1
|
Goergen JA, Peigh G, Hsu M, Wilk A, Nayak T, Crosson L, Lenane J, Knight BP, Passman R. Comparison of data quality and monitoring completion rates between clinic and self-applied ECG patches. Heart Rhythm 2023; 20:407-413. [PMID: 36464126 PMCID: PMC9714183 DOI: 10.1016/j.hrthm.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/28/2022] [Accepted: 11/22/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, direct-to-patient, self-applied ECG patch use has substantially increased. There are limited data comparing clinic with self-applied electrocardiogram (ECG) patches. OBJECTIVE The purpose of this study was to compare rates of ECG patch return, percentages of time patches yielded analyzable data (analyzable time), and percentages of prescribed time ECG patches were worn between clinic and self-applied ECG patches before and during COVID-19. METHODS A retrospective analysis of patients prescribed an ECG patch during "pre-COVID" (March 1, 2019, through March 1, 2020) and "COVID" (April 4, 2020, through April 1, 2021) years was performed. ECG patch return rates, mean percentages of analyzable time, and mean percentages of prescribed wear time were compared between clinic and self-applied groups. RESULTS Among the 29,093 ECG patch prescriptions (19% COVID self-applied), the COVID self-applied group had a lower return rate (90.8%) than did both clinic-applied groups (COVID: 97.1%; pre-COVID: 98.1%; P < .001). Among the 28,048 ECG patches (17.5% self-applied) returned for analysis, the COVID self-applied group demonstrated a lower mean percentage of analyzable time (95.9% ± 8.2%) than did both clinic-applied groups (COVID: 96.6% ± 6.6%; pre-COVID 96.6% ± 7.4%; P < .001). There were no differences in the mean percentage of prescribed wear time between groups (pre-COVID clinic-applied: 96.7% ± 34.3%; COVID clinic-applied: 97.4% ± 39.8%; COVID self-applied: 98.1% ± 52.1%; P = .09). CONCLUSION Self-applied ECG patches were returned at a lower rate and had a statistically lower percentage of analyzable time than clinic-applied patches. However, there were no differences between groups in mean percentages of prescribed wear time, and mean percentages of analyzable time were >95% in all groups.
Collapse
Affiliation(s)
- Jack A. Goergen
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Graham Peigh
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Mike Hsu
- iRhythm Technologies, San Francisco, California
| | - Alan Wilk
- iRhythm Technologies, San Francisco, California
| | - Tanvi Nayak
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Bradley P. Knight
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Rod Passman
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
| |
Collapse
|
2
|
Gupta N, Yang J, Reynolds K, Lenane J, Garcia E, Sung SH, Harrison TN, Solomon MD, Go AS. Diagnostic Yield, Outcomes, and Resource Utilization With Different Ambulatory Electrocardiographic Monitoring Strategies. Am J Cardiol 2022; 166:38-44. [PMID: 34953575 DOI: 10.1016/j.amjcard.2021.11.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/01/2022]
Abstract
Accurate diagnosis of arrhythmias is improved with longer monitoring duration but can risk delayed diagnosis. We compared diagnostic yield, outcomes, and resource utilization by arrhythmia monitoring strategy in 330 matched adults (mean age 64 years, 40% women, and 30% non-White) without previously documented atrial fibrillation or atrial flutter (AF/AFL) who received ambulatory electrocardiographic monitoring by 14-day Zio XT (patch-based continuous monitor), 24-hour Holter, or 30-day event monitor (external loop recorder) between October 2011 and May 2014. Patients were matched by age, gender, site, likelihood of receiving Zio XT patch, and indication for monitoring, and subsequently followed for monitoring results, management changes, clinical outcomes, and resource utilization. AF/AFL ≥30 seconds was noted in 6% receiving Zio XT versus 0% by Holter (p = 0.04) and 3% by event monitor (p = 0.07). Nonsustained ventricular tachycardia was noted in 24% for Zio XT patch versus 8% (p <0.001) for Holter and 4% (p <0.001) for event monitor. No significant differences between monitoring strategies in outcomes or resource utilization were observed. Prolonged monitoring with 14-day Zio XT patch or 30-day event monitor was superior to 24-hour Holter in detecting new AF/AFL but not different from each other. Documented nonsustained ventricular tachycardia was more frequent with Zio XT than 24-hour Holter and 30-day event monitor without apparent increased risk of adverse outcomes or excess utilization. In conclusion, additional efforts are needed to further personalize electrocardiographic monitoring strategies that optimize clinical management and outcomes.
