A pandemic response to home delivery for ambulatory ECG monitoring: Development and validation

At-home ECG monitoring with a real-time outpatient cardiac telemetry system during the COVID-19 pandemic

CONTEXT

During the COVID-19 pandemic, essential in-person electrocardiogram (ECG) recordings became unfeasible, while patients continued to suffer from cardiac conditions. To circumvent these challenges, the cardiology clinic (Long Island Heart Rhythm Center [LIHRC]) at the New York Institute of Technology College of Osteopathic Medicine (NYITCOM) transitioned to a remote real-time outpatient cardiac telemetry (ROCT) service.

OBJECTIVES

The goal of this study is to test the hypothesis that at-home ROCT, provided by the LIHRC, is an effective method of providing ECG monitoring to symptomatic patients during the COVID-19 pandemic.

METHODS

Seventeen patients at the LIHRC that required ECGs between March 11 and August 1, 2020, were included in this study. The patients' medical records were de-identified and reviewed for age, gender, ROCT indications, findings, patient comfort, and ease of use. A retrospective analysis of observational de-identified data obtained from the LIHRC was approved and permitted by the NYITCOM Institutional Review Board (BHS-1465). These FDA-cleared medical devices (DMS-300, DM Software, Stateline, NV) were shipped to the patients' homes and were self-applied through adhesive chest patches. The devices communicated with a cloud-based system that produced reports including a continuous 6-lead ECG and many other cardiovascular parameters. Additionally, a patient-activated symptom recorder was available to correlate symptoms to ECG findings.

RESULTS

Seventeen patients (15 women) from the LIHRC were included in the analysis with an average monitoring duration of 27 h (range, 24-72 h). The patients' ages ranged from 21 to 85 years old with a mean of 37 years old and a standard deviation of 19. ROCT indications included palpitations (n=9), presyncope (n=8), chest pain (n=5), syncope (n=3), and shortness of breath (n=2). One also received ROCT due to short PR intervals observed on a prepandemic ECG. Two patients experienced palpitations while wearing the ROCT device: one had supraventricular tachycardia at 150 beats per minute; the other had unifocal premature ventricular contractions (PVCs) and eventually underwent a successful cardiac ablation. Most patients experienced no symptomatic episodes during ROCT (n=15). The 6-lead ROCT ECG for five of those patients showed arrhythmias including wandering atrial pacemaker (n=2), PVCs (n=2), sinus tachycardia (n=1), premature atrial contractions (PACs) (n=1), ectopic atrial rhythms (n=1), and sinus arrhythmia (n=1). One patient who experienced issues with our device was able to obtain a device from a separate clinic and was found to have bradycardia, PVCs, and nonsustained ventricular tachycardia. Overall, 16/17 (94.1%) patients were monitored effectively with the LIHRC ROCT system, and all (17/17, 100%) patients were monitored effectively with a ROCT system either from the LIHRC or a separate clinic.

CONCLUSIONS

With the unique challenges of the COVID-19 pandemic, physicians can use this innovative ROCT method to prevent infection and diagnose cardiac diseases. Most patients and staff were able to utilize the system without issues. Therefore, this system may also be utilized to deliver patient-centered care to those with limited mobility when coupled with a telemedicine visit.

Resting 12‑lead ECG tests performed by patients at home amid the COVID-19 pandemic — Results from the first 1000 patients

Background

There were surges in the demand for telehealth and home care in the COVID-19 pandemic. A new home ECG testing model was developed and used in the real-world clinical practice.

Methods

Since June 2020, QT Medical, Inc. (Diamond Bard, California) has been providing home ECG testing service by mail. Upon receiving the order from a clinician, an ECG testing kit was sent to the patient by mail. The kit included an ECG recorder, a prepositioned electrode strip of proper size for the patient (determined by the ordering clinician), printed instructions for performing the test, and a return envelope. We reviewed and analyzed the de-identified administrative dataset of the first 1000 ECG tests ordered by 37 medical practices.

Results

Of the 1000 patients served by this mail delivery home ECG testing service, 77.3% were female and 22.7% were male. Their ages ranged from 1 year old to 96 years old, mean 49.5 ± 13.4 years (median 52). 92.9% patients completed their tests with clinical quality ECGs uploaded to their ordering clinician's online accounts. Of those who did not complete the tests, the main reason was they “no longer needed the test”. Failure to complete the test due to technical issues was 1.4%. Only one patient had to repeat the test due to inadequate ECG quality as judged by the ordering physician. The median turnaround time, from the kit being mailed out to the recorder being returned, was 10 days. Overall, 2.2% of the ECG devices were lost in shipping or unreturned by patients.

Conclusion

Of the first 1000 patients who had their ECG tests at homes, it was found that this home ECG testing platform and care model could be reliably used by patients with no training to acquire clinical grade ECG. The current study proved that medical standard, resting 12‑lead ECG can be performed by the majority of patients at home.