The Use of Wearable ECG Devices in the Clinical Setting: a Review

Springer Science and Business Media LLC - Tập 10 - Trang 67-72 - 2022
Paola Kamga1, Rasik Mostafa1, Saba Zafar1
1Michigan State University College of Osteopathic Medicine, Detroit, Michigan, USA

Tóm tắt

This review investigates the use of wearable electrocardiograms (ECGs) in the clinic and acute care setting, and their impact on patient care, particularly pertaining to the management of cardiac arrhythmias. Wearable ECGs have consistently demonstrated their non-inferiority in detecting arrhythmias when compared to the current standard of care. Different studies have highlighted their ability to improve patient care and reduce healthcare costs, while more devices are being created to work as a screening tool at a larger scale or to fit the physical abilities of a variety of patients. The use of wearable cardiac monitoring devices demonstrated considerable symptom–rhythm correlation in various clinical settings, which often resulted in a reduction in time to diagnosis and lower rates of ED visits. However, this relatively new technology raised concerns for patient accessibility and privacy among others. Further research is needed to assess their sensitivity and specificity in the clinical setting, as well as their limitations.

Tài liệu tham khảo

Cairns C, Kang K. National Hospital Ambulatory Medical Care Survey: 2019 Emergency Department Summary Tables. https://doi.org/10.15620/cdc:115748. Rui P, Kang K, Albert M. National Hospital Ambulatory Medical Care Survey: 2013 Emergency Department Summary Tables. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). Circulation. 2004;110(9):e82-292. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine - PubMed. 2022. https://pubmed.ncbi.nlm.nih.gov/17679616/. Diercks DB, Kirk JD, Lindsell CJ, et al. Door-to-ECG time in patients with chest pain presenting to the ED. Am J Emerg Med. 2006;24(1):1–7. A Method for Improving Arrival‐to‐electrocardiogram Time in Emergency Department Chest Pain Patients and the Effect on Door‐to‐balloon Time for ST‐segment Elevation Myocardial Infarction - Takakuwa - 2009 - Academic Emergency Medicine - Wiley Online Library. https://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2009.00493.x. Accessed 30 Apr 30 2022 Garbern SC, Mbanjumucyo G, Umuhoza C, et al. Validation of a wearable biosensor device for vital sign monitoring in septic emergency department patients in Rwanda. Digital Health. 2019. Kathleen TH, Angelo BB, Garan H, et al. Evaluating the utility of mHealth ECG heart monitoring for the detection and management of atrial fibrillation in clinical practice. J Atr Fibrillation. 2017;9(5):1546. • Reed JM, Grubb NR, Lang CC, et al. 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). Assessed the use of smartphone-based event recorders in an ED setting and based on greater detection rate and faster rhythm detection time, the authors illustrated the potential application and effectiveness of wearable ECG devices in acute care settings. •• Cullen J, Reed MJ, Muir A, Murphy R, Pollard V, Zangana G, Krupej S, Askham S, Holdsworth P, Davies L. Experience of a smartphone ambulatory ECG clinic for emergency department patients with palpitation: a single-center cohort study. Eur J Emerg Med. 2021;28(6):463–8 This study found considerable symptom-rhythm correlation after using a smartphone ambulatory ECG in a clinic where patients were sent following an emergency department visit for cardiac related symptoms. • Perez MV, Mahaffey KW, Hedlin H, Rumsfeld JS, Garcia A, Ferris T, Balasubramanian V, Russo AM, Rajmane A, Cheung L, Hung G, Lee J, Kowey P, Talati N, Nag D, Gummidipundi SE, Beatty A, Hills MT, Desai S, Granger CB, Desai M, Turakhia MP. Apple heart study investigators. Large-scale assessment of a smartwatch to identify atrial fibrillation. N Engl J Med. 2019;381(20):1909–17. This study found that a considerable number of patients who received an irregular pulse notification were ultimately diagnosed with atrial fibrillation. Samol A, Bischof K, Luani B, Pascut D, Wiemer M, Kaese S. Recording of bipolar multichannel ECGs by a smartwatch: Modern ECG diagnostic 100 years after Einthoven. Sensors (Basel). 2019;19(13):2894. Samol A, Bischof K, Luani B, Pascut D, Wiemer M, Kaese S. Single-lead ECG recordings including Einthoven and Wilson leads by a smartwatch: a new era of patient directed early ECG differential diagnosis of cardiac diseases? Sensors. 