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023 For how long should we monitor ED palpitation patients in the outpatient setting?
  1. Matt Reed1,
  2. Neil Grubb2,
  3. Chris Lang2,
  4. Rachel O’Brien3,
  5. Kirsty Simpson3,
  6. Mia Padarenga3,
  7. Alison Grant3,
  8. Sharon Tuck4,
  9. Liza Keating5,
  10. Frank Coffey6,
  11. Lucy Jones7,
  12. Tim Harris8,
  13. Gavin Lloyd9,
  14. James Gagg10,
  15. Jason Smith11
  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. 4Edinburgh Clinical Research Facility, Epidemiology and Statistics Core, University of Edinburgh, Western General Hospital
  5. 5Royal Berkshire Hospital
  6. 6DREEAM – Department of Research and Education in Emergency Medicine, Acute Medicine and Major Trauma, Nottingham University Hospitals NHS Trust
  7. 7Chesterfield Royal Hospital NHS Foundation Trust
  8. 8Queen Mary’s University
  9. 9Royal Devon and Exeter Hospital
  10. 10Department of Emergency Medicine, Musgrove Park Hospital
  11. 11Emergency Department, University Hospitals Plymouth NHS Trust


Background The IPED study showed that use of a smartphone-based event recorder (AliveCor) 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). The pocket sized AliveCor (now Kardia) mobile (AliveCor, San Francisco, USA) is a monitoring device that requires the patient to trigger the ECG recording. With minimal training, two fingers from each hand are placed on the monitor (which can be connected to the back of a smartphone) for 30 s to take an ECG recording.

This pre-planned analysis looked at the time to symptomatic rhythm detection in the intervention (AliveCorgroup)to determine the optimum AliveCor device monitoring period in the outpatient setting.

Method and results 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 assessment were enrolled. Time to symptomatic rhythm detection was recorded and analysed.

Conclusions 243 participants were recruited over an 18-month period. A symptomatic rhythm was detected at 90 days in 69 (n=124; 55.6%; 95% CI 46.9–64.4%) participants in the intervention (AliveCor) group.

92.8% of patients who recorded a symptomatic rhythm during the 90 day period recorded this rhythm during the first 28 days (figure 1/table 1).

Abstract 023 Figure 1

Time to symptomatic rhythm detection in the intervention (AliveCor) group (n=69)

Abstract 023 Table 1

Cumulative symptomatic rhythm detection in the intervention (AliveCor) group (n=69)

Conclusion: ED palpitation patients discharged with a smartphone-based event recorder such as the AliveCor should be reviewed after 4 weeks to enable efficient device usage and timely treatment if required. Patients in whom a diagnosis has not been made can be re-reviewed at 90 days. (1541 characters/285 words)

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