Evaluating IoT-Based Services to Support Patient Empowerment in Digital Home Hospitalization Services

Six-Lead Electrocardiography Enables Identification of Rhythm and Conduction Anomalies of Patients in the Telemedicine-Based, Hospital-at-Home Setting: A Prospective Validation Study

BACKGROUND

The hospital-at-home (HAH) model is a viable alternative for conventional in-hospital stays worldwide. Serum electrolyte abnormalities are common in acute patients, especially in those with many comorbidities. Pathologic changes in cardiac electrophysiology pose a potential risk during HAH stays. Periodical electrocardiogram (ECG) tracing is therefore advised, but few studies have evaluated the accuracy and efficiency of compact, self-activated ECG devices in HAH settings. This study aimed to evaluate the reliability of such a device in comparison with a standard 12-lead ECG.

METHODS

We prospectively recruited consecutive patients admitted to the Sheba Beyond Virtual Hospital, in the HAH department, during a 3-month duration. Each patient underwent a 12-lead ECG recording using the legacy device and a consecutive recording by a compact six-lead device. Baseline patient characteristics during hospitalization were collected. The level of agreement between devices was measured by Cohen's kappa coefficient for inter-rater reliability (Ϗ).

RESULTS

Fifty patients were included in the study (median age 80 years, IQR 14). In total, 26 (52%) had electrolyte disturbances. Abnormal D-dimer values were observed in 33 (66%) patients, and 12 (24%) patients had elevated troponin values. We found a level of 94.5% raw agreement between devices with regards to nine of the options included in the automatic read-out of the legacy device. The calculated Ϗ was 0.72, classified as a substantial consensus. The rate of raw consensus regarding the ECG intervals' measurement (PR, RR, and QT) was 78.5%, and the calculated Ϗ was 0.42, corresponding to a moderate level of agreement.

CONCLUSION

This is the first report to our knowledge regarding the feasibility of using a compact, six-lead ECG device in the setting of an HAH to be safe and bearing satisfying agreement level with a legacy, 12-lead ECG device, enabling quick, accessible arrythmia detection in this setting. Our findings bear a promise to the future development of telemedicine-based hospital-at-home methodology.

A Brief Review on Flexible Electronics for IoT: Solutions for Sustainability and New Perspectives for Designers

The Internet of Things (IoT) is gaining more and more popularity and it is establishing itself in all areas, from industry to everyday life. Given its pervasiveness and considering the problems that afflict today's world, that must be carefully monitored and addressed to guarantee a future for the new generations, the sustainability of technological solutions must be a focal point in the activities of researchers in the field. Many of these solutions are based on flexible, printed or wearable electronics. The choice of materials therefore becomes fundamental, just as it is crucial to provide the necessary power supply in a green way. In this paper we want to analyze the state of the art of flexible electronics for the IoT, paying particular attention to the issue of sustainability. Furthermore, considerations will be made on how the skills required for the designers of such flexible circuits, the features required to the new design tools and the characterization of electronic circuits are changing.