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Gaillard N, Deharo JC, Suissa L, Defaye P, Sibon I, Leclercq C, Alamowitch S, Guidoux C, Cohen A. Scientific statement from the French neurovascular and cardiac societies for improved detection of atrial fibrillation after ischaemic stroke and transient ischaemic attack. Arch Cardiovasc Dis 2024:S1875-2136(24)00287-0. [PMID: 39271364 DOI: 10.1016/j.acvd.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 09/15/2024]
Abstract
Atrial fibrillation (AF) is the primary cause of ischaemic stroke and transient ischaemic attack (TIA). AF is associated with a high risk of recurrence, which can be reduced using optimal prevention strategies, mainly anticoagulant therapy. The availability of effective prophylaxis justifies the need for a significant, coordinated and thorough transdisciplinary effort to screen for AF associated with stroke. A recent French national survey, initiated and supported by the Société française neurovasculaire (SFNV) and the Société française de cardiologie (SFC), revealed many shortcomings, such as the absence or inadequacy of telemetry equipment in more than half of stroke units, insufficient and highly variable access to monitoring tools, delays in performing screening tests, heterogeneous access to advanced or connected ambulatory monitoring techniques, and a lack of dedicated human resources. The present scientific document has been prepared on the initiative of the SFNV and the SFC with the aim of helping to address the current shortcomings and gaps, to promote efficient and cost-effective AF detection, and to improve and, where possible, homogenize the quality of practice in AF screening among stroke units and outpatient post-stroke care networks. The working group, composed of cardiologists and vascular neurologists who are experts in the field and are nominated by their peers, reviewed the literature to propose statements, which were discussed in successive cycles, and maintained, either by consensus or by vote, as appropriate. The text was then submitted to the SFNV and SFC board members for review. This scientific statement document argues for the widespread development of patient pathways to enable the most efficient AF screening after stroke. This assessment should be carried out by a multidisciplinary team, including expert cardiologists and vascular neurologists.
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Affiliation(s)
- Nicolas Gaillard
- Service de Neurologie, Clinique Beau Soleil, Institut Mutualiste Montpelliérain, 19, avenue de Lodève, 34070 Montpellier, France; Département de Neurologie, Hôpital Universitaire Gui-de-Chauliac, 80, avenue Augustin-Fliche, 34080 Montpellier, France
| | - Jean-Claude Deharo
- Assistance publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, Marseille, France; Aix-Marseille Université, C2VN, 13005 Marseille, France.
| | - Laurent Suissa
- Stroke Unit, University Hospital La Timone, AP-HM, Marseille, France; Centre de recherche en CardioVasculaire et Nutrition (C2VN), 13005 Marseille, France
| | - Pascal Defaye
- Cardiology Department, University Hospital, Grenoble Alpes University, CS 10217, 38043 Grenoble, France
| | - Igor Sibon
- Université Bordeaux, CHU de Bordeaux, Unité Neurovasculaire, Hôpital Pellegrin, 33000 Bordeaux, France; INCIA-UMR 5287-CNRS Équipe ECOPSY, Université de Bordeaux, Bordeaux, France
| | - Christophe Leclercq
- Department of Cardiology, University of Rennes, CHU de Rennes, lTSI-UMR1099, 35000 Rennes, France
| | - Sonia Alamowitch
- Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, AP-HP, Hôpital Saint-Antoine, Sorbonne Université, Paris, France; STARE Team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, 75013 Paris, France
| | - Céline Guidoux
- Department of Neurology and Stroke Unit, Bichat Hospital, Assistance publique-Hôpitaux de Paris, 75018 Paris, France
| | - Ariel Cohen
- Hôpitaux de l'est parisien (Saint-Antoine-Tenon), AP-HP, Sorbonne Université, Inserm ICAN 1166, 184, Faubourg-Saint-Antoine, 75571 Paris cedex 12, France
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Ho JSY, Ho ESY, Yeo LLL, Kong WKF, Li TYW, Tan BYQ, Chan MY, Sharma VK, Poh KK, Sia CH. Use of wearable technology in cardiac monitoring after cryptogenic stroke or embolic stroke of undetermined source: a systematic review. Singapore Med J 2024; 65:370-379. [PMID: 38449074 PMCID: PMC11321540 DOI: 10.4103/singaporemedj.smj-2022-143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 05/28/2023] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Prolonged cardiac monitoring after cryptogenic stroke or embolic stroke of undetermined source (ESUS) is necessary to identify atrial fibrillation (AF) that requires anticoagulation. Wearable devices may improve AF detection compared to conventional management. We aimed to review the evidence for the use of wearable devices in post-cryptogenic stroke and post-ESUS monitoring. METHODS We performed a systematic search of PubMed, EMBASE, Scopus and clinicaltrials.gov on 21 July 2022, identifying all studies that investigated the use of wearable devices in patients with cryptogenic stroke or ESUS. The outcomes of AF detection were analysed. Literature reports on electrocardiogram (ECG)-based (external wearable, handheld, patch, mobile cardiac telemetry [MCT], smartwatch) and photoplethysmography (PPG)-based (smartwatch, smartphone) devices were summarised. RESULTS A total of 27 relevant studies were included (two randomised controlled trials, seven prospective trials, 10 cohort studies, six case series and two case reports). Only four studies compared wearable technology to Holter monitoring or implantable loop recorder, and these studies showed no significant differences on meta-analysis (odds ratio 2.35, 95% confidence interval [CI] 0.74-7.48, I 2 = 70%). External wearable devices detected AF in 20.7% (95% CI 14.9-27.2, I 2 = 76%) of patients and MCT detected new AF in 9.6% (95% CI 7.4%-11.9%, I 2 = 56%) of patients. Other devices investigated included patch sensors, handheld ECG recorders and PPG-based smartphone apps, which demonstrated feasibility in the post-cryptogenic stroke and post-ESUS setting. CONCLUSION Wearable devices that are ECG or PPG based are effective for paroxysmal AF detection after cryptogenic stroke and ESUS, but further studies are needed to establish how they compare with Holter monitors and implantable loop recorder.
