Improving care for patients with atrial fibrillation through the use of a personal electrocardiogram.

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia affecting more than six million people in the United States. The economic burden is estimated to be >$6 billion annually with catastrophic events dramatically increasing expenditure. When patients experience symptoms, they commonly present to an acute care facility; this can be costly and anxiety provoking. LOCAL PROBLEM: Same-day access issues prohibit patients from communicating directly with their cardiology provider, forcing them to use resources and increasing psychological burden. METHODS: A convenience sample, made up of 43 patients, was given a KardiaMobile device. Eligible patients had ≥2 AF-related emergency department (ED) or urgent care (UC) visits over 12 months, needed rate control with medication titration, or were monitored for AF reoccurrence after reestablishing sinus rhythm. INTERVENTIONS: Patients emailed recordings daily and when experiencing symptoms. The recordings were reviewed by a nurse practitioner (NP); abnormal readings were followed by a phone call, telehealth, or in-person visit. RESULTS: An independently designed survey was conducted online; almost all respondents (97%) found value in the project and the device. Virtually all respondents (97%) felt that the program improved access. A majority (86%) reported decreased anxiety. Had the respondents not been in the program, 34% indicated that they would have presented to an ED and 25% would have presented to an UC, realizing a cost savings of $81,950 in reduced ED visits alone. CONCLUSION: A personal electrocardiogram, with NP oversight, to manage AF is cost-effective and reduces unnecessary resource utilization. It is patient centered, improves access, and empowers patients to manage their symptoms.

Association of heart rate recovery and maximum oxygen consumption in patients with chronic congestive heart failure.

BACKGROUND: Peak oxygen consumption (peak VO2) is one of the strongest predictors of mortality in patients with congestive heart failure (CHF). In contrast to measurements of peak VO2, which requires analysis of expired gases, heart rate recovery, defined as maximum heart rate minus heart rate at 1 minute after exercise, is easily obtained. The current study was undertaken to determine the association between peak VO2 and heart rate recovery in patients with CHF. METHODS: Retrospective data on VO2 and heart rate recovery were analyzed in 296 patients with CHF secondary to left ventricular systolic dysfunction (left ventricular ejection fraction [LVEF] <50%) who had undergone cardiopulmonary exercise testing (CPET). Patients exercised on a treadmill using a graded work rate protocol with the work increasing to a symptom-limited maximum. Peak oxygen consumption was defined as the highest value of oxygen uptake attained in the final 20 seconds of exercise when the respiratory exchange ratio was >1.0. RESULTS: Heart rate recovery and peak VO2 correlated moderately (r = 0.47, p < 0.001). The degree of correlation was similar in patients receiving beta-blockers (r = 0.47, p < 0.001) and those not receiving beta-blockers (r = 0.49, p < 0.001). CONCLUSIONS: Although heart rate recovery and peak VO2 correlated moderately, from a clinical standpoint, this finding is probably not strong enough to use heart rate recovery in lieu of peak VO2. This modest correlation of two independent predictors of outcome may suggest their usefulness when combined in a multivariate score.