Collapse
Affiliation(s)
- Nigel Gupta
- Department of Cardiac Electrophysiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Jingrong Yang
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern, California, Pasadena, California
| | - Judith Lenane
- iRhythm Technologies, Inc., San Francisco, California
| | - Elisha Garcia
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Sue Hee Sung
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Teresa N Harrison
- Department of Research and Evaluation, Kaiser Permanente Southern, California, Pasadena, California
| | - Matthew D Solomon
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Cardiology, Kaiser Oakland Medical Center, Oakland, California
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California; Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, San Francisco, California; Department of Medicine, Stanford University, Stanford, California.
| |
Collapse
|
3
|
Reynbakh O, Braunstein ED, Hsu M, Ellis J, Crosson L, Lenane J, Krumerman A, Di Biase L, Ferrick KJ. Arrhythmia patterns during and after hospitalization for COVID-19 infection detected via patch-based mobile cardiac telemetry. American Heart Journal Plus: Cardiology Research and Practice 2022; 13:100084. [PMID: 35036973 PMCID: PMC8744398 DOI: 10.1016/j.ahjo.2022.100084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 12/28/2022]
Abstract
Background Coronavirus infection is the cause of the current world-wide pandemic. Cardiovascular complications occur in 20–30% of patients with COVID-19 infection including myocardial injury and arrhythmias. Current understanding of specific arrhythmia type and frequency is limited. Objective We aimed to analyze arrhythmia type and frequency in patients with COVID infection, identifying arrhythmia patterns over time during hospitalization and post discharge utilizing a patch based mobile cardiac telemetry system. Methods A prospective cohort study during the COVID-19 pandemic was performed. We included in our study patients hospitalized with COVID-19 infection who had a patch-based mobile telemetry device placed for cardiac monitoring. Results Quantitative reports for 59 patients were available for analysis. Arrhythmias were detected in 72.9% of patients and at a consistent frequency throughout the monitoring period in 52.9%–89.5% of patients daily. The majority of arrhythmias were SVT (59.3% of patients) and AF (22.0%). New onset AF was noted in 15.0% of all patients and was significantly associated with older age (OR 1.4 for 5 yrs. difference; 95% CI 1.03–2.13). Of 9 patients who were discharged with continued patch monitoring, 7 (78%) had arrhythmic events during their outpatient monitoring period. Conclusion In COVID-19 patients arrhythmias were observed throughout hospitalization with a consistent daily frequency. Patients continued to exhibit cardiac arrhythmias after hospital discharge of a type and frequency similar to that seen during hospitalization. These findings suggest that the risk of arrhythmia associated with COVID infection remains elevated throughout the hospital course as well as following hospital discharge.
Collapse
|
4
|
Reynbakh O, Braunstein ED, Hsu M, Ellis J, Crosson L, Lenane J, Krumerman A, Di Biase L, Ferrick KJ. Arrhythmia patterns in patients with COVID-19 infection during and post hospitalization detected via a patch-based mobile cardiac telemetry system. Eur Heart J 2021. [PMCID: PMC8767609 DOI: 10.1093/eurheartj/ehab724.0313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Coronavirus infection (COVID-19) is the cause of the current world-wide pandemic. Cardiovascular complications occur in 20–30% of patients with COVID-19 infection including myocardial injury and arrhythmias. Current understanding of specific arrhythmia type and frequency is limited. In response to COVID-19 pandemic and overwhelmed hospital critical care and telemetry recourses, patch-based cardiac monitoring system received emergency Food and Drug Administration (FDA) approval for inpatient monitoring. A patch-based cardiac telemetry system has been shown to be useful for patient management during the COVID-19 pandemic and provides detailed analysis of cardiac rhythms. Purpose To analyze arrhythmia type and frequency in patients with COVID-19 infection, identifying arrhythmia patterns over time during hospitalization and after discharge. Methods A prospective cohort study during the COVID-19 pandemic was performed. We included patients hospitalized with COVID-19 infection who had a patch-based mobile telemetry device placed for cardiac monitoring. A quantitative