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Affiliation(s)
- Jamie SY Ho
- Department of Medicine, Alexandra Hospital, Singapore
| | - Elizabeth SY Ho
- Department of Computer Science and Technology, University of Cambridge, Cambridge, UK
| | - Leonard LL Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - William KF Kong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Tony YW Li
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Benjamin YQ Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark Y Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Vijay K Sharma
- Division of Neurology, Department of Medicine, National University Health System, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kian-Keong Poh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore
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van der Maten G, Meijs MFL, van der Palen J, Brouwers PJAM, von Birgelen C, van Opstal J, den Hertog HM. Atrial fibrillation detected with outpatient cardiac rhythm monitoring in patients with ischemic stroke or TIA of undetermined cause. J Stroke Cerebrovasc Dis 2023; 32:107400. [PMID: 37801878 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023] Open
Abstract
OBJECTIVES Guidelines advise cardiac rhythm monitoring for 3 up to 30 days for detecting atrial fibrillation (AF) in patients with ischemic stroke of undetermined cause. However, the optimal monitoring duration is unknown. We aimed to determine the AF detection rate during 7-day outpatient cardiac rhythm monitoring in this patient group. METHODS Participants from a large tertiary hospital in a prospective observational study (ATTEST) underwent outpatient cardiac rhythm monitoring after a negative standard diagnostic evaluation (i.e., 12-lead electrocardiogram and in-hospital telemetry). Primary outcome was the rate of newly detected AF. RESULTS We examined 373 patients [age: 67.8±11.6 years; women: 166(44.5%); stroke: 278(74.5%)]. Median monitoring duration was 7 days (Inter Quartile Range (IQR) 7-7), performed after median of 36 days (IQR 27-47). AF was newly detected in 17(4.6%) patients, 5.4% of patients with ischemic stroke and 2.1% of patients with TIA. 53% of AF was detected on day-1, after day-3 73% of new AF was found. First AF episodes were detected up to day-7. Diabetes and increasing age were independent predictors of new AF. CONCLUSION After ischemic stroke or TIA of undetermined cause, 7-day outpatient cardiac rhythm monitoring detected new AF in 4.6%. Patients with AF had significantly more cardiovascular risk factors. Although about 50% of first AF episodes occurred during the first day of monitoring, new AF was detected up to day-7, implying that the recommended minimum of 3 days cardiac rhythm monitoring after ischemic stroke of undetermined cause is insufficient. Subsequent long-term rhythm monitoring should be considered in selected patients.
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Affiliation(s)
- Gerlinde van der Maten
- Department of Neurology, Medisch Spectrum Twente, Koningstraat 1, PO box 50 000, KA 7500, Enschede, The Netherlands; Department of Health Technology & Services Research, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands.
| | - Matthijs F L Meijs
- Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Job van der Palen
- Section Cognition, Education and Data, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands; Medical School wente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Paul J A M Brouwers
- Department of Neurology, Medisch Spectrum Twente, Koningstraat 1, PO box 50 000, KA 7500, Enschede, The Netherlands
| | - Clemens von Birgelen
- Department of Health Technology & Services Research, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands; Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Jurren van Opstal
- Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
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Al-Sabbagh MQ, Thirunavukkarasu S, Eswaradass P. Advances in Cardiac Workup for Transient Ischemic Attack: Improving Diagnostic Yield and Reducing Recurrent Stroke Risk. Cardiol Rev 2023:00045415-990000000-00155. [PMID: 37750739 DOI: 10.1097/crd.0000000000000607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Transient ischemic attack (TIA) is a warning sign for an impending stroke, with a 10-20% chance of a stroke occurring within 90 days of the initial event. Current clinical practice for cardiac workup in TIA includes cardiac enzymes, with 12-lead electrocardiogram, transthoracic echocardiography, and 24-hour Holter monitoring. However, the diagnostic yield of these investigations is variable, and there is a need for better diagnostic approaches to increase the detection of cardiac abnormalities in a cost-effective way. This review article examines the latest research on emerging diagnostic tools and strategies and discusses the potential benefits and challenges of using these advanced diagnostic approaches in clinical practice. Novel biomarkers, imaging techniques, and prolonged rhythm monitoring devices have shown great promise in enhancing the diagnostic yield of cardiac workup in TIA patients. Echocardiography, Transcranial Doppler ultrasound, cardiac MRI, and cardiac CT are among the promising diagnostic tools being studied. We conclude the article with a suggested diagnostic algorithm for cardiac workup in TIA. Further research is necessary to enhance their usefulness and to outline future directions for research and clinical practice in this field.
