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018 Clinician prediction of cardiac arrhythmia in patients presenting to the ED with palpitation or pre-syncope
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  1. Matt Reed1,
  2. Neil Grubb2,
  3. Chris Lang2,
  4. Rachel O’Brien3,
  5. Kirsty Simpson4,
  6. Mia Padarenga3,
  7. Alison Grant1,
  8. Sharon Tuck5,
  9. Liza Keating6,
  10. Frank Coffey7,
  11. Lucy Jones8,
  12. Tim Harris9,
  13. Gavin Lloyd10,
  14. James Gagg11,
  15. Jason Smith12
  1. 1Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh
  2. 2Department of Cardiology, Royal Infirmary of Edinburgh
  3. 3Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh
  4. 4Emergency Medicine Research Group Edinburgh (EMERGE)
  5. 5Edinburgh Clinical Research Facility, Epidemiology and Statistics Core, University of Edinburgh
  6. 6Emergency Department, Royal Berkshire NHS Foundation Trust
  7. 7DREEAM – Department of Research and Education in Emergency Medicine, Acute Medicine and Major Trauma
  8. 8Chesterfield Royal Hospital NHS Foundation Trust
  9. 9Queen Mary’s University
  10. 10Royal Devon and Exeter Hospital
  11. 11Musgrove Park Hospital
  12. 12Emergency Department, University Hospitals Plymouth NHS Trust

Abstract

The IPED study showed that use of a smartphone-based event recorder in ED patients presenting with palpitation or pre-syncope, increased the number of patients in whom an ECG was captured during symptoms over five-fold to more than 55% at 90 days (Reed MJ et al. Lancet eClinical Medicine 2019; 8: 37–46).

This pre-planned analysis looked at the ability of ED clinicians to predict cardiac arrhythmia in patients presenting to the ED with palpitation or pre-syncope.

Pre-planned sub study analysis of a randomised controlled multi-centre trial. Participants ≥16 years old presenting to 10 UK hospital EDs with palpitation or pre-syncope whose underlying ECG rhythm during these episodes remained undiagnosed after ED assessmentwere enrolled. The treating ED clinician was asked to rate the likelihood of underlying cardiac arrhythmia ranging from 1 (least likely) to 10 (most likely). Participants were then randomised to either an intervention group using a smartphone-based event recorder or a standard care control group. Primary endpoint of this sub study was symptomatic cardiac arrhythmia at 90 days.

243 patients were enrolled. 6 patients had no ED clinician likelihood rating recorded and two further patients were lost to follow-up leaving 235 available for analysis. There were 12 patients recording a symptomatic cardiac arrhythmia at 90 days. These were atrial fibrillation (8), SVT (3), sinus bradycardia (<40 bpm; 1) and atrial flutter (1). One patient recorded 2 categories of arrhythmia. The AUC for prediction of cardiac arrhythmia was 0.81 (95% CI; 0.71–0.90). An ED clinician likelihood rating of 5 or more had 92% sensitivity and 59% specificity for predicting cardiac arrhythmia.

Abstract 018 Figure 1
Abstract 018 Figure 1

ROC analysis of ED clinician likelihood rating for symptomatic cardiac dysrhythmia at 90 days

Conclusion ED clinicians are able to predict the liklihood of cardiac arrhythmia in patients presenting to the ED with palpitation or pre-syncope with reasonable accuracy.

https://doi.org/10.1136/emermed-2019-RCEM.18

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