Critical care Detecting arrhythmias using wearables
Prolonged ECG monitoring devices such as Holter monitors are cumbersome, can only be worn for short periods, and might miss paroxysmal arrhythmias. Furthermore, implantable devices (loop recorders) are invasive and require specialist training to insert and analyse. Wearable technology can be advantageous for arrhythmia detection; several modern smartwatches use photoplethysmography sensors, and more recently ECG technology, to detect heart rate and rhythm.
Photoplethysmography sensors can detect atrial fibrillation, the most common significant arrhythmia, with a sensitivity and specificity of 91–100% in comparison with ECG. The Apple Heart study investigated the use of smartwatch- based arrhythmia detection in 419 297 participants. Through the watch’s photoplethysmography sensor, if an irregular cardiac rhythm was detected, a notification advised a telemedicine consultation and to wear an ECG recording patch for 7 days.
Within a median monitoring period of 117 days, 2,161 participants received an irregular pulse notification (0.52%). After exclusions, 450 participants returned usable ECG data, 34% of which were confirmed to have atrial fibrillation. Although undergoing simultaneous ECG monitoring, the positive predictive value of subsequent irregular pulse notifications was 84%.
In a similar study performed across China, 246,541 people downloaded a mobile atrial fibrillation app that used data from a photoplethysmography wristband or watch. Of these, 187 912 people used the app via their smartphone and 0.23% received a notification of a suspected atrial fibrillation. After follow-up, the positive predictive value of the photoplethysmography detected signal was 91.6%.
These studies were the first demonstration of a general population-wide approach to arrhythmia screening using a commercially available wearable device with telemedicine. Given that atrial fibrillation was diagnosed in asymptomatic participants, future research should consider whether major sequelae such as the incidence of stroke can be reduced by this approach in adequately powered prospective controlled trials. Source: Wearable technology and the cardiovascular system: the future of patient assessment
Another huge issue highlighted by the adoption of these advanced cardiac monitoring devices is the inadvertent creation of a digital divide. While we would like to assume that most patients have access to a smartphone or reliable internet connection, this is far from the case and therefore not all patients are candidates for remote monitoring. In a day and age where technology should be making healthcare more accessible and fairer for all patients, the rise in wearable devices is doing the opposite. Especially when research has continued to consistently highlight that those who fall under the low socioeconomic status bracket are more likely to develop cardiovascular disease.
“There appears to be little regulatory or privacy concerns with using arrhythmia detection monitoring in clinical practice.” Dr Subasit Acharji
The future of cardiac monitoring Cardiac monitoring devices have already come a long way from the bulky machines of the past to the affordable and accessible smart devices of today, but the journey of innovation is far from over. The future of cardiac monitoring devices is huge
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and with the ongoing growth of telehealth services, patients will continue to have the ability to remotely connect with their various healthcare providers, sharing real-time data from their monitoring devices. These remote consultations will be especially valuable for those individuals who live in remote areas, have mobility issues, or simply prefer the convenience of virtual healthcare. We can also expect to see an increase in the development of user-friendly interfaces and mobile apps that allow patients to easily access and, importantly, understand their cardiac health data. Advanced data visualisation techniques, including 3D representations of the heart’s electrical activity, will make it easier for patients to grasp the status of their cardiovascular health.
“Asymptomatic atrial fibrillation detection as risk factors for first-time stroke patients is also a developing area of investigation,” says Acharji. While screening for atrial fabulation in the general population has been a heavily debated issue among the medical community for some time now, technological advances have made screening within high-risk populations easier.
“Detection of heart block as a cause of syncope or seizures,” is also a promising area for advancement suggests Acharji. The presence of heart disease in patients with syncope has been identified as the most important factor in prognosis and risk stratification, according to the American Heart Association Journals.
While research in this area is still ongoing, several studies have identified permanent pacemakers in patients with severe syncope showed an 85% relative risk reduction during a tilt test. The use of pacemakers to treat syncope could potentially be a huge advancement in the field of cardiac health research. The ultimate goal of the future of cardiac monitoring devices is to facilitate more in the way of early intervention and proactive care. Devices will not only be able to alert patients to potential health issues, but also automatically connect with healthcare providers in case of critical anomalies arising. This real-time collaboration between patients and physicians will save lives and reduce the burden on healthcare systems by preventing emergencies and costly hospitalisations. At the same time, “tracking our health information makes us more mindful and conscious of our body and our health choices”, says Kharazi, which can also lead to heart-healthy behaviours. These advances are revolutionising patient care and bridging the gap between patients and healthcare providers, by promoting proactive and individualised care. And undoubtedly, future advancements being made in the field will continue to strengthen patient experiences – and their hearts.
Practical Patient Care /
www.practical-patient-care.com
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