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Affiliation(s)
- Mohammed Q Al-Sabbagh
- From the Department of Neurology, University of Kansas Medical Center, Kansas City, KS
| | | | - Prasanna Eswaradass
- From the Department of Neurology, University of Kansas Medical Center, Kansas City, KS
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Junarta J, O'Neill P, Dikdan SJ, Pang Z, Fradin JJ, Frisch DR. Mobile electrocardiographic devices and healthcare utilization in post-atrial fibrillation ablation patients. J Electrocardiol 2023; 80:139-142. [PMID: 37390585 DOI: 10.1016/j.jelectrocard.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND The use of mobile electrocardiogram (mECG) devices is becoming more prevalent. mECG devices allow instant access to recording arrhythmias and enable automatic rhythm interpretation. Providers can remotely evaluate patients and this may reduce in-person healthcare utilization. We sought to evaluate the utility of mECG devices in reducing healthcare utilization among patients who underwent atrial fibrillation (AF) ablation. METHODS We identified a population of patients with paroxysmal or persistent AF presenting for their first AF ablation. Patients were divided into two groups: KardiaMobile (AliveCor, Mountain View, CA) mECG users and non-KardiaMobile users. Healthcare utilization was compared between the two groups for one year post-ablation. RESULTS 184 patients were studied (76 KardiaMobile users, 108 non-KardiaMobile users). There was no difference in the number of office visits (p = 0.59), cardiac-specific emergency department visits (p = 0.26), cardiac-specific hospital admissions (p = 0.13), ablations or cardioversions completed (p = 0.24), telephone encounters (p = 0.05), patient electronic health record messages (p = 0.40), or cardiac imaging (transthoracic or transesophageal echocardiograms) tests ordered (p = 0.36). Exposure to the device was associated with a reduction in ambulatory cardiac monitor use (p = 0.04). There was no difference in sinus rhythm maintenance over 12 months by Kaplan-Meier survival analysis (log rank test p = 0.05) between groups. CONCLUSION Mobile technology is available for heart rhythm monitoring and can give instant feedback to the user. mECG use is associated with a significant reduction in ambulatory cardiac monitor use in the post-ablation period. There was no difference in other AF-related healthcare utilization.
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Affiliation(s)
- Joey Junarta
- Department of Medicine, Thomas Jefferson University Hospital, USA
| | - Parker O'Neill
- Department of Medicine, Thomas Jefferson University Hospital, USA
| | - Sean J Dikdan
- Jefferson Heart Institute, Thomas Jefferson University Hospital, USA
| | - Zachary Pang
- Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - James J Fradin
- Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Daniel R Frisch
- Sidney Kimmel Medical College, Thomas Jefferson University, USA.
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Jung S, Lee HA, Kang IS, Shin SH, Chang Y, Woo Shin D, Park MS, Kim YD, Nam HS, Heo JH, Kim TH, Yu HT, Lee JM, Heo SH, Woo HG, Park JK, Roh SY, Kim CK, Lee YS, Do JK, Kim DH, Song TJ, Park J. Clinical Implications of Atrial Fibrillation Detection Using Wearable Devices in Patients With Cryptogenic Stroke (CANDLE-AF) Trial: Design and Rationale. Front Cardiovasc Med 2022; 9:837958. [PMID: 35445088 PMCID: PMC9013795 DOI: 10.3389/fcvm.2022.837958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/28/2022] [Indexed: 11/14/2022] Open
Abstract
Background Although many electrocardiography wearable devices have been released recently for the detection of atrial fibrillation (AF), there are few studies reporting prospective data for wearable devices compared to the strategy of the existing guidelines in the detection of atrial fibrillation (AF) after cryptogenic stroke. A tiny single-patch monitor is more convenient than a conventional Holter monitor recording device and, therefore, longer duration of monitoring may be acceptable. Methods and Design The CANDLE-AF study is a multicenter, prospective, randomized controlled trial. Patients with transient ischemic attack or ischemic stroke without any history of AF will be enrolled. The superiority of the 72-h single-patch monitor to standard strategy and non-inferiority of the 72-h single-patch monitor to an event-recorder-type device will be investigated. Single-patch monitor arm will repeat monitoring at 1, 3, 6, and 12 months, event-recorder-type arm will repeat monitoring twice daily for 12 months. The enrollment goal is a total of 600 patients, and the primary outcome is the detection of AF which continues at least 30 s during study period. The secondary outcome is the rate of changes from antiplatelet to anticoagulant and major adverse cardiac and cerebrovascular events within 1 year. Conclusions The results of CANDLE-AF will clarify the role of a single-lead patch ECG for the early detection of AF in patients with acute ischemic stroke. In addition, the secondary outcome will be analyzed to determine whether more sensitive AF detection can affect the prognosis and if further device development is meaningful. (cris.nih.go.kr KCT0005592).
