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Evaluating atrial fibrillation artificial intelligence for the emergency department, statistical and clinical implications. Am J Emerg Med 2022; 57:98-102. [DOI: 10.1016/j.ajem.2022.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/06/2022] [Accepted: 04/10/2022] [Indexed: 11/22/2022] Open
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Książczyk M, Dębska-Kozłowska A, Warchoł I, Lubiński A. Enhancing Healthcare Access-Smartphone Apps in Arrhythmia Screening: Viewpoint. JMIR Mhealth Uhealth 2021; 9:e23425. [PMID: 34448723 PMCID: PMC8433858 DOI: 10.2196/23425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/04/2021] [Accepted: 07/28/2021] [Indexed: 01/23/2023] Open
Abstract
Atrial fibrillation is the most commonly reported arrhythmia and, if undiagnosed or untreated, may lead to thromboembolic events. It is therefore desirable to provide screening to patients in order to detect atrial arrhythmias. Specific mobile apps and accessory devices, such as smartphones and smartwatches, may play a significant role in monitoring heart rhythm in populations at high risk of arrhythmia. These apps are becoming increasingly common among patients and professionals as a part of mobile health. The rapid development of mobile health solutions may revolutionize approaches to arrhythmia screening. In this viewpoint paper, we assess the availability of smartphone and smartwatch apps and evaluate their efficacy for monitoring heart rhythm and arrhythmia detection. The findings obtained so far suggest they are on the right track to improving the efficacy of early detection of atrial fibrillation, thus lowering the risk of stroke and reducing the economic burden placed on public health.
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Affiliation(s)
- Marcin Książczyk
- Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, Łódź, Poland.,Department of Noninvasive Cardiology, Medical University of Lodz, Łódź, Poland
| | - Agnieszka Dębska-Kozłowska
- Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, Łódź, Poland
| | - Izabela Warchoł
- Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, Łódź, Poland
| | - Andrzej Lubiński
- Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, Łódź, Poland
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Wan EY, Ghanbari H, Akoum N, Itzhak Attia Z, Asirvatham SJ, Chung EH, Dagher L, Al-Khatib SM, Stuart Mendenhall G, McManus DD, Pathak RK, Passman RS, Peters NS, Schwartzman DS, Svennberg E, Tarakji KG, Turakhia MP, Trela A, Yarmohammadi H, Marrouche NF. HRS White Paper on Clinical Utilization of Digital Health Technology. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2021; 2:196-211. [PMID: 35265910 PMCID: PMC8890053 DOI: 10.1016/j.cvdhj.2021.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This collaborative statement from the Digital Health Committee of the Heart Rhythm Society provides everyday clinical scenarios in which wearables may be utilized by patients for cardiovascular health and arrhythmia management. We describe herein the spectrum of wearables that are commercially available for patients, and their benefits, shortcomings and areas for technological improvement. Although wearables for rhythm diagnosis and management have not been examined in large randomized clinical trials, undoubtedly the usage of wearables has quickly escalated in clinical practice. This document is the first of a planned series in which we will update information on wearables as they are revised and released to consumers.
