Inpatient cardiac monitoring using a patch‐based mobile cardiac telemetry system during the COVID‐19 pandemic

Abstract

Introduction Coronavirus disease 2019 (COVID‐19) is a worldwide pandemic, and cardiovascular complications and arrhythmias in these patients are common. Cardiac monitoring is recommended for at risk patients; however, the availability of telemetry capable hospital beds is limited. We sought to evaluate a patch‐based mobile telemetry system for inpatient cardiac monitoring during the pandemic. Methods A prospective cohort study was performed of inpatients hospitalized during the pandemic who had mobile telemetry devices placed; patients were studied up until the time of discharge or death. The primary outcome was a composite of management changes based on data obtained from the system and detection of new arrhythmias. Other clinical outcomes and performance characteristics of the mobile telemetry system were studied. Results Eighty‐two patients underwent mobile telemetry device placement, of which 31 (37.8%) met the primary outcome, which consisted of 24 (29.3%) with new arrhythmias detected and 18 (22.2%) with management changes. Twenty‐one patients (25.6%) died during the study, but none from primary arrhythmias. In analyses, age and heart failure were associated with the primary outcome. Monitoring occurred for an average of 5.3 ± 3.4 days, with 432 total patient‐days of monitoring performed; of these, QT‐interval measurements were feasible in 400 (92.6%). Conclusion A mobile telemetry system was successfully implemented for inpatient use during the COVID‐19 pandemic and was shown to be useful to inform patient management, detect occult arrhythmias, and monitor the QT‐interval. Patients with advanced age and structural heart disease may be more likely to benefit from this system.

Mobile cardiac monitoring during the COVID‐19 pandemic: Necessity is the mother of invention

“…There are previous reports of the feasibility of using a different cardiac monitoring technology during the COVID‐19 pandemic 4,5 . The report in this issue of JCE confirms these and extends arrhythmia and QT monitoring with different patch‐based technology 8 . As an observational study, there are inherent limitations, including the absence of a control group using conventional monitoring 8 .…”

“…In this issue of the Journal of Cardiovascular Electrophysiology (JCE), Braunstein et al 8 report the results of an observational study using a patch‐based mobile cardiac telemetry system previously reserved for the outpatient setting. This approach was used to assess rhythm and QT intervals for COVID‐19‐positive hospitalized patients in a unit not used previously for telemetry while receiving one or more medications with potential for QT prolongation.…”

“…This approach was used to assess rhythm and QT intervals for COVID‐19‐positive hospitalized patients in a unit not used previously for telemetry while receiving one or more medications with potential for QT prolongation. The patch‐based cardiac monitoring technology (Zio Patch AT (iRhythm Technologies Inc., San Francisco, CA, USA) had been approved by the US Food and Drug Administration (FDA) for arrhythmia monitoring in the outpatient setting 8 . This system received emergency FDA approval for inpatient monitoring during COVID 19 pandemic 8 …”

“…The patch‐based cardiac monitoring technology (Zio Patch AT (iRhythm Technologies Inc., San Francisco, CA, USA) had been approved by the US Food and Drug Administration (FDA) for arrhythmia monitoring in the outpatient setting 8 . This system received emergency FDA approval for inpatient monitoring during COVID 19 pandemic 8 …”

“…The study reports 82 patients in whom this mobile patch‐based technology was used on an inpatient basis for monitoring of arrhythmias and QT intervals 8 . Thirty‐eight percent of patients met the primary outcome, a composite of detection of new arrhythmias, and changes in clinical management.…”