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Affiliation(s)
- Sodam Jung
- Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Hye Ah Lee
- Clinical Trial Center, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - In Sook Kang
- Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Sang Hoon Shin
- Division of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Yoonkyung Chang
- Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Dong Woo Shin
- Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Moo-Seok Park
- Department of Neurology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Seoul, South Korea
| | - Hee Tae Yu
- Division of Cardiology, Severance Cardiovascular Hospital, Seoul, South Korea
| | - Jung Myung Lee
- Division of Cardiology, Kyung Hee University Hospital, Seoul, South Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea
| | - Jin-Kyu Park
- Division of Cardiology, Hanyang University Seoul Hospital, Seoul, South Korea
| | - Seung-Young Roh
- Devision of Cardiology, Korea University Guro Hospital, Seoul, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul, South Korea
| | - Young-Soo Lee
- Division of Cardiology, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Jin Kuk Do
- Department of Neurology, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Dong-Hyeok Kim
- Division of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
- *Correspondence: Dong-Hyeok Kim
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University Seoul Hospital, Seoul, South Korea
- Tae-Jin Song
| | - Junbeom Park
- Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
- Junbeom Park
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Mobile Single-Lead Electrocardiogram Technology for Atrial Fibrillation Detection in Acute Ischemic Stroke Patients. J Clin Med 2022; 11:jcm11030665. [PMID: 35160117 PMCID: PMC8836576 DOI: 10.3390/jcm11030665] [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] [Received: 12/15/2021] [Revised: 01/13/2022] [Accepted: 01/24/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: AliveCor KardiaMobile (KM) is a portable electrocardiography recorder for detection of atrial fibrillation (AF). The aim of the study was to define the group of acute ischemic stroke (AIS) patients who can use the KM device and assess the diagnostic test accuracy. (2) Methods: the AIS patients were recruited to the study. Thirty-second single-lead electrocardiogram (ECG) usages were recorded on demand for three days using KM portable device. Each KM ECG record was verified by a cardiologist. The feasibility was evaluated using operationalization criteria. (3) Results: the recruitment rate among AIS patients was 26.3%. The withdrawal rate before the start of the intervention was 26%. The withdrawal rate after the start of the intervention was 6%. KM device detected AF in 2.8% of AIS patients and in 2.2% of ECG records. Cardiologist confirmed the AF in 0.3% AIS patients. Sensitivity and specificity of KM for AF was 100% and 98.3%, respectively. (4) Conclusions: the results of this study suggest that it is feasible to use KM device to detect AF in the selected AIS patients (younger and in better neurological condition). KM detected AF in the selected AIS patients with high specificity and sensitivity.
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Johnson DM, Junarta J, Gerace C, Frisch DR. Usefulness of Mobile Electrocardiographic Devices to Reduce Urgent Healthcare Visits. Am J Cardiol 2021; 153:125-128. [PMID: 34229856 DOI: 10.1016/j.amjcard.2021.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/08/2021] [Accepted: 05/14/2021] [Indexed: 11/15/2022]
Abstract
Mobile electrocardiogram (mECG) devices are being used increasingly, supplying recordings to providers and providing automatic rhythm interpretation. Given the intermittent nature of certain cardiac arrhythmias, mECGs allow instant access to a recording device. In the current COVID-19 pandemic, efforts to limit in-person patient interactions and avoid overwhelming emergency and inpatient services would add value. Our goal was to evaluate whether a mECG device would reduce healthcare utilization overall, particularly those of urgent nature. We identified a cohort of KardiaMobile (AliveCor, USA) mECG users and compared their healthcare utilization 1 year prior to obtaining the device and 1 year after. One hundred and twenty-eight patients were studied (mean age 64, 47% female). Mean duration of follow-up pre-intervention was 9.8 months. One hundred and twenty-three of 128 individuals completed post-intervention follow-up. Patients were less likely to have cardiac monitors ordered (30 vs 6; p <0.01), outpatient office visits (525 vs 382; p <0.01), cardiac-specific ED visits (51 vs 30; p <0.01), arrhythmia related ED visits (45 vs 20; p <0.01), and unplanned arrhythmia admissions (34 vs 11; p <0.01) in the year after obtaining a KardiaMobile device compared to the year prior to obtaining the device. Mobile technology is available for heart rhythm monitoring and can give feedback to the user. This study showed a reduction of in-person, healthcare utilization with mECG device use. In conclusion, this strategy would be expected to decrease the risk of exposure to patients and providers and would avoid overwhelming emergency and inpatient services.
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Affiliation(s)
- Drew M Johnson
- Thomas Jefferson University Hospital, Department of Medicine, Division of Cardiology, Philadelphia, PA.
| | - Joey Junarta
- Thomas Jefferson University Hospital, Department of Medicine, Division of Cardiology, Philadelphia, PA
| | - Christopher Gerace
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Daniel R Frisch
- Thomas Jefferson University Hospital, Department of Medicine, Division of Cardiology, Philadelphia, PA
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Expanding a single‑lead mobile electrocardiographic device to multiple‑lead recordings improves diagnostic accuracy and confidence. J Electrocardiol 2021; 67:77-83. [PMID: 34091367 DOI: 10.1016/j.jelectrocard.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/29/2021] [Accepted: 05/10/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Mobile electrocardiographic (mECG) devices that record ECG lead I have been used to detect atrial fibrillation. Other arrhythmias may not be readily diagnosed with one lead. Obtaining multi‑lead tracings from an mECG (MLmECG) to simulate a 12‑lead ECG may lead to more accurate diagnoses. METHODS We developed a method to generate multi‑lead ECGs using a mECG device by attaching it with alligator clips connected to an insulated copper wire to adhesive electrodes on the patient's limbs and torso according to standard lead configurations. Different rhythm and conduction abnormalities from a sample of inpatients were collected. Arrhythmias were recorded in three ways (single lead, MLmECG, and standard 12‑lead) and grouped by category. Recordings were sent to cardiology fellows in the form of a multiple choice survey. Participants were asked for their diagnosis and confidence in their decision. RESULTS Survey response rate was 100%. Single‑lead, MLmECG, and 12‑lead yielded 48.2%, 81.6%, and 88.6% of agreement with the correct diagnosis, respectively (single‑lead vs. MLmECG or 12‑lead; p < 0.01). Overall mean confidence scores were 3.34, 4.35, and 4.53 out of 5, for single‑lead, MLmECG, and 12‑lead ECG, respectively (single‑lead vs. MLmECG or 12‑lead; p < 0.01, MLmECG vs. 12‑lead; p = 0.09). CONCLUSION The diagnostic accuracy of MLmECGs were similar to that of a standard 12‑lead ECG. Fellows' confidence in their diagnosis were similar between MLmECG or 12‑lead ECG, and higher with both modalities compared to a single‑lead tracing. The ability to recreate, as fully as possible, a standard 12‑lead ECG is a reasonable goal for mobile technology.
