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Article

Establishing a Smartphone Ambulatory ECG Service for Patients Presenting to the Emergency Department with Pre-Syncope and Palpitations

1
Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
2
Acute Care Group, Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Nine Edinburgh BioQuarter, 9 Little France Road, Edinburgh EH16 4UX, UK
3
Acute Medicine, NHS Lothian, Edinburgh EH16 4SA, UK
*
Author to whom correspondence should be addressed.
Academic Editors: Franca Dipaola, Monica Solbiati and Emanuele Pivetta
Medicina 2021, 57(2), 147; https://doi.org/10.3390/medicina57020147
Received: 11 January 2021 / Revised: 1 February 2021 / Accepted: 4 February 2021 / Published: 6 February 2021
(This article belongs to the Special Issue Syncope in the Emergency Department)
Background and Objectives: The Investigation of Palpitations in the ED (IPED) study showed that a smartphone-based event recorder increased the number of patients in whom an electrocardiogram (ECG) was captured during symptoms over five-fold to more than 55% at 90 days compared to standard care and concluded that this safe, non-invasive and easy-to-use device should be considered part of on-going care to all patients presenting acutely with unexplained palpitations or pre-syncope. This study reports the process of establishing a smartphone palpitation and pre-syncope ambulatory care Clinic (SPACC) service. Materials and Methods: A clinical standard operating procedure (SOP) was devised, and funding was secured through a business case for the purchase of 40 AliveCor devices in the first instance. The clinic was launched on 22 July 2019. Results: Between 22 July 2019 and 31 October 2019, 68 patients seen in the emergency departments (EDs) with palpitations or pre-syncope were referred to SPACC. Of those, 30 were male and 38 were female, and the mean age was 45.8 years old (SD 15.1) with a range from 18 years old to 80 years old. A total of 50 (74%) patients underwent full investigation. On the first assessment, seven (10%) patients were deemed to have non-cardiac palpitations and were not fitted with the device. All patients who underwent full investigation achieved symptomatic rhythm correlation most with sinus rhythm, ventricular ectopics, or bigeminy. A symptomatic cardiac dysrhythmia was detected in six (8.8%) patients. Three patients had supraventricular tachycardia (4%), two had atrial fibrillation (3%), and one had atrial flutter (2%). Qualitative feedback from the SPACC team suggested several areas where improvement to the clinic could be made. Conclusion: We believe a smartphone palpitation service based on ambulatory care is simple to implement and is effective at detecting cardiac dysrhythmia in ED palpitation patients. View Full-Text
Keywords: emergency department; diagnosis; ECG monitoring; cardiac dysrhythmias emergency department; diagnosis; ECG monitoring; cardiac dysrhythmias
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MDPI and ACS Style

Reed, M.J.; Muir, A.; Cullen, J.; Murphy, R.; Pollard, V.; Zangana, G.; Krupej, S.; Askham, S.; Holdsworth, P.; Davies, L. Establishing a Smartphone Ambulatory ECG Service for Patients Presenting to the Emergency Department with Pre-Syncope and Palpitations. Medicina 2021, 57, 147. https://doi.org/10.3390/medicina57020147

AMA Style

Reed MJ, Muir A, Cullen J, Murphy R, Pollard V, Zangana G, Krupej S, Askham S, Holdsworth P, Davies L. Establishing a Smartphone Ambulatory ECG Service for Patients Presenting to the Emergency Department with Pre-Syncope and Palpitations. Medicina. 2021; 57(2):147. https://doi.org/10.3390/medicina57020147

Chicago/Turabian Style

Reed, Matthew J., Alexandra Muir, Julia Cullen, Ross Murphy, Valery Pollard, Goran Zangana, Sean Krupej, Sylvia Askham, Patricia Holdsworth, and Lauren Davies. 2021. "Establishing a Smartphone Ambulatory ECG Service for Patients Presenting to the Emergency Department with Pre-Syncope and Palpitations" Medicina 57, no. 2: 147. https://doi.org/10.3390/medicina57020147

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