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Affiliation(s)
- Elaine Y. Wan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | | | | | | | | | | | - Lilas Dagher
- Tulane Research Innovation for Arrhythmia Discoveries (TRIAD), Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA
| | | | | | | | - Rajeev K. Pathak
- Cardiac Electrophysiology Unit, Department of Cardiology, Canberra Hospital and Health Services, Australian National University, Canberra, Australia
| | - Rod S. Passman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Emma Svennberg
- Karolinska Institutet, Department of Medicine Huddinge, Karolinska University Hospital, Stockholm, Sweden
| | - Khaldoun G. Tarakji
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mintu P. Turakhia
- Department of Medicine, Stanford University, Stanford, California; Veterans Affairs Palo Alto Health Care System, Palo Alto, California, and Center for Digital Health, Stanford, CA, USA
| | - Anthony Trela
- Lucile Packard Children’s Hospital, Pediatric Cardiology, Palo Alto, CA, USA
| | - Hirad Yarmohammadi
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Nassir F. Marrouche
- Tulane Research Innovation for Arrhythmia Discoveries (TRIAD), Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA
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Bray JJH, Lloyd EF, Adenwalla F, Kelly S, Wareham K, Halcox JPJ. Single-lead ECGs (AliveCor) are a feasible, cost-effective and safer alternative to 12-lead ECGs in community diagnosis and monitoring of atrial fibrillation. BMJ Open Qual 2021; 10:e001270. [PMID: 33741652 PMCID: PMC7986662 DOI: 10.1136/bmjoq-2020-001270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/20/2021] [Accepted: 03/04/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Community management of atrial fibrillation (AF) often requires the use of electrocardiographic (ECG) investigation. Patients discharged following treatment of AF with fast ventricular response (fast AF) can require numerous ECGs to monitor rate and/or rhythm control. Single-lead ECGs have been proposed as a more convenient and relatively accurate alternative to 12-lead ECGs for rate/rhythm management and also diagnosis of AF. We aimed to examine the feasibility of using the AliveCor single-lead ECG monitor for diagnosis and monitoring of AF in the community setting. METHODS During the course of 6 months, this evaluation of a clinical service improvement pathway used the AliveCor in management of patients requiring (1) follow-up ECGs for AF with previously documented rapid ventricular rate or (2) ECG confirmation of rhythm where AF was suspected. Twelve AliveCor devices provided to the acute community medical team were used to produce 30 s ECG rhythm strips (iECG) that were electronically sent to an overreading physician. RESULTS Seventy-four patients (mean age 82 years) were managed on this pathway. (1) The AliveCor was successfully used to monitor the follow-up of 37 patients with fast AF, acquiring a combined total of 113 iECGs (median 1.5 ±3.75 per patient). None of these patients required a subsequent 12-lead ECG and this approach saved an estimate of up to £134.49 per patient. (2) Of 53 patients with abnormal pulses, the system helped identify 8 cases of new onset AF and 19 cases of previously known AF that had reverted from sinus back into AF. CONCLUSIONS We have demonstrated that the AliveCor system is a feasible, cost-effective, time-efficient and potentially safer alternative to serial 12-lead ECGs for community monitoring and diagnosis of AF.
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Affiliation(s)
- Jonathan James Hyett Bray
- Institute of Life Sciences 2, Swansea University Medical School, Swansea, UK
- General Medicine, Cardiff and Vale NHS Trust, Cardiff, UK
| | - Elin Fflur Lloyd
- Cardiology, Swansea Bay University Health Board, Port Talbot, Neath Port Talbot, UK
| | - Firdaus Adenwalla
- Swansea Bay University Health Board, Port Talbot, Neath Port Talbot, UK
| | - Sarah Kelly
- Swansea Bay University Health Board, Port Talbot, Neath Port Talbot, UK
| | - Kathie Wareham
- Institute of Life Sciences 2, Swansea University Medical School, Swansea, UK
- Morriston Hospital, Swansea, Wales, UK
| | - Julian P J Halcox
- Institute of Life Sciences 2, Swansea University Medical School, Swansea, UK
- Singleton Hospital, Swansea, Wales, UK
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The use of a traditional nonlooping event monitor versus a loan-based program with a smartphone ECG device in the pediatric cardiology clinic. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2020; 2:71-75. [PMID: 35265892 PMCID: PMC8890102 DOI: 10.1016/j.cvdhj.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background A smartphone-enabled device has been developed that provides a single-lead electrocardiogram using a portable monitor. The increase in direct-to-consumer medical devices may lead to health disparities affecting members of socially disadvantaged populations. Objective Here we provide a single center’s experience in the use of this device in a pediatric cardiology clinic using a loan-based program. We also compare it to retrospective data from patients who received a traditional nonlooping event monitor. Methods Forty AliveCor Kardia monitor devices were purchased with grant support from the South Carolina TeleHealth Alliance. The devices were provided between June 2018 and August 2019 to patients presenting to the pediatric cardiology clinic who would have otherwise received a nonlooping event monitor. A retrospective chart review was performed for all patients who were given a MicroER nonlooping event monitor between May and December of 2017. Results Over a 15-month period, 65 patients were given the smartphone device. A total of 692 tracings were recorded by patients with 9 abnormal recordings. Of the devices expected to be returned, 35 devices have been returned to clinic (54%). Over an 8-month period, 61 patients received the traditional event monitors, accounting for a total of 142 transmissions with 3 abnormal transmissions. Conclusion Our results reveal adequate use of the device with reliable tracings and show more frequent utilization of the smartphone-enabled device. Utilization of these devices in a loan-based program may improve access to care with improved methods to ensure return of the devices.