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Frisch DR, Frankel ES, Farzad DJ, Woo SH, Kubey AA. Initial Experience in Monitoring QT Intervals Using a Six-lead Contactless Mobile Electrocardiogram in an Inpatient Setting. J Innov Card Rhythm Manag 2021; 12:4433-4440. [PMID: 33777482 PMCID: PMC7987428 DOI: 10.19102/icrm.2021.120301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/30/2020] [Indexed: 12/20/2022] Open
Abstract
Mobile electrocardiograms (ECGs) (mECGs) using smartphone applications are an emerging technology. In the coronavirus disease 2019 (COVID-19) era, minimizing patient contact has gained increasing importance. Additionally, increased QT/corrected QT (QTc) monitoring has concurrently been required. The KardiaMobile 6L ECG device, cleared by the United States Food and Drug Administration (FDA) for recording ECGs, along with the KardiaStation tablet application is a platform (AliveCor, Mountain View, CA, USA) that addresses these two issues. A team of residents, fellows, hospitalists, and cardiologists identified inpatients in need of QT/QTc interval monitoring to pilot the adoption of a system composed of a KardiaMobile 6L ECG device with the accompanying KardiaStation tablet application. Concurrent standard ECGs provided validation. Adoption and performance issues were recorded. Four patients agreed to participate in QT/QTc interval monitoring, three of whom were positive for severe acute respiratory syndrome coronavirus 2 viral infection. After basic instructions were given to the patients and their clinical nurses, all patients recorded mECGs successfully. Patients were able to record their own mECG tracings at least once without any assistance. The 12-lead ECGs and mECGs each showed the correct rhythm, and the measured QTc intervals on each modality were consistently acceptable (< 500 ms). Contactless ECGs were successfully uploaded to KardiaStation for QT/QTc interval measurement and archiving. In this study, we showed that an FDA-cleared product, KardiaMobile 6L, has the ability to provide high-quality contactless ECGs for reliable QT/QTc interval measurements. Hospitalized patients were able to perform recordings when requested after receiving simple instructions at the time of first use. This technology has applications during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Daniel R Frisch
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.,Division of Hospital Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Eitan S Frankel
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.,Division of Hospital Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Darius J Farzad
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.,Division of Hospital Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Sang H Woo
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.,Division of Hospital Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alan A Kubey
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.,Division of Hospital Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA.,Department of Medicine, Mayo Clinic, Rochester, MN, USA
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11
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Zeiger W, DeBoer S, Probasco J. Patterns and Perceptions of Smartphone Use Among Academic Neurologists in the United States: Questionnaire Survey. JMIR Mhealth Uhealth 2020; 8:e22792. [PMID: 33361053 PMCID: PMC7790607 DOI: 10.2196/22792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/08/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022] Open
Abstract
Background Smartphone technology is ubiquitous throughout neurologic practices, and numerous apps relevant to a neurologist’s clinical practice are now available. Data from other medical specialties suggest high utilization of smartphones in routine clinical care. However, the ways in which these devices are used by neurologists for patient care–related activities are not well defined. Objective This paper aims to characterize current patterns of smartphone use and perceptions of the utility of smartphones for patient care–related activities among academic neurology trainees and attending physicians. We also seek to characterize areas of need for future app development. Methods We developed a 31-item electronic questionnaire to address these questions and invited neurology trainees and attendings of all residency programs based in the United States to participate. We summarized descriptive statistics for respondents and specifically compared responses between trainees and attending physicians. Results We received 213 responses, including 112 trainee and 87 attending neurologist responses. Neurology trainees reported more frequent use of their smartphone for patient care–related activities than attending neurologists (several times per day: 84/112, 75.0% of trainees; 52/87, 59.8% of attendings; P=.03). The most frequently reported activities were internet use, calendar use, communication with other physicians, personal education, and health care–specific app use. Both groups also reported regular smartphone use for the physical examination, with trainees again reporting more frequent usage compared with attendings (more than once per week: 35/96, 36.5% of trainees; 8/58, 13.8% of attendings; P=.03). Respondents used their devices most commonly for the vision, cranial nerve, and language portions of the neurologic examination. The majority of respondents in both groups reported their smartphones as “very useful” or “essential” for the completion of patient care–related activities (81/108, 75.0% of trainees; 50/83, 60.2% of attendings; P=.12). Neurology trainees reported a greater likelihood of using their smartphones in the future than attending neurologists (“very likely”: 73/102, 71.6% of trainees; 40/82, 48.8% of attendings; P=.005). The groups differed in their frequencies of device usage for specific patient care–related activities, with trainees reporting higher usage for most activities. Despite high levels of use, only 12 of 184 (6.5%) respondents reported ever having had any training on how to use their device for clinical care. Regarding future app development, respondents rated vision, language, mental status, and cranial nerve testing as potentially being the most useful to aid in the performance of the neurologic examination. Conclusions Smartphones are used frequently and are subjectively perceived to be highly useful by academic neurologists. Trainees tended to use their devices more frequently than attendings. Our results suggest specific avenues for future technological development to improve smartphone use for patient care–related activities. They also suggest an unmet need for education on effectively using smartphone technology for clinical care.
