Patient Preferences and Engagement With Ambulatory Heart Rhythm Monitoring

This scoping review sought to identify and map published evidence describing adult patients’ preferences, experiences and engagement with ambulatory heart rhythm monitoring (AHRM).

The authors framed the question to capture any adult population (>18 years) undergoing ambulatory monitoring for cardiac arrhythmia across primary, secondary or tertiary care, and to include the broad range of currently used AHRM technologies.

A secondary objective was to highlight gaps in the evidence to inform future research and implementation in arrhythmia care.

The investigators pre-registered the protocol and used a Population–Concept–Context construct to define eligibility and support consistency.

The final update of the search was performed on 3 January 2026.

Devices considered included Holter monitors, patch monitors, event recorders, mobile cardiac telemetry, external and implantable loop recorders, wearables and other implantable cardiac devices used in ambulatory care.

Study retrieval and selection yielded 54 eligible records from an initial pool of 1,320 citations.

All data relevant to the review were presented in the article or supplementary materials.

• Methodological framework: The review followed established scoping review methodology with guidance from the Joanna Briggs Institute and reporting aligned to the PRISMA-ScR checklist.
• Sources and search strategy: Searches were run across multiple bibliographic databases (Medline/PubMed, Embase/Ovid, Web of Science, CINAHL/EBSCOhost, PsycINFO/Ovid) and Google Scholar; both keyword and controlled-language terms were employed.
• Inclusion criteria: Quantitative, qualitative, mixed-methods, multiple-method and review articles that reported data about patient preferences, experiences or engagement with any AHRM device were eligible.
• Data integration and synthesis: The review included both quantitative and qualitative literature and used triangulation to integrate findings across methods.

They highlighted that arrhythmia is a major driver of emergency and outpatient utilisation and that sequelae such as heart failure and stroke contribute materially to morbidity and mortality.

The authors noted incomplete integration of patient preference into practice and an absence of established methods for doing so in AHRM.

• Clinical need and relevance: The authors positioned the review against a rising burden of arrhythmia in ambulatory care, particularly atrial fibrillation (AF), and framed AHRM as foundational to diagnosis and longitudinal surveillance.
• Rationale for patient-centred inquiry: The review emphasised that selection of monitoring devices has traditionally been clinician-led, whereas contemporary guidelines and policy discourse increasingly advocate incorporation of patient experience, values and preferences into arrhythmia care.

Two principal, cross-cutting themes emerged from synthesis of the quantitative and qualitative literature: factors intrinsic to patients, and factors intrinsic to devices.

Each theme encompassed discrete subdomains that the authors used to organise reported determinants of preference, experience and engagement.

Device wear-time, data transmission demands and need for troubleshooting were among operational features influencing user experience.

• Patient factors affecting AHRM engagement:
• Clinical and demographic characteristics: Studies reported variations in engagement and preference according to clinical presentation and patient sociodemographic attributes, although the review noted heterogeneity across studies and contexts.
• Education and expectations: Patient understanding of monitoring purpose, expected duration and likely implications influenced their experience and willingness to engage.
• Prior experience and stated preferences: Past encounters with monitoring modalities and explicit device preferences were linked to acceptability and adherence.
• Impact on daily life and healthcare interactions: Disruption to routine activities, work and social roles, plus interactions with healthcare teams, were reported as meaningful determinants of engagement.
• Device-related factors:
• Cross-device issues: Features shared across multiple device types—such as skin irritation from adhesive electrodes, physical discomfort, visibility of the device and restrictions on bathing or activity—were described as factors that reduced tolerance and could affect adherence.
• Device-specific characteristics: Some determinants derived from the operational or activation requirements of particular devices (for example, user activation of event recorders versus continuous automated capture).

Despite this variability, the synthesis identified consistent domains that appear to shape patient engagement and preferences across device types.

Incorporation of these considerations was presented as a way to potentially improve adherence and equity of access, though concrete efficacy or outcomes were not asserted in the source beyond mapping the evidence.

They noted under-prescription of guideline therapies in certain subgroups and documented socioeconomic disparities in arrhythmia incidence and outcomes, asserting that improved AHRM that better engages at-risk populations could be important for system-level prevention strategies.

The review itself did not test these system-level hypotheses but positioned the patient experience literature as relevant to those challenges.

• Heterogeneity and incompleteness: The authors concluded that the existing literature is fragmented and heterogeneous in design, populations studied, and outcomes reported.
• Relevance for device development and service design: The review highlighted that patient and device factors identified in the literature should be considered when developing and evaluating novel monitoring technologies and when designing models of arrhythmia surveillance within healthcare systems.
• Equity and system-level concerns: The authors placed the patient-level findings within broader concerns about the effectiveness and equity of current arrhythmia care delivery.

• Evidence limitations: The source repeatedly characterised the body of evidence as incomplete and methodologically diverse, limiting the ability to draw firm, generalisable conclusions.
• Reporting gaps: The review acknowledged inconsistency in how studies defined and measured patient experience, preference and engagement, and variable device representation across studies.
• Scope constraints: While the review deliberately included a broad range of device types and clinical contexts to map the field, that breadth contributed to heterogeneity that constrained synthesis.

• Integration into development and testing: The authors recommended that the patient- and device-level considerations identified be integrated into the design, testing and evaluation of new AHRM technologies and surveillance strategies; the review did not provide specific implementation steps or clinical guidance.
• Research gaps: The review identified a need for more coherent, comparative and patient-centred research to characterise preferences across diverse populations and to establish standardised methods for measuring experience and engagement; precise priorities or study designs were not specified in the text provided.

• Quantitative effect sizes and comparative performance: The source did not report pooled estimates, comparative effectiveness metrics or quantified impacts of particular device features on adherence or diagnostic yield.
• Generalisability across settings and populations: Given heterogeneity and incomplete reporting, the review could not definitively establish how findings translate between different healthcare systems, demographic groups or specific arrhythmia indications.
• Outcome linkage: The review mapped patient-reported determinants of engagement but did not provide data within the article text linking those determinants to downstream clinical outcomes or health system metrics.

This scoping review maps a heterogeneous but thematically coherent literature showing that both patient characteristics and device attributes shape preferences, experience and engagement with ambulatory heart rhythm monitors.

The authors conclude that these dimensions warrant deliberate attention in the development and evaluation of AHRM strategies to support effective arrhythmia surveillance and care delivery, while acknowledging substantive evidence gaps and methodological variability in the underlying studies.