Professor Jay Wright, consultant cardiologist at Liverpool Heart and Chest Hospital and advisor to iRhythm, explains why modern heart rhythm diagnostics must be more accessible.
Inequality is the quiet driver of too many poor outcomes in cardiology in England. We see it in patients who get diagnosed early, who get referred promptly, and who end up in hospital after a preventable event. As a country, we’ve made huge strides in cardiovascular care and developed innovative wearable technologies that accurately pick up on cardiac irregularities, yet the benefits remain unevenly distributed. If we’re serious about improving heart health, we need to ensure that modern methods for detecting rhythm disorders, which can lead to greater patient engagement, fewer repeat appointments and reduced waiting lists, are available to every community, not just those near well‑resourced services. With more consistently accurate and timely diagnostics across England, gaps in cardiovascular outcomes can close.
The unequal burden of heart disease
Around 390 people die each day in England from heart and circulatory diseases; more than 2 million live with arrhythmias, and 1.5 million live with atrial fibrillation (AF). The pressures are rising as people live longer after surviving previously fatal illnesses, while obesity, high cholesterol, physical inactivity and alcohol consumption continue to take their toll. Add to that the uncertain longer‑term effects of widespread vaping and post‑viral syndromes since the pandemic, and demand on cardiology is not easing.
Crucially, this burden is not shared equally. Deaths caused by cardiovascular disease (CVD) account for one-fifth of the life expectancy gap between the most and least deprived communities in England. There are clear and consistent gaps between the most deprived and least deprived groups across cardiovascular pathways, including: prevalence of risk factors (such as high cholesterol, physical inactivity, hypertension), hospital admissions, management of healthcare, and health outcomes, especially premature mortality.
Patients in communities with less flexible work, poorer transport and fewer local services find it harder to access timely assessment. A recent study showed that those living in the most deprived areas of England are less likely to receive treatment after an aortic stenosis diagnosis, which, if left untreated, can lead to heart failure.
It’s clear that cardiovascular outcomes still map closely to socioeconomic status, geography and access to care. With these barriers, access to earlier diagnostics is still missing the mark for many and outdated equipment only reinforces the postcode lottery of care.
How legacy tools widen today’s gaps
For decades, standard ambulatory electrocardiogram (ECG) options have been adopted across England. They are relatively cumbersome devices restricted to short monitoring windows that were never designed for sporadic symptoms. The consequences of the continued use of these outdated models are compromised care from missed events, repeat appointments and growing waiting lists.
The knock-on effects are behavioural and systemic. Without timely, accurate answers, patients disengage and conditions escalate. Early diagnosis, by contrast, prompts behaviour change, improves adherence and reduces re‑presentations. The impact is sharpest in deprived areas, where legacy diagnostics slow care and restrict access.
The potential of prolonged ECG patch technology in tackling inequalities
Today, there are prolonged ECG patch technologies which can drastically improve patient outcomes and, therefore, regional inequalities. These small, unobtrusive patches record continuously for up to two weeks and have a higher diagnostic yield than a portable, battery-powered 24-hour Holter. Adopted more widely, these devices have the potential to address regional inequalities. They fit around life, so people can work, exercise and shower as normal, which improves adherence. Patches can be posted to patients with clear instructions, applied at home and returned for analysis. That single operational shift removes multiple hospital trips and opens the door to people who cannot spare the time or cost of repeated visits.
Alongside better detection, these innovative patches also use leading AI technology to ease the administrative burden and free up time for clinicians, leading to quicker pathways between diagnosis and treatment. AI‑supported analysis distils long‑form ECG data into structured, relevant reports for clinicians. Physiologists spend less time on manual annotation, and consultants are able to assess patients more accurately with higher-quality information to hand. This aligns closely with the 10 Year Health Plan; improving earlier diagnosis, making care more efficient and empowering patients through technology.
These devices could ultimately help to tackle long waiting lists and lead to better diagnoses. However, due to unclear frameworks and a lack of standardised guidance, prolonged ECG monitoring devices are not rolled out widely across England.
How to make innovation more accessible
To convert proven technology into national progress, we need clear commissioning guidance for prolonged ambulatory ECG monitoring so Integrated Care Boards can plan with confidence. There needs to be evidence-based recommendations on monitoring duration and device selection for specific patient groups. There also needs to be aligned reimbursement and procurement so modern patch-based services are correctly coded and fairly tariffed. Adopting a system to repeat proven technologies from one Trust to many without starting from scratch each time would help to delay additional administration and create some national consistency.
Cardiac inequalities in England are real and measurable across prevention, access, treatment and outcomes, and they have widened in recent years, especially along lines of deprivation. In a strained national health system, technologies and innovations with proven clinical benefit must reach patients faster. With digitally-supported patient pathways, there are fewer unnecessary hospital visits, better use of specialist time and more patients diagnosed before harm occurs. The result: accessibility and equity in England improving in tandem.