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Affiliation(s)
- William Zeiger
- Department of Neurology, University of California, Los Angeles School of Medicine, Los Angeles, CA, United States
| | - Scott DeBoer
- Medstar Franklin Square Medical Center, Baltimore, MD, United States.,Department of Neurology, Georgetown University, Washington, DC, United States
| | - John Probasco
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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12
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Abstract
Ischemic strokes related to atrial fibrillation are highly prevalent, presenting with severe neurologic syndromes and associated with high risk of recurrence. Although advances have been made in both primary and secondary stroke prevention for patients with atrial fibrillation, the long-term risks for stroke recurrence and bleeding complications from antithrombotic treatment remain substantial. We summarize the major advances in stroke prevention for patients with atrial fibrillation during the past 30 years and focus on novel diagnostic and treatment approaches currently under investigation in ongoing clinical trials. Non–vitamin K antagonist oral anticoagulants have been proven to be safer and equally effective compared with warfarin in stroke prevention for patients with nonvalvular atrial fibrillation. Non–vitamin K antagonist oral anticoagulants are being investigated for the treatment of patients with atrial fibrillation and rheumatic heart disease, for the treatment of patients with recent embolic stroke of undetermined source and indirect evidence of cardiac embolism, and in the prevention of vascular-mediated cognitive decline in patients with atrial fibrillation. Multiple clinical trials are assessing the optimal timing of non–vitamin K antagonist oral anticoagulant initiation after a recent ischemic stroke and the benefit:harm ratio of non–vitamin K antagonist oral anticoagulant treatment in patients with atrial fibrillation and history of previous intracranial bleeding. Ongoing trials are addressing the usefulness of left atrial appendage occlusion in both primary and secondary stroke prevention for patients with atrial fibrillation, including those with high risk of bleeding. The additive value of prolonged cardiac monitoring for subclinical atrial fibrillation detection through smartphone applications or implantable cardiac devices, together with the optimal medical management of individuals with covert paroxysmal atrial fibrillation, is a topic of intensive research interest. Colchicine treatment and factor XIa inhibition constitute 2 novel pharmacologic approaches that might provide future treatment options in the secondary prevention of cardioembolic stroke attributable to atrial fibrillation.
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Affiliation(s)
- Aristeidis H Katsanos
- Division of Neurology, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Canada (A.H.K., R.G.H.)
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York (H.K.)
| | - Jeff S. Healey
- Division of Cardiology, Population Health Research Institute, McMaster University, Hamilton, Canada (J.S.H.)
| | - Robert G. Hart
- Division of Neurology, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Canada (A.H.K., R.G.H.)
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13
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Sohns C, Khalaph M, Bergau L, Sommer P. [Smart and simple : Current role of implantables and wearables in daily practice]. Herzschrittmacherther Elektrophysiol 2020; 31:265-272. [PMID: 32757084 PMCID: PMC7403787 DOI: 10.1007/s00399-020-00707-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/03/2020] [Indexed: 12/02/2022]
Abstract
In den letzten Jahren hat die Verwendung von Implantables und Wearables zum Monitoring von Herzfrequenz und -rhythmus stetig zugenommen. Inzwischen stehen smarte und einfache Lösungen zur Verfügung, um den Herzrhythmus kontinuierlich zu überwachen und die dokumentierten Daten weiterzuleiten. Aus diesem Grund können Implantables und Wearables auch einfach und direkt an telemedizinische Zentren angebunden werden. Als große Herausforderung für den verstärkten Einsatz von Monitoring-Devices gilt weiterhin eine relativ ungefilterte Datenflut. Dieser Übersichtsartikel zeigt anhand einiger ausgewählter Beispiele die Anwendung und Funktionalität von Monitoring-Devices und soll auf diesem Wege den potenziellen Stellenwert von Implantables und Wearables in unserem klinischen elektrophysiologischen Alltag darstellen und differenziert diskutieren.
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Affiliation(s)
- Christian Sohns
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland.
| | - Moneeb Khalaph
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland
| | - Leonard Bergau
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland
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14
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Shabaan M, Arshid K, Yaqub M, Jinchao F, Zia MS, Bojja GR, Iftikhar M, Ghani U, Ambati LS, Munir R. Survey: smartphone-based assessment of cardiovascular diseases using ECG and PPG analysis. BMC Med Inform Decis Mak 2020; 20:177. [PMID: 32727453 PMCID: PMC7392662 DOI: 10.1186/s12911-020-01199-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/22/2020] [Indexed: 11/17/2022] Open
Abstract
A number of resources, every year, being spent to tackle early detection of cardiac abnormalities which is one of the leading causes of deaths all over the Globe. The challenges for healthcare systems includes early detection, portability and mobility of patients. This paper presents a categorical review of smartphone-based systems that can detect cardiac abnormalities by the analysis of Electrocardiogram (ECG) and Photoplethysmography (PPG) and the limitation and challenges of these system. The ECG based systems can monitor, record and forward signals for analysis and an alarm can be triggered in case of abnormality, however the limitation of smart phone’s processing capabilities, lack of storage and speed of network are major challenges. The systems based on PPG signals are non-invasive and provides mobility and portability. This study aims to critically review the existing systems, their limitation, challenges and possible improvements to serve as a reference for researchers and developers.
