EKG vs XHS: Grades, Fees and Holdings Compared

First Trust Nasdaq Lux Digital Health Solutions ETF

EKGDNasdaq

State Street SPDR S&P Health Care Services ETF

XHSANYSE Arca

Overlap

10.3%by weight

Expense ratio

XHS −0.30pt a year

EKG0.65%XHS0.35%

Avg volume · 30D

XHS 7.3×the volume

EKG4.35KXHS31.9K

3Y return · a year

EKG +1.2pt

EKG+22.7%XHS+21.5%

EKG vs XHS Performance

Oct 31, 2025 – Nov 2, 2026

+27.4%EKG+38.0%XHS

Expense ratio: EKG 0.65%; XHS 0.35%, better
Fund size: EKG $10M; XHS $234M
1Y total return: EKG +27.4%; XHS +38.0%, better
Yield (12M): EKG No data; XHS 0.15%
Holdings: EKG 52; XHS 63
Avg volume (30D): EKG 4.35K sh; XHS 31.9K sh, better
NAV per share: EKG $23.95; XHS $144.25
52W range

ETF.net Grade

Pillar letters and Scores for EKG, XHS, with each pillar’s weight
Pillar	EKG	XHS
Cost30% weight	D27	A81Higher
Mission25% weight	A71	Not scored
Risk15% weight	D34	A78Higher
Tradability15% weight	D38	C54Higher
Holdings10% weight	C46	A87Higher
Durability5% weight	F22	B64Higher

Rank among Health Care (Broad) funds

How we build Categories ›

Same Category. EKG and XHS are both graded against the same 25 Health Care (Broad) funds, so their Grades compare head to head.

Health Care (Broad)⁠

Category · 25 funds

See all 25 ›

XHS ranks 4th and EKG 19th of 25 funds in the Health Care (Broad) Category.

Rank 1AXLVState Street Health Care Select Sector SPDR ETFScore 85
Rank 2AFHLCFidelity MSCI Health Care Index ETFScore 83
Rank 3AVHTVanguard Health Care ETFScore 77
Rank 4AXHSState Street SPDR S&P Health Care Services ETFScore 74
Rank 5AIYHiShares U.S. Healthcare ETFScore 71
Rank 18CHEALGlobal X HealthTech ETFScore 39
Rank 19DEKGFirst Trust Nasdaq Lux Digital Health Solutions ETFScore 32
Rank 20DHRTSTema Heart & Health ETFScore 31

Our read on each fund

ETF.net Research

EKGDFirst Trust Nasdaq Lux Digital Health Solutions ETF

XHSAState Street SPDR S&P Health Care Services ETF

In short

EKG A ticker that spells out the mandate. EKG skips the pharma giants and tracks a Nasdaq index of health technology names: roughly 40 stocks building the digital plumbing of medicine, from diagnostics and devices to health data.

XHS Most health care ETFs are pharma funds in disguise. XHS buys the delivery system instead: insurers, hospitals, distributors and clinics, roughly equal weighted so one giant insurer does not run the show.

Stated mandate

EKG The Fund seeks to track, before fees and expenses, the price and yield performance of the Nasdaq Lux Health TechTM Index.

XHS The fund seeks to track the total return of the S&P Health Care Services Select Industry Index before fees and expenses, providing targeted exposure to health care services companies.

Why people hold it

EKG Genuinely narrow. Roughly 40 health tech names, not a broad sector fund where a few pharma megacaps set the outcome.
Rules-based, not a stock picker's fund. It tracks the Nasdaq Lux Health Tech Index, so holdings follow published index rules rather than manager discretion.ftportfolios.com
Launched in 2022, so there is a real multi-year record to inspect instead of a back-test on a brand-new theme fund.

XHS No drugmakers, no device makers. The index tracks four slices of care delivery: distributors, facilities, health care services and managed care.ssga.com
Modified equal weighting spreads about 60 names across large, mid and small caps, so the portfolio is not a bet on two or three mega caps.ssga.com
0.35% a year sits below the 0.50% median for broad health care ETFs, on a fund that has been running since 2011.
Ranks in the top quartile of the broad health care ETFs we grade.

Worth knowing

EKG 0.65% a year sits above the health care sector median, and the cohort's broad index heavyweights (VHT, XLV, FHLC) charge under a tenth of a percent.
A small fund that trades thinly. Wider bid-ask spreads are the usual trade-off versus the cohort's most heavily traded names.
One theme, about 40 stocks, no regular distribution schedule. Single names and the health tech cycle carry the weight here.

XHS Cheap against the median, not against the giants: XLV, VHT and FHLC charge under a tenth of a percent for cap weighted whole sector exposure.
Thinly traded next to the big sector funds, so spreads and limit orders matter more here.
Leaving out pharma and biotech means it moves differently from a whole sector fund, and insurers and hospitals sit close to reimbursement policy.ssga.com

Full EKG profile⁠

Full XHS profile⁠

EKG vs XHS Holdings

How EKG and XHS differ

Overlap by weight

10.3%

Shared holdings make up 17.4% of XHS and 13.0% of EKG.

