Update

Smartphone-based ECG device ‘raises arrhythmia detection fivefold’

Patients attending A&E with unexplained palpitations should routinely be given the smartphone-linked devices to improve diagnosis of abnormal heart rhythms, say researchers.


7 March 2019, by Siobhan Chan

Person holding a smartphone ECG device 

A smartphone-based ECG device is five times more effective at detecting previously unexplained arrhythmias than standard care, according to research part-funded by the BHF.

The AliveCor KardiaMobile device, which sticks to the back of a smartphone and connects to an app, helped to diagnose the underlying symptom-causing arrhythmias more often than standard care in emergency departments.

Researchers from the University of Edinburgh and NHS Lothian said the devices should be offered routinely to people who present to A&E with unexplained palpitations or pre-syncope.

Cost-effective ECG

Around 300,000 people attend UK emergency departments for palpitations or pre-syncope every year1, but because abnormal heart rhythms can be intermittent many patients have recovered by the time they are seen in A&E. Their ECG is recorded as normal, so the cause of their symptoms isn’t found. Only around 20% of A&E admissions for these symptoms typically lead to a diagnosis.2

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The randomised controlled trial, published in EClinicalMedicine, recruited participants who presented to 10 UK emergency departments with palpitations or pre-syncope but whose underlying ECG rhythm remained undiagnosed.

Some patients were given an AliveCor device to take home and were trained in its use. They also received standard care. A control group received only standard care, such as Holter monitoring (ambulatory monitoring with a wearable ECG device), follow-up with a GP, or being asked to attend A&E if symptoms returned.

When patients with the device felt symptoms of palpitations or pre-syncope, they recorded an ECG by placing two fingers from each hand on the device attached to their smartphone. The ECGs were sent to emergency physicians working with the research centre in Edinburgh for review.

Clinicians went on to diagnose the cause of the symptoms in 69 out of 124 patients who were given the devices, compared to 11 of 116 in the control group.

The device also cut the cost of a diagnosis by an average of £921, from £1,395 to £474, due to the relative higher costs of Holter monitoring used in the control group.

Detecting atrial fibrillation

The most commonly recorded heart rhythms were sinus rhythm, sinus tachycardia and ectopic beats. The study found eight cases of atrial fibrillation (AF), three cases of supraventricular tachycardia, and one case of atrial flutter, all in the group who received devices.

Study authors said the “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.

Dr Matthew Reed from the Emergency Medicine Research Group Edinburgh (EMERGE) at Edinburgh Royal Infirmary, said:  “For those with harmless palpitations this device can quickly give reassurance, whilst for those with serious underlying heart conditions it can act as a lifesaver. We are now calling for this technology to be rolled out in emergency departments across the country.”

The study was funded by the BHF and Chest Heart and Stroke Scotland (CHSS).

 


How could 3D technology help patients with AF? Our patient magazine, Heart Matters, explores new research.

Read the article

References

  1. Reed M 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
  2. Cheung C et al. Comparing 14-day adhesive patch with 24-h Holter monitoring. Future Cardiol. 2014; 10(3): 319-22