analysis including type, frequency and duration of detected arrhythmias was performed at the end of the monitoring period. Results A total of 103 patients hospitalized with COVID-19 diagnosis underwent monitoring. Quantitative reports for 59 patients were available for analysis, among those 59% were males, median age 65 (IQR 56–76) yrs. Mean wear time was 6.8±5.0 days. Arrhythmias were detected in 72.9% of patients. Majority of arrhythmias were SVT (59.3% of patients) and AF (22.0%). Episodes of AF duration >30 min were detected in 12 patients. New onset AF was noted in 15.0% of patients and was significantly associated with age (OR 1.4 for 5 yrs difference; 95% CI 1.01–2.05). Brady arrhythmias (2nd degree, 3rd degree AV bock, pause≥3 seconds) were seen in 18.7% of patients. Arrhythmias were consistently detected throughout the monitoring period in 52.9%-89.5% of patients daily (Figure 1). In 9 patients who were discharged with continued patch monitoring, 3 patients (33.3%) had arrhythmic events during their outpatient monitoring period. Conclusion A majority of patients hospitalized with COVID-19 infection had arrhythmias detected by patch cardiac monitor. Arrhythmias were observed throughout hospitalization with a consistent daily frequency. Patients continued to exhibit cardiac arrhythmias after hospital discharge of a type similar to that seen during hospitalization. New onset AF often occurred and was associated with older age. Inpatient application of a patch cardiac telemetry with continued monitoring as outpatient is feasible and effective in detecting occult arrhythmias in patients with COVID-19 infection. Funding Acknowledgement Type of funding sources: None.
Daily frequency of arrhythmias detected ![]()
Collapse
Affiliation(s)
- O Reynbakh
- Montefiore Medical Center Albert Einstein College of Medicine, New York, United States of America
| | - E D Braunstein
- Montefiore Medical Center Albert Einstein College of Medicine, New York, United States of America
| | - M Hsu
- iRhythm Technologies, Inc., San Francisco, United States of America
| | - J Ellis
- iRhythm Technologies, Inc., Lincolnshire, United States of America
| | - L Crosson
- iRhythm Technologies, Inc., Lincolnshire, United States of America
| | - J Lenane
- iRhythm Technologies, Inc., Lincolnshire, United States of America
| | - A Krumerman
- Montefiore Medical Center Albert Einstein College of Medicine, New York, United States of America
| | - L Di Biase
- Montefiore Medical Center Albert Einstein College of Medicine, New York, United States of America
| | - K J Ferrick
- Montefiore Medical Center Albert Einstein College of Medicine, New York, United States of America
| |
Collapse
|
5
|
Go AS, Reynolds K, Yang J, Gupta N, Lenane J, Sung SH, Harrison TN, Liu TI, Solomon MD. Association of Burden of Atrial Fibrillation With Risk of Ischemic Stroke in Adults With Paroxysmal Atrial Fibrillation: The KP-RHYTHM Study. JAMA Cardiol 2019; 3:601-608. [PMID: 29799942 DOI: 10.1001/jamacardio.2018.1176] [Citation(s) in RCA: 165] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance Atrial fibrillation is a potent risk factor for stroke, but whether the burden of atrial fibrillation in patients with paroxysmal atrial fibrillation independently influences the risk of thromboembolism remains controversial. Objective To determine if the burden of atrial fibrillation characterized using noninvasive, continuous ambulatory monitoring is associated with the risk of ischemic stroke or arterial thromboembolism in adults with paroxysmal atrial fibrillation. Design, Setting, and Participants This retrospective cohort study conducted from October 2011 and October 2016 at 2 large integrated health care delivery systems used an extended continuous cardiac monitoring system to identify adults who were found to have paroxysmal atrial fibrillation on 14-day continuous ambulatory electrocardiographic monitoring. Exposures The burden of atrial fibrillation was defined as the percentage of analyzable wear time in atrial fibrillation or flutter during the up to 14-day monitoring period. Main Outcomes and Measures Ischemic stroke and other arterial thromboembolic events occurring while patients were not taking anticoagulation were identified through November 2016 using electronic medical records and were validated by manual review. We evaluated the association of the burden of atrial fibrillation with thromboembolism while not taking anticoagulation after adjusting for the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) or CHA2DS2-VASc stroke risk scores. Results Among 1965 adults with