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Affiliation(s)
| | - Kaleem Arshid
- Beijing University of Technology, Chaoyang District, Beijing, China
| | - Muhammad Yaqub
- Beijing University of Technology, Chaoyang District, Beijing, China
| | - Feng Jinchao
- Beijing University of Technology, Chaoyang District, Beijing, China. .,Beijing Laboratory of Advanced Information Networks, Beijing, China.
| | - M Sultan Zia
- The University of Lahore, Gujarat Campus, Gujarat, Pakistan
| | | | | | - Usman Ghani
- Punjab Education Department, Gugarat, Pakistan
| | | | - Rizwan Munir
- Beijing University of Post and Telecommunication, Beijing, China
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15
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Abstract
Atrial fibrillation (AF) is a major cause of morbidity and mortality globally, and much of this is driven by challenges in its timely diagnosis and treatment. Existing and emerging mobile technologies have been used to successfully identify AF in a variety of clinical and community settings, and while these technologies offer great promise for revolutionizing AF detection and screening, several major barriers may impede their effectiveness. The unclear clinical significance of device-detected AF, potential challenges in integrating patient-generated data into existing healthcare systems and clinical workflows, harm resulting from potential false positives, and identifying the appropriate scope of population-based screening efforts are all potential concerns that warrant further investigation. It is crucial for stakeholders such as healthcare providers, researchers, funding agencies, insurers, and engineers to actively work together in fulfilling the tremendous potential of mobile technologies to improve AF identification and management on a population level.
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Affiliation(s)
- Eric Y Ding
- From the Department of Population and Quantitative Health Sciences and Division of Cardiology, Department of Medicine, University of Massachusetts Medical School (E.Y.D., D.D.M.)
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.)
| | - David D McManus
- From the Department of Population and Quantitative Health Sciences and Division of Cardiology, Department of Medicine, University of Massachusetts Medical School (E.Y.D., D.D.M.)
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16
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Biersteker TE, Boogers MJ, de Lind van Wijngaarden RA, Groenwold RH, Trines SA, van Alem AP, Kirchhof CJ, van Hof N, Klautz RJ, Schalij MJ, Treskes RW. Use of Smart Technology for the Early Diagnosis of Complications After Cardiac Surgery: The Box 2.0 Study Protocol. JMIR Res Protoc 2020; 9:e16326. [PMID: 32314974 PMCID: PMC7201318 DOI: 10.2196/16326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/19/2019] [Accepted: 02/26/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF), sternal wound infection, and cardiac decompensation are complications that can occur after cardiac surgery. Early detection of these complications is clinically relevant, as early treatment is associated with better clinical outcomes. Remote monitoring with the use of a smartphone (mobile health [mHealth]) might improve the early detection of complications after cardiac surgery. OBJECTIVE The primary aim of this study is to compare the detection rate of AF diagnosed with an mHealth solution to the detection rate of AF diagnosed with standard care. Secondary objectives include detection of sternal wound infection and cardiac decompensation, as well as assessment of quality of life, patient satisfaction, and cost-effectiveness. METHODS The Box 2.0 is a study with a prospective intervention group and a historical control group for comparison. Patients undergoing cardiac surgery at Leiden University Medical Center are eligible for enrollment. In this study, 365 historical patients will be used as controls and 365 other participants will be asked to receive either The Box 2.0 intervention consisting of seven home measurement devices along with a video consultation 2 weeks after discharge or standard cardiac care for 3 months. Patient information will be analyzed according to the intention-to-treat principle. The Box 2.0 devices include a blood pressure monitor, thermometer, weight scale, step count watch, single-lead electrocardiogram (ECG) device, 12-lead ECG device, and pulse oximeter. RESULTS The study started in November 2018. The primary outcome of this study is the detection rate of AF in both groups. Quality of life is measured with the five-level EuroQol five-dimension (EQ-5D-5L) questionnaire. Cost-effectiveness is calculated from a society perspective using prices from Dutch costing guidelines and quality of life data from the study. In the historical cohort, 93.9% (336/358) completed the EQ-5D-5L and patient satisfaction questionnaires 3 months after cardiac surgery. CONCLUSIONS The rationale and design of a study to investigate mHealth devices in postoperative cardiac surgery patients are presented. The first results are expected in September 2020. TRIAL REGISTRATION ClinicalTrials.gov NCT03690492; http://clinicaltrials.gov/show/NCT03690492. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16326.
