on the same day in 14 percent, and after diagnosis in 28 percent. AF
was the most common arrhythmia (75–83 percent). Patients with AF before CKD showed high cardiometabolic
burden: 68 percent had hypertension, 45 percent had a major adverse cardiovascular event (MACE), and 94
percent had at least one metabolic comorbidity. These findings suggest that arrhythmias may serve as early
indicators of CKD progression.
- **CKD and CKM Syndrome: Accelerated Progression to Arrhythmias**(“*CKD and CKM Syndrome: Accelerated
Progression to Arrhythmias in a National Cohort”*4 *study*)
In a cohort of 3.5 million adults with obesity, 26,478 (0.8 percent) progressed to CKD; within four months
of CKD onset, 4 percent developed a major arrhythmia, most commonly atrial fibrillation (65 percent) and
supraventricular tachycardia (14 percent). Seventy percent of arrhythmias occurred in CKD Stage 3,
identifying kidney dysfunction as a potential inflection point in arrhythmia risk and highlighting the value
of enhanced rhythm surveillance as kidney function declines.
- **Onset of Arrhythmias Across the CKM Continuum** (“*Onset of
Arrhythmias in the CKM Continuum: Real-World Insights from a National Cohort”*3 *study*)
Across CKM stages, arrhythmia incidence increased from 6.3 percent after Stage 1 to 9.2 percent after Stage
2 and 12.5 percent after Stage 3. Younger patients (ages 18–34) accounted for 41% of arrhythmia cases
identified after Stage 1, suggesting earlier onset in this population. These findings underscore the
potential value of early arrhythmia monitoring among individuals at risk of CKM progression.
These findings expand understanding of how arrhythmias evolve within the CKM syndrome continuum and strengthen the
case for earlier rhythm assessment in at-risk populations. Consistent with these findings, other published
data7 in patients with Type 2 diabetes—a key metabolic condition within the CKM syndrome
continuum—show that arrhythmias are often first detected in acute care settings, contributing to higher
healthcare costs, and may be mitigated through early detection using ambulatory cardiac monitoring.
**Redefining Cardiac Care Through Proactive Detection and Predictive Insight**
With an estimated 27 million people in the U.S. at risk for undiagnosed arrhythmias,10 iRhythm remains
committed to reaching these patients sooner through scalable, clinically validated solutions. The company is
advancing a new standard of proactive, data-driven cardiac monitoring designed to identify arrhythmias before
they lead to stroke, hospitalization, or other serious outcomes.
iRhythm’s collaboration with Lucem Health, represents the next step in that evolution—combining iRhythm’s
proactive efforts with its proven ECG monitoring service with Lucem’s AI-powered risk stratification to more
precisely identify individuals at risk. Early pilot testing conducted by iRhythm, in collaboration with Lucem
Health, suggests promising improvement in targeting patient populations with elevated arrhythmia risk and
enabling earlier clinical engagement with greater precision.11
Together, the data published in *Heart Rhythm* and those presented at AHA 2025 build on iRhythm’s comprehensive
clinical evidence program, encompassing more than 125 original research manuscripts,12 insights
derived from over 2 billion hours of curated heartbeat data13 and nearly 12 million patient reports
posted since the company’s inception—underscoring the company’s ongoing commitment to expanding evidence that
supports improved patient outcomes.
**About iRhythm Technologies**
iRhythm is a leading digital health care company that creates trusted 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.
1 Battisti AJ, et al. Relationship of Symptom Frequency and Symptom-Rhythm Correlation to Arrhythmia Type
and Time to Detection: Insights from Ambulatory ECG Monitoring in Over 1 Million Patients. Heart Rhythm. 2025
Nov 6:S1547-5271(25)03049-8. doi: 10.1016/j.hrthm.2025.11.007. Epub ahead of print.
2 Ashburner JM et al. Compliance, ECG Quality, and Engagement With a Smartphone App in Patients With
In-Clinic Compared With Home-Based, Self-Applied Long-Term Continuous ECG Patch Monitors. American Heart
Association Scientific Sessions, November 10, 2025; New Orleans, Louisiana.
3 Russo P et al. “Onset of Arrhythmias in the CKM Continuum: Real-World Insights From a National Cohort.”
American Heart Association Scientific Sessions, 2025; New Orleans, Louisiana.
4 Russo P et al. “CKD and CKM Syndrome: Accelerated Progression to Arrhythmias in a National Cohort.”
American Heart Association Scientific Sessions, 2025; New Orleans, Louisiana.
5 Russo P et al. “Arrhythmias as Early Predictors of Chronic Kidney Disease: Real-World Evidence From a
National Cardio-Kidney-Metabolic Cohort.” American Heart Association Scientific Sessions, 2025; New Orleans,
Louisiana.
6 Reynolds MR, et al. Comparative effectiveness and healthcare utilization for ambulatory cardiac monitoring
strategies in Medicare beneficiaries. Am Heart J. 2024 Mar;269:25-34
7 Russo P et al. Clinical and Economic Burden of Cardiac Arrhythmias in Patients with Type 2 Diabetes. J
Health Med Econ Vol. 11 No. 1:151
8 Khan SS et al. AHA Presidential Advisory on Cardiovascular-Kidney-Metabolic Health and Disease.
Circulation. 2023;148:e202–e221.
9 Turakhia MP et al. Chronic kidney disease and arrhythmias: conclusions from a KDIGO Controversies
Conference. European Heart Journal, 2018; 39(24): 2314–2325.
10 iRhythm internal estimate based on analysis of public and proprietary sources, including U.S. Census
Bureau data, CDC healthcare utilization data, Medicare Public Use Files, IQVIA, Komodo Health, Definitive
Healthcare, and peer-reviewed literature on arrhythmia prevalence, symptom presentation, and diagnostic
pathways. Full source list available upon request.
11 The predictive-AI solution does not represent the functionality of any Zio branded medical device.
12 Data on file. iRhythm Technologies, 2025.
13 Data on file. iRhythm Technologies, 2024.
FAQ
What did iRhythm (IRTC) report in the Heart Rhythm study published November 11, 2025?
The study of >1.1 million Zio LTCM users found mean time to first arrhythmia exceeded 48 hours and
that 64% of daily-symptom patients with actionable arrhythmias were undetected in the first 48 hours.
How effective was at-home self-application of Zio 14-day patches in AHA 2025 data for IRTC?
Analysis of 742,268 devices showed median wear >13.8 days, >98% analyzable ECG time, ≤2% early
terminations, and higher MyZio app use (52% vs 17%).
What do the CKM/CKD analyses presented by iRhythm at AHA 2025 mean for arrhythmia screening?
Large analyses across >10 million patients showed arrhythmia incidence rises across CKM stages and that
arrhythmias often appear before or early in CKD, supporting earlier rhythm assessment.
How might IRTC’s Zio monitoring impact detection timelines for atrial fibrillation in at-risk patients?
The published and AHA data indicate Zio LTCM can detect arrhythmias later than 48 hours and identify
arrhythmia emergence earlier across CKM/CKD stages, enabling proactive monitoring.
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