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Sohinki D, Berman AE. What Coronavirus Disease 2019 Has Taught Us About Modern Electrophysiology Practice. J Innov Card Rhythm Manag 2020; 11:4187-4190. [PMID: 32874744 PMCID: PMC7452735 DOI: 10.19102/icrm.2020.110801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Daniel Sohinki
- Division of Adult Cardiology, Medical College of Georgia, Augusta, GA, USA
| | - Adam E. Berman
- Division of Adult Cardiology, Medical College of Georgia, Augusta, GA, USA
- Division of Pediatric Cardiology, Medical College of Georgia, Augusta, GA, USA
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Kropp CM, Huber NL, Sager D, Tripp C, Burch A, Naniwadekar A, Nekkanti R, Sadaf MI, Mounsey JP, Sears SF. Mobile-ECG screening in rural pharmacies: rates of atrial fibrillation and associated risk factors. Heart Lung 2020; 49:377-380. [PMID: 32014313 DOI: 10.1016/j.hrtlng.2020.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Atrial fibrillation (AFib) is a growing health concern, affecting more than 40 million patients worldwide and increasing stroke risk by five times. Community screening initiatives in rural healthcare establishments are becoming more feasible with the development of innovative, mobile-ECG (mECG) technology. The purpose of this research was to characterize increased rates of stroke risk factors and to determine AFib incidence in rural, pharmacy settings. METHODS The researchers examined the prevalence of risk factors associated with AFib and calculated CHA₂DS₂-VASc stroke risk scores in a previously undiagnosed AFib community sample of 250 participants. Eligible participants at two rural pharmacies were administered a 1-lead mECG reading. Participants were then asked to complete questionnaires on demographic and medical history information. All participants were given educational materials on AFib and medical referrals when indicated. RESULTS Prevalence rates of six, known independent stroke risk factors (CHA₂DS₂-VASc scores: (2.68 ± 1.35)) were significantly higher in the study sample than reported national US averages. Screening via mECG indicated preliminary AFib rates of approximately 4%; however, upon independent adjudication of the readings from three electrophysiologists AFib prevalence ranged between 1% and 8%. DISCUSSION Collectively, an alarming rate of untreated stroke risk in a rural pharmacy sample was identified by the researchers utilizing mECG technology. These results suggest potential value to the use of mECG technology to screen for AFib in at-risk communities.
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Affiliation(s)
- Caley M Kropp
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Nichelle L Huber
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - David Sager
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Connor Tripp
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Ashley Burch
- Department of Psychology, East Carolina University, Greenville, NC, USA; Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Aditi Naniwadekar
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Rajasekhar Nekkanti
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Murrium I Sadaf
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - J Paul Mounsey
- Department of Psychology, East Carolina University, Greenville, NC, USA; Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Samuel F Sears
- Department of Psychology, East Carolina University, Greenville, NC, USA; Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA.