2019;19(20):4377. Avila CO. Novel use of apple watch 4 to obtain 3-lead electrocardiogram and detect cardiac ischemia. Perm J. 2019;23:19–025. Bansal A, Joshi R. Portable out-of-hospital electrocardiography: a review of current technologies. J Arrhythm. 2018;34(2):129–38. Tung CE, Su D, Turakhia MP, Lansberg MG. Diagnostic yield of extended cardiac patch monitoring in patients with stroke or TIA. Front Neurol. 2015;5:266. Kaura A, Sztriha L, Chan FK, Aeron-Thomas J, Gall N, Piechowski-Jozwiak B, Teo JT. Early prolonged ambulatory cardiac monitoring in stroke (EPACS): an open-label randomised controlled trial. Eur J Med Res. 2019;24(1):25. Reed MJ, Grubb NR, Lang CC, Gray AJ, Simpson K, MacRaild A, Weir CJ. Diagnostic yield of an ambulatory patch monitor in patients with unexplained syncope after initial evaluation in the emergency department: the PATCH-ED study. Emerg Med J. 2018;35(8):477–85. •• Aljuaid M,et al. Smartphone ECG monitoring system helps lower emergency room and clinic visits in post-atrial fibrillation ablation patients. Clinical Medicine Insights. Cardiology. 2020;14:1179546820901508. This study found that the use of wearable ECG monitoring devices considerably reduced the number of unplanned outpatient visits and ED visits for cardiac arrhythmias. Spaich S, Kern H, Zelniker TA, et al. Feasibility of CardioSecur®, a Mobile 4-Electrode/22-Lead ECG device, in the prehospital emergency setting. Front Cardiovasc Med. 2020;7: 551796. Doliwa PS, Frykman V, Rosenqvist M. Short-term ECG for out of hospital detection of Silent atrial fibrillation episodes. Scandinavian Cardiovasc J. 2009;43(3):163–8. Usadel L, Haverkämper G, Herrmann S, et al. Arrhythmia detection in pediatric patients: ECG quality and diagnostic yield of a patient-triggered Einthoven Lead-I event recorder (Zenicor EKG-2™). Pediatr Cardiol. 2016;37:491–6. Kaasenbrood F, Hollander M, Rutten FH, Gerhards LJ, Hoes AW, Tieleman RG. Yield of screening for atrial fibrillation in primary care with a hand-held, single-lead electrocardiogram device during influenza vaccination. Europace. 2016;18(10):1514–20. Tieleman RG, Plantinga Y, Rinkes D, et al. Validation and clinical use of a novel diagnostic device for screening of atrial fibrillation. Europace. 2014;16(9):1291–5. https://doi.org/10.1093/europace/euu057. Fukuma N, Hasumi E, Fujiu K, et al. Feasibility of a T-shirt-type wearable electrocardiography monitor for detection of covert atrial fibrillation in young healthy adults. Sci Rep. 2019;9:11768. https://doi.org/10.1038/s41598-019-48267-1. • Ogasawara T, Mukaino M, Otaka Y, et al. Validation of data imputation by ensemble averaging to quantify 24-h behavior using heart rate of stroke rehabilitation inpatients. J Med Biol Eng. 2021;41:322–30. This study compares the ECG findings of a Holter monitor to the findings of that of the T-shirt type ECG monitor. Duarte R, Stainthorpe A, Mahon J, et al. Lead-I ECG for detecting atrial fibrillation in patients attending primary care with an irregular pulse using single-time point testing: a systematic review and economic evaluation. PLoS ONE. 2019;14(12): e0226671. Evans GF, Shirk A, Muturi P, Soliman EZ. Feasibility of using mobile ECG recording technology to detect atrial fibrillation in low-resource settings. Glob Heart. 2017;12(4):285–9. Drew BJ, Califf RM, Funk M, et al. Practice standards for electrocardiographic monitoring in hospital settings. Circulation. 2004;110(17):2721–46. US Preventive Services Task Force, Curry SJ, Krist AH, et al. Screening for cardiovascular disease risk with electrocardiography: US preventive services task force recommendation statement. JAMA. 2018;319(22):2308–14. Scquizzato T, Frontera A, Limite LR, Landoni G. Smartwatch-detected atrial fibrillation in the Emergency Department: possible implications and treatment. J Cardiovasc Med (Hagerstown). 2021;22(4):327–8. Desteghe L, Raymaekers Z, Lutin M, et al. Performance of handheld electrocardiogram devices to detect atrial fibrillation in a cardiology and geriatric ward setting. Europace. 2017;19(1):29–39. Foster KR, Torous J. The opportunity and obstacles for smartwatches and wearable sensors. IEEE Pulse. 2019;10(1):22–5. Share of tech users among Americans 65 and older grew in past decade. Pew Research Center. 2022. Record shares of Americans have smartphones, home broadband. Pew Research Center. 2017.