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Affiliation(s)
- Tom E Biersteker
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Mark J Boogers
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Rolf Hh Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Serge A Trines
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Anouk P van Alem
- Department of Cardiology, Haaglanden Medisch Centrum, Den Haag, Netherlands
| | | | - Nicolette van Hof
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Robert Jm Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Roderick W Treskes
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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17
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Frisch DR, Weiss M, Dikdan SJ, Keith SW, Sarkar K. Improved accuracy and confidence with multiple‐lead recordings from a single‐lead mobile electrocardiographic device. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1191-1196. [DOI: 10.1111/pace.13775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/16/2019] [Accepted: 08/07/2019] [Indexed: 01/01/2023]
Affiliation(s)
| | - Max Weiss
- Thomas Jefferson University Hospital Philadelphia PA
| | | | | | - Kumar Sarkar
- Thomas Jefferson University Hospital Philadelphia PA
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18
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Screening for Atrial Fibrillation Using a Mobile, Single-Lead Electrocardiogram in Canadian Primary Care Clinics. Can J Cardiol 2019; 35:840-845. [DOI: 10.1016/j.cjca.2019.03.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/27/2019] [Accepted: 03/27/2019] [Indexed: 12/28/2022] Open
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19
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Li KHC, White FA, Tipoe T, Liu T, Wong MC, Jesuthasan A, Baranchuk A, Tse G, Yan BP. The Current State of Mobile Phone Apps for Monitoring Heart Rate, Heart Rate Variability, and Atrial Fibrillation: Narrative Review. JMIR Mhealth Uhealth 2019; 7:e11606. [PMID: 30767904 PMCID: PMC6396075 DOI: 10.2196/11606] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/06/2018] [Accepted: 11/25/2018] [Indexed: 12/19/2022] Open
Abstract
Background Mobile phone apps capable of monitoring arrhythmias and heart rate (HR) are increasingly used for screening, diagnosis, and monitoring of HR and rhythm disorders such as atrial fibrillation (AF). These apps involve either the use of (1) photoplethysmographic recording or (2) a handheld external electrocardiographic recording device attached to the mobile phone or wristband. Objective This review seeks to explore the current state of mobile phone apps in cardiac rhythmology while highlighting shortcomings for further research. Methods We conducted a narrative review of the use of mobile phone devices by searching PubMed and EMBASE from their inception to October 2018. Potentially relevant papers were then compared against a checklist for relevance and reviewed independently for inclusion, with focus on 4 allocated topics of (1) mobile phone monitoring, (2) AF, (3) HR, and (4) HR variability (HRV). Results The findings of this narrative review suggest that there is a role for mobile phone apps in the diagnosis, monitoring, and screening for arrhythmias and HR. Photoplethysmography and handheld electrocardiograph recorders are the 2 main techniques adopted in monitoring HR, HRV, and AF. Conclusions A number of studies have demonstrated high accuracy of a number of different mobile devices for the detection of AF. However, further studies are warranted to validate their use for large scale AF screening.
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Affiliation(s)
- Ka Hou Christien Li
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong).,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong).,Faculty of Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Timothy Tipoe
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong).,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Martin Cs Wong
- Division of Family Medicine and Primary Health Care, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Aaron Jesuthasan
- Faculty of Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Adrian Baranchuk
- Division of Cardiology, Kingston General Hospital, Queen's University, Kington, ON, Canada
| | - Gary Tse
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong).,Division of Cardiology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Bryan P Yan
- Division of Cardiology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong).,Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China (Hong Kong).,Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
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20
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Koltowski L, Balsam P, Glowczynska R, Rokicki JK, Peller M, Maksym J, Blicharz L, Maciejewski K, Niedziela M, Opolski G, Grabowski M. Kardia Mobile applicability in clinical practice: A comparison of Kardia Mobile and standard 12-lead electrocardiogram records in 100 consecutive patients of a tertiary cardiovascular care center. Cardiol J 2019; 28:543-548. [PMID: 30644079 DOI: 10.5603/cj.a2019.0001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Mobile devices are gaining a rising number of users in all countries around the globe. Novel solutions to diagnose patients with out-of-hospital onset of arrhythmic symptoms can be easily used to record such events, but the effectiveness of these devices remain unknown. METHODS In a group of 100 consecutive patients of an academic cardiology care center (mean age 68 ± 14.2 years, males: 66%) a standard 12-lead electrocardiogram (ECG) and a Kardia Mobile (KM) record were registered. Both versions were assessed by three independant groups of physicians. RESULTS The analysis of comparisons for standard ECG and KM records showed that the latter is of lower quality (p < 0.001). It was non-inferior for detection of atrial fibrillation and atrial flutter, showed weaker rhythm detection in pacemaker stimulation (p = 0.008), and was superior in sinus rhythm detection (p = 0.02), though. The sensitivity of KM to detect pathological Q-wave was low compared to specificity (20.6% vs. 93.7%, respectively, p < 0.001). Basic intervals measured by the KM device, namely PQ, RR, and QT were significantly different (shorter) than those observed in the standard ECG method (160 ms vs. 180 ms [p < 0.001], 853 ms vs. 880 ms [p = 0.03] and 393 ms vs. 400 ms [p < 0.001], respectively). CONCLUSIONS Initial and indicative value of atrial fibrillation and atrial flutter detection in KM is comparable to results achieved in standard ECG. KM was superior in detection of sinus rhythm than eye-ball evaluation of 12-lead ECG. Though, the PQ and QT intervals were shorter in KM as compared to 12-lead ECG. Clinical value needs to be verified in large studies, though.
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Affiliation(s)
- Lukasz Koltowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Pawel Balsam
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland.
| | - Renata Glowczynska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Jakub K Rokicki
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Michal Peller
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Jakub Maksym
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Leszek Blicharz
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Kacper Maciejewski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Magdalena Niedziela
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Grzegorz Opolski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
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22
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Benezet-Mazuecos J, García-Talavera CS, Rubio JM. Smart devices for a smart detection of atrial fibrillation. J Thorac Dis 2018; 10:S3824-S3827. [PMID: 30631488 DOI: 10.21037/jtd.2018.08.138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Juan Benezet-Mazuecos
- Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz-Quironsalud, Universidad Autónoma de Madrid, Madrid, Spain
| | - Camila S García-Talavera
- Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz-Quironsalud, Universidad Autónoma de Madrid, Madrid, Spain
| | - José Manuel Rubio
- Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz-Quironsalud, Universidad Autónoma de Madrid, Madrid, Spain
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