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Kazmi SHA, Datta S, Chi G, Nafee T, Yee M, Kalia A, Sharfaei S, Shojaei F, Mirwais S, Gibson CM. The AngelMed Guardian ® System in the Detection of Coronary Artery Occlusion: Current Perspectives. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2020; 13:1-12. [PMID: 32021496 PMCID: PMC6954830 DOI: 10.2147/mder.s219865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 12/13/2019] [Indexed: 11/23/2022] Open
Abstract
Total ischemic time, which specifies the time from the onset of chest pain to initiation of reperfusion during percutaneous coronary intervention, consists of two intervals: symptom to door time and door to balloon time. A door to balloon time of 90 mins or less has become a quality-of-care metric in the management of ST elevation myocardial infarction (STEMI). While national efforts made by the American College of Cardiology (ACC) and American Heart Association (AHA) have curtailed in-hospital door to balloon time over the years, a reduction in pre-hospital symptoms to door time presents a challenge in modern interventional Cardiology. Early and complete revascularization has been associated with improved clinical outcomes in MI and strategies that may help reduce symptom to door time, and thus the total ischemic time, are crucial. Rapidly evolving ST-segment changes commonly develop prior to ischemia-related symptom onset, and are detectable even in patients with clinically unrecognized silent MIs. Therefore, a highly intelligent ischemia detection system that alerts patients of ST segment deviation may allow for rapid identification of acute coronary occlusion. The AngelMed Guardian® System is a cardiac activity monitoring and alerting system designed for rapid identification of intracardiac ST-segment changes among patients at a high risk for recurrent ACS events. This article reviews the clinical studies evaluating the design, safety and efficacy of the AngelMed Guardian System and discusses the clinical implications of the device.
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Affiliation(s)
- Syed Hassan Abbas Kazmi
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sudarshana Datta
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Gerald Chi
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tarek Nafee
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Megan Yee
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Akshun Kalia
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sadaf Sharfaei
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Fahimehalsadat Shojaei
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sabawoon Mirwais
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - C Michael Gibson
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Mobile Self-Monitoring ECG Devices to Diagnose Arrhythmia that Coincide with Palpitations: A Scoping Review. Healthcare (Basel) 2019; 7:healthcare7030096. [PMID: 31426383 PMCID: PMC6787597 DOI: 10.3390/healthcare7030096] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/08/2019] [Accepted: 08/13/2019] [Indexed: 01/19/2023] Open
Abstract
The use and deployment of mobile devices across society is phenomenal with an increasing number of individuals using mobile devices to track their everyday health. However, there is a paucity of academic material examining this recent trend. Specifically, little is known about the use and deployment of mobile heart monitoring devices for measuring palpitations and arrhythmia. In this scoping literature review, we identify the contemporary evidence that reports the use of mobile heart monitoring to assess palpitations and arrhythmia across populations. The review was conducted between February and March 2018. Five electronic databases were searched: Association for Computing Machinery (ACM), CINHAL, Google Scholar, PubMed, and Scopus. A total of 981 records were identified and, following the inclusion and exclusion criteria, nine papers formed the final stage of the review. The results identified a total of six primary themes: purpose, environment, population, wearable devices, assessment, and study design. A further 24 secondary themes were identified across the primary themes. These included detection, cost effectiveness, recruitment, type of setting, type of assessment, and commercial or purpose-built mobile device. This scoping review highlights that further work is required to understand the impact of mobile heart monitoring devices on how arrhythmias and palpitations are assessed and measured across all populations and ages of society. A positive trend revealed by this review demonstrates how mobile heart monitoring devices can support primary care providers to deliver high levels of care at a low cost to the service provider. This has several benefits: alleviation of patient anxiety, lowering the risk of morbidity and mortality, while progressively influencing national and international care pathway guidelines. Limitations of this work include the paucity of knowledge and insight from primary care providers and lack of qualitative material. We argue that future studies consider qualitative and mixed methods approaches to complement quantitative methodologies and to ensure all actors’ experiences are recorded.