Level by level

Holdings10 in both10.3%
Sector3 Sectors91.3%
Asset classEquity100%
Countryby domicile100%

Sector

Sector weights in EKG and XHS, widest gap first
Sector	More in EKGMore in XHS	EKG	XHS
Technology	EKG +8.7 points	8.7%	0.0%
Health Care	XHS +6.8 points	91.3%	98.1%
Financials	XHS +1.9 points	0.0%	1.9%

Country, concentration and asset class

Country by domicile

Country weights in EKG and XHS, widest gap first
Country	More in EKGMore in XHS	EKG	XHS
United States	Same weight	100.0%	100.0%

Concentration

Weight in the 10 largest Holdings

EKG58.6%
XHS20.7%

Securities held

EKG51
XHS61

Asset class

EKG: Equity
XHS: Equity

Holdings

Only in EKG41
In both10
Only in XHS51

Only in EKG

41 securities, 87.0% of EKG by weight

Natera, Inc.9.47%
Intuitive Surgical, Inc.8.44%
Veeva Systems Inc. (Class A)8.05%
IQVIA Holdings Inc.7.53%
DexCom, Inc.6.65%
Illumina, Inc.4.06%
ResMed Inc.3.52%
Qiagen N.v.3.46%
Globus Medical, Inc. (Class A)3.27%
Insulet Corporation3.04%
Tempus AI, Inc. (Class A)2.80%
Align Technology, Inc.2.75%
Oscar Health, Inc. (Class A)2.62%
Twist Bioscience Corporation2.25%
GRAIL, Inc.2.00%
10X Genomics, Inc. (Class A)1.87%
CareDx, Inc.1.40%
Heartflow, Inc.1.38%
Adaptive Biotechnologies Corporation1.32%
Caris Life Sciences, Inc.1.30%
Doximity, Inc. (Class A)1.21%
iRhythm Holdings, Inc.1.12%
Waystar Holding Corp.0.89%
Veracyte, Inc.0.86%
Establishment Labs Holdings Inc.0.54%
Inspire Medical Systems, Inc.0.52%
TransMedics Group, Inc.0.51%
Butterfly Network, Inc.0.46%
Teladoc Health, Inc.0.44%
Schrodinger, Inc.0.42%
Certara, Inc.0.37%
Tandem Diabetes Care, Inc.0.35%
PROCEPT BioRobotics Corporation0.32%
Alphatec Holdings, Inc.0.32%
Cytek Biosciences, Inc.0.25%
Kestra Medical Technologies, Ltd.0.24%
QuidelOrtho Corporation0.21%
Phreesia Inc.0.20%
Ceribell, Inc.0.20%
Beta Bionics, Inc.0.18%
Minimed Group, Inc.0.16%

Only in XHS

51 securities, 82.5% of XHS by weight

Surgery Partners Inc2.71%
Amn Healthcare Services Inc2.25%
Option Care Health Inc2.22%
Concentra Group Holdings Par1.98%
Corvel Corp1.93%
Labcorp Holdings Inc1.89%
Hca Healthcare Inc1.86%
Pacs Group Inc1.83%
U.s. Physical Therapy Inc1.83%
Mckesson Corp1.81%
Healthequity Inc1.80%
Ensign Group Inc/The1.78%
Encompass Health Corp1.78%
Pediatrix Medical Group Inc1.77%
Quest Diagnostics Inc1.77%
The Cigna Group1.76%
Centene Corp1.76%
Elevance Health Inc1.75%
Nutex Health Inc1.75%
Davita Inc1.74%
Clover Health Investments Co1.74%
Cardinal Health Inc1.72%
UnitedHealth Group Inc1.72%
Acadia Healthcare Co Inc1.72%
Chemed Corp1.72%
Addus Homecare Corp1.72%
Humana Inc1.71%
Radnet Inc1.71%
Molina Healthcare Inc1.69%
Cencora Inc1.68%
Tenet Healthcare Corp1.65%
Universal Health Services B1.65%
Henry Schein Inc1.62%
Brightspring Health Services1.60%
Astrana Health Inc1.58%
Cvs Health Corp1.56%
Aveanna Healthcare Holdings1.56%
National Healthcare Corp1.54%
Guardian Phrmcy Services A1.53%
Agilon Health Inc1.51%
Castle Biosciences Inc1.42%
Sonida Senior Living Inc1.42%
Brookdale Senior Living Inc1.39%
Pennant Group Inc/The1.39%
Adapthealth Corp1.32%
Starling Oncology Inc1.18%
Alignment Healthcare Inc1.02%
Fulgent Genetics Inc0.75%
Strata Critical Medical Inc0.72%
Opko Health Inc0.54%

Weight gaps

All 10 Holdings in both funds, largest gap first.

