Managing mass events and competitions with difficult-to-access locations using mobile electrocardiac monitoring

The Current State of Mobile Phone Apps for Monitoring Heart Rate, Heart Rate Variability, and Atrial Fibrillation: Narrative Review

Background

Mobile phone apps capable of monitoring arrhythmias and heart rate (HR) are increasingly used for screening, diagnosis, and monitoring of HR and rhythm disorders such as atrial fibrillation (AF). These apps involve either the use of (1) photoplethysmographic recording or (2) a handheld external electrocardiographic recording device attached to the mobile phone or wristband.

Objective

This review seeks to explore the current state of mobile phone apps in cardiac rhythmology while highlighting shortcomings for further research.

Methods

We conducted a narrative review of the use of mobile phone devices by searching PubMed and EMBASE from their inception to October 2018. Potentially relevant papers were then compared against a checklist for relevance and reviewed independently for inclusion, with focus on 4 allocated topics of (1) mobile phone monitoring, (2) AF, (3) HR, and (4) HR variability (HRV).

Results

The findings of this narrative review suggest that there is a role for mobile phone apps in the diagnosis, monitoring, and screening for arrhythmias and HR. Photoplethysmography and handheld electrocardiograph recorders are the 2 main techniques adopted in monitoring HR, HRV, and AF.

Conclusions

A number of studies have demonstrated high accuracy of a number of different mobile devices for the detection of AF. However, further studies are warranted to validate their use for large scale AF screening.

Medical Care at a Large Vertical Running Event

OBJECTIVE

Vertical running events, during which participants race up the stairwells of skyscrapers, are becoming increasingly popular. Such events have unique and specific operational and clinical considerations for event medical directors, but descriptions of the medical care provided at these events are lacking. We sought to perform a descriptive analysis of the medical care delivered at a single, large vertical running event.

METHODS

A retrospective chart review of medical encounters at a large vertical running event from 2011-2017 was performed. Participants competed in either the full course (94 stories) or half course (54 stories); potential patients also included observers. Medical staffing included a main medical station at the finish line, medical way stations along the routes (within stairwells), and medical response teams. Descriptive statistics were used for analysis.

RESULTS

During the study period, a total of 23,920 participants completed the event, with 84.6% participating in the full course. Medical staff treated 150 unique patients during 154 medical encounters (0.6% treatment rate). The median age of patients was 36 (IQR 27, 43), and 40.3% were male. Most encounters (66.4%) occurred at the finish line main medical area. Of medical encounters occurring along the race routes, 56.1% of encounters occurred before the halfway point in the full course. Encounters were clustered around medical way stations along the half course. The most common chief complaints were gastrointestinal (27.3%), respiratory (25.3%), syncope/near-syncope (24.7%), trauma (12.3%), and chest pain (10.4%). One cardiac arrest was observed. The most frequent interventions were oral fluids or food (40.3%), respiratory care (18.2%), and minor trauma care (12.3%). An electrocardiogram (ECG) was obtained in 10.4% of encounters, and intravenous fluids were started on 1.9% of patients. Eleven patients (7.3% of treated patients and 0.05% of all participants) were transported by ambulance.

CONCLUSIONS

Medical encounters during vertical running events, the majority of which are not life-threatening, mainly occur at the finish line but can occur at any point along the route. Understanding the nature and location of medical encounters along a vertical running event route can help inform event medical directors supervising care at these increasingly popular events.

ECG by mobile technologies

Mobile electrocardiographs consist of three components: a mobile device (e.g. a smartphone), an electrocardiographic device or accessory, and a mobile application. Mobile platforms are small computers with sufficient computational power, good quality display, suitable data storage, and several possibilities of data transmission. Electrocardiographic electrodes and sensors for mobile use utilize unconventional materials, e.g. rubber, e-textile, and inkjet-printed nanoparticle electrodes. Mobile devices can be handheld, worn as vests or T-shirts, or attached to patient's skin as biopatches. Mobile electrocardiographic devices and accessories may additionally record other signals including respiratory rate, activity level, and geolocation. Large-scale clinical studies that utilize electrocardiography are easier to conduct using mobile technologies and the collected data are suitable for "big data" processing. This is expected to reveal phenomena so far inaccessible by standard electrocardiographic techniques.