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Bose R, Saxon LA. The Democratization of Diagnosis: Bringing the Power of Medical Diagnosis to the Masses. EClinicalMedicine 2019; 8:6-7. [PMID: 31193676 PMCID: PMC6537544 DOI: 10.1016/j.eclinm.2019.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/05/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Rupan Bose
- Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
| | - Leslie A. Saxon
- Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
- USC Center for Body Computing, Los Angeles, CA, United States of America
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Reed MJ, Grubb NR, Lang CC, O'Brien R, Simpson K, Padarenga M, Grant A, Tuck S, Keating L, Coffey F, Jones L, Harris T, Lloyd G, Gagg J, Smith JE, Coats T. Multi-centre Randomised Controlled Trial of a Smartphone-based Event Recorder Alongside Standard Care Versus Standard Care for Patients Presenting to the Emergency Department with Palpitations and Pre-syncope: The IPED (Investigation of Palpitations in the ED) study. EClinicalMedicine 2019; 8:37-46. [PMID: 31193636 PMCID: PMC6537555 DOI: 10.1016/j.eclinm.2019.02.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 02/07/2019] [Accepted: 02/15/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients with palpitations and pre-syncope commonly present to Emergency Departments (EDs) but underlying rhythm diagnosis is often not possible during the initial presentation. This trial compares the symptomatic rhythm detection rate of a smartphone-based event recorder (AliveCor) alongside standard care versus standard care alone, for participants presenting to the ED with palpitations and pre-syncope with no obvious cause evident at initial consultation. METHODS Multi-centre open label, randomised controlled trial. Participants ≥ 16 years old presenting to 10 UK hospital EDs were included. Participants were randomised to either (a) intervention group; standard care plus the use of a smartphone-based event recorder or (b) control group; standard care alone. Primary endpoint was symptomatic rhythm detection rate at 90 days. Trial registration number NCT02783898 (ClinicalTrials.gov). FINDINGS Two hundred forty-three participants were recruited over an 18-month period. A symptomatic rhythm was detected at 90 days in 69 (n = 124; 55.6%; 95% CI 46.9-64.4%) participants in the intervention group versus 11 (n = 116; 9.5%; 95% CI 4.2-14.8) in the control group (RR 5.9, 95% CI 3.3-10.5; p < 0.0001). Mean time to symptomatic rhythm detection in the intervention group was 9.5 days (SD 16.1, range 0-83) versus 42.9 days (SD 16.0, range 12-66; p < 0.0001) in the control group. The commonest symptomatic rhythms detected were sinus rhythm, sinus tachycardia and ectopic beats. A symptomatic cardiac arrhythmia was detected at 90 days in 11 (n = 124; 8.9%; 95% CI 3.9-13.9%) participants in the intervention group versus 1 (n = 116; 0.9%; 95% CI 0.0-2.5%) in the control group (RR 10.3, 95% CI 1.3-78.5; p = 0.006). INTERPRETATION Use of a smartphone-based event recorder increased the number of patients in whom an ECG was captured during symptoms over five-fold to more than 55% at 90 days. This safe, non-invasive and easy to use device should be considered part of on-going care to all patients presenting acutely with unexplained palpitations or pre-syncope. FUNDING This study was funded by research awards from Chest, Heart and Stroke Scotland (CHSS) and British Heart Foundation (BHF) which included funding for purchasing the devices. MR was supported by an NHS Research Scotland Career Researcher Clinician award.
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Affiliation(s)
- Matthew J. Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
- Edinburgh Acute Care, Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, The Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
- Corresponding author at: Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK.
| | - Neil R. Grubb
- Department of Cardiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Christopher C. Lang
- Department of Cardiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Rachel O'Brien
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Kirsty Simpson
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Mia Padarenga
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Alison Grant
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Sharon Tuck
- Edinburgh Clinical Research Facility, Epidemiology and Statistics Core, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Liza Keating
- Emergency Department, Royal Berkshire NHS Foundation Trust, Reading RG1 5AN, UK
| | - Frank Coffey
- DREEAM - Department of Research and Education in Emergency medicine, Acute medicine and Major trauma, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Derby Road, Nottingham, NG7 2UH, UK
| | - Lucy Jones
- Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield Rd, Calow, Chesterfield S44 5BL, UK
| | - Tim Harris
- Barts Health NHS Trust, Whitechapel, London E1 1BB, UK
| | - Gavin Lloyd
- Royal Devon and Exeter Hospital, Barrack Rd, Exeter EX2 5DW, UK
| | - James Gagg
- Department of Emergency Medicine, Musgrove Park Hospital, Taunton & Somerset NHS Foundation Trust, Taunton TA1 5DA, UK
| | - Jason E. Smith
- Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK
| | - Tim Coats
- Emergency Medicine Academic Group, Department of Cardiovascular Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
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