Holding weights in EKG and XHS, widest gap first
Holding	More in EKGMore in XHS	EKG	XHS
Guardant Health, Inc.GH	EKG +2.27 points	4.14%	1.87%
Progyny, Inc.PGNY	XHS +1.22 points	0.50%	1.72%
Omada Health, Inc.OMDA	XHS +1.19 points	0.31%	1.50%
NeoGenomics, Inc.NEO	XHS +1.14 points	0.53%	1.67%
Privia Health Group, Inc.PRVA	XHS +1.11 points	0.66%	1.77%
LifeStance Health Group, Inc.LFST	XHS +0.90 points	0.88%	1.78%
BillionToOne, Inc. (Class A)BLLN	XHS +0.84 points	1.06%	1.90%
GeneDx Holdings Corp.WGS	XHS +0.73 points	0.62%	1.35%
Hinge Health, Inc. (Class A)HNGE	EKG +0.29 points	2.40%	2.11%
Hims & Hers Health, Inc.HIMS	EKG +0.11 points	1.86%	1.75%

All 51 EKG holdings⁠All 61 XHS holdings⁠

How we measure overlap

Each holding counts at its smaller weight in the two funds, summed over the full Holdings. Sector, country and asset class use the same rule on each fund’s split. Cash, FX and derivative lines stay out of the counts. Two bond funds get no overlap figure.

EKG vs XHS Cost

Overpaying EKG vs XHS

$5,591

On $10,000 over 30 years. 7% growth a year before fees, expense ratio only.

EKG 0.65%
$12,717
XHS 0.35%
$7,126

Amount$10,000

Years30 years

Cost over time

EKG 0.65%
XHS 0.35%
Overpaying

Year by year

Year	EKG	XHS	Overpaying
10	$1,163	$634	$529
20	$4,440	$2,454	$1,986
30	$12,717	$7,126	$5,591

Expense ratio

0.65%EKG
0.35%XHS, cheaper

XHS0.35%EKG0.65%

0.08%0.85%

Middle half of Health Care (Broad) funds
Median 0.50%

XHS 5th cheapest of 25 funds

EKG 18th cheapest of 25 funds

EKG vs XHS Dividends

Last 12 months to Nov 2, 2026

Yield (12M): EKG No data; XHS 0.15%
Payout (12M): EKG None; XHS $0.21
Last payment: EKG No data; XHS $0.01
Ex-dividend: EKG No data; XHS Sep 21, 2026
Paid on: EKG No data; XHS Sep 23, 2026
Frequency: EKG No data; XHS Quarterly

Distribution history

Per share, 2017 to 2026, same scale for both

EKGAll EKG payments⁠

No distribution history available.

XHSQuarterly · 39 paymentsAll XHS payments⁠

EKG vs XHS Risk

Fall from peak · 5 years

This chart needs five years of history for both funds.

Risk facts

VolatilityStd dev, 3 years: EKG 22.1%XHS 20.8%, better
Return per unit of riskSharpe ratio, 3 years: EKG 0.92, betterXHS 0.85
Worst fallMax drawdown, 5 years: EKG −43.8%since Mar 2022XHS −30.0%
Market sensitivityBeta, 5 years: EKG 1.43XHS 0.93; Market = 1

EKG and XHS in the news

All news⁠

Deep Dive
Health care's 1.8% week was four large caps, not a biotech rally
Sep 19, 2026XHS
Deep Dive
Health care ETFs spent 2026 between a 28% biotech rally and a 16% device slide
Sep 14, 2026XHS

Popular comparisons

EKGDvsXLVA
First Trust Nasdaq Lux Digital Health Solutions ETF · State Street Health Care Select Sector SPDR ETF
Expense ratio
0.65% · 0.08%
Category
XHSAvsXLVA
State Street SPDR S&P Health Care Services ETF · State Street Health Care Select Sector SPDR ETF
Expense ratio
0.35% · 0.08%
Category
EKGDvsFHLCA
First Trust Nasdaq Lux Digital Health Solutions ETF · Fidelity MSCI Health Care Index ETF
Expense ratio
0.65% · 0.08%
Category
XHSAvsFHLCA
State Street SPDR S&P Health Care Services ETF · Fidelity MSCI Health Care Index ETF
Expense ratio
0.35% · 0.08%
Category
EKGDvsVHTA
First Trust Nasdaq Lux Digital Health Solutions ETF · Vanguard Health Care ETF
Expense ratio
0.65% · 0.09%
Category
XHSAvsVHTA
State Street SPDR S&P Health Care Services ETF · Vanguard Health Care ETF
Expense ratio
0.35% · 0.09%
Category

EKG vs XHS

In short

Stated mandate

Why people hold it

Worth knowing

How EKG and XHS differ

Level by level

Sector

Country, concentration and asset class

Country by domicile

Concentration

Asset class

Holdings

Only in EKG

Only in XHS

Weight gaps

Cost over time

Year by year

Distribution history

Fall from peak · 5 years

Risk facts

Health care's 1.8% week was four large caps, not a biotech rally

Health care ETFs spent 2026 between a 28% biotech rally and a 16% device slide

How EKG and XHS differ

Level by level

Sector

Country, concentration and asset class

Country by domicile

Concentration

Asset class

Holdings

Only in EKG

Only in XHS

Weight gaps