paroxysmal atrial fibrillation, the mean (SD) age was 69 (11.8) years, 880 (45%) were women, 496 (25%) were persons of color, the median ATRIA stroke risk score was 4 (interquartile range [IQR], 2-7), and the median CHA2DS2-VASc score was 3 (IQR, 1-4). The median burden of atrial fibrillation was 4.4% (IQR ,1.1%-17.23%). Patients with a higher burden of atrial fibrillation were less likely to be women or of Hispanic ethnicity, but had more prior cardioversion attempts compared with those who had a lower burden. After adjusting for either ATRIA or CHA2DS2-VASc stroke risk scores, the highest tertile of atrial fibrillation burden (≥11.4%) was associated with a more than 3-fold higher adjusted rate of thromboembolism while not taking anticoagulants (adjusted hazard ratios, 3.13 [95% CI, 1.50-6.56] and 3.16 [95% CI, 1.51-6.62], respectively) compared with the combined lower 2 tertiles of atrial fibrillation burden. Results were consistent across demographic and clinical subgroups. Conclusions and Relevance A greater burden of atrial fibrillation is associated with a higher risk of ischemic stroke independent of known stroke risk factors in adults with paroxysmal atrial fibrillation.
Collapse
Affiliation(s)
- Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland.,Departments of Epidemiology, Biostatistics and Medicine, University of California-San Francisco, San Francisco.,Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Jingrong Yang
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Nigel Gupta
- Department of Cardiac Electrophysiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | | | - Sue Hee Sung
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Teresa N Harrison
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Taylor I Liu
- Department of Cardiac Electrophysiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Matthew D Solomon
- Division of Research, Kaiser Permanente Northern California, Oakland.,Department of Cardiology, Kaiser Permanente Oakland Medical Center, Oakland, California
| |
Collapse
|
6
|
Teo JT, Lenane J, Sztriha L, Chan FK, Aeron-Thomas J, Gall N, Kaura A, Piechowski-Jozwiak B. Abstract WP229: Randomised Clinical Trial of Early Prolonged Ambulatory Cardiac monitoring After Stroke (EPACS): Interim Analysis. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.wp229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Cardioembolism in paroxysmal atrial fibrillation (PAF) is a preventable cause of ischaemic stroke or transient ischaemic attack (TIA), but the transient nature of PAF means that a short-duration Holter monitor misses a significant proportion of cases. Systems for recording beyond 3-7 days have significant limitations: event-triggered loop recorders are cumbersome while implanted loop recorders require a minor surgical procedure. There is a need for a patient-friendly long-duration cardiac monitoring system for stroke patients which can be performed without significant delay from the index event and with superior yield to Holter ECG’s.
Methods:
We conducted a pragmatic randomised controlled trial of cardiac monitoring after an ischaemic stroke or TIA to increase detection of paroxysmal atrial fibrillation (recruited within 72 hours of index event) using a wearable water-proof adhesive cardiac monitoring patch (Zio® Patch, iRhythm Technologies) that can be fitted immediately by the clinician early after the index event for up to 14 days or a standard Holter ECG. The trial aimed to recruit 120 patients across two locations - urban teaching hospital (Kings College Hospital, London) and suburban district hospital (Princess Royal University Hospital, Orpington). ISCRTN Registration 50253271.
Results:
In August 2016, the interim analysis detected PAF in 4/17 cases in the active arm and 0/16 cases in the control arm. The commonest arrhythmias detected were atrial tachyarrhythmias followed by PAF. Those in the control arm of Holter ECG’s had significant delays to initiate cardiac monitoring due to scheduling delays and patient non-attendance. There were no device-attributable serious adverse events. Further late-breaking results will be available in February 2017.
Conclusion:
The convenience of the Zio® Patch cardiac monitor substantially increased the uptake and efficiency of cardiac monitoring early after ischaemic strokes and TIA.
Collapse
Affiliation(s)
- James T Teo
- Kings College Hosp, London, London, United Kingdom
| | | | | | - Fong K Chan
- Kings College Hosp, London, London, United Kingdom
| | | | | | - Amit Kaura
- Kings College Hosp, London, London, United Kingdom
| | | |
Collapse
|