Fewer emergency department alarms is associated with reduced use of medications for acute agitation.

BACKGROUND AND OBJECTIVES: Patient monitoring systems provide critical information but often produce loud, frequent alarms that worsen patient agitation and stress. This may increase the use of physical and chemical restraints with implications for patient morbidity and autonomy. This study analyzes how augmenting alarm thresholds affects the proportion of alarm-free time and the frequency of medications administered to treat acute agitation. METHODS: Our emergency department's patient monitoring system was modified on June 28, 2022 to increase the tachycardia alarm threshold from 130 to 150 and to remove alarm sounds for several arrhythmias, including bigeminy and premature ventricular beats. A pre-post study was performed lasting 55 days before and 55 days after this intervention. The primary outcome was change in number of daily patient alarms. The secondary outcomes were alarm-free time per day and median number of antipsychotic and benzodiazepine medications administered per day. The safety outcome was the median number of patients transferred daily to the resuscitation area. We used quantile regression to compare outcomes between the pre- and post-intervention period and linear regression to correlate alarm-free time with the number of sedating medications administered. RESULTS: Between the pre- and post-intervention period, the median number of alarms per day decreased from 1332 to 845 (-37%). This was primarily driven by reduced low-priority arrhythmia alarms from 262 to 21 (-92%), while the median daily census was unchanged (33 vs 32). Median hours per day free from alarms increased from 1.0 to 2.4 (difference 1.4, 95% CI 0.8-2.1). The median number of sedating medications administered per day decreased from 14 to 10 (difference - 4, 95% CI -1 to -7) while the number of escalations in level of care to our resuscitation care area did not change significantly. Multivariable linear regression showed a 60-min increase of alarm-free time per day was associated with 0.8 (95% CI 0.1-1.4) fewer administrations of sedating medication while an additional patient on the behavioral health census was associated with 0.5 (95% CI 0.0-1.1) more administrations of sedating medication. CONCLUSION: A reasonable change in alarm parameter settings may increase the time patients and healthcare workers spend in the emergency department without alarm noise, which in this study was associated with fewer doses of sedating medications administered.

Continuous Fetal Cardiac Monitoring during Fetoscopic Myelomeningocele Repair and Relationship to Spectral Doppler Changes.

INTRODUCTION: No evidence-based protocols exist for fetal cardiac monitoring during fetoscopic myelomeningocele (fMMC) repair and intraprocedural spectral Doppler data are limited. We determined the feasibility of continuous fetal echocardiography during fMMC repair and correlated Doppler changes with qualitative fetal cardiac function during each phase of fMMC repair. METHODS: Patients undergoing fMMC repair had continuous fetal echocardiography interpreted in real-time by pediatric cardiology. Fetal data included fetal heart rate (FHR), qualitative cardiac function, mitral and tricuspid valve inflow waveforms, and umbilical artery (UA), umbilical vein (UV), ductus arteriosus (DA), and ductus venosus (DV) Dopplers. RESULTS: UA abnormalities were noted in 14/25 patients, UV abnormalities were observed in 2 patients, and DV and DA abnormalities were each noted in 4 patients. Qualitative cardiac function was normal for all patients with the exception of one with isolated left ventricular dysfunction during myofascial flap creation, concurrent with an abnormal UA flow pattern. All abnormalities resolved by the first postoperative day. CONCLUSIONS: Continuous fetal echocardiography was feasible during all fMMC repairs. Spectral Doppler changes in the UA were common during fMMC procedures but qualitative cardiac dysfunction was rare. Abnormalities in the UV, DV, and DA Dopplers, FHR, and cardiac function were less common findings.

Long-term use of an implantable loop recorder for ECG recording in horses.

Potential arrhythmias recorded by cardiac monitors using the built-in human algorithm are as follows: total number of episodes, ventricular tachycardia, asystole, bradycardia, atrial tachycardia, atrial fibrillation and the percentage of time spent in atrial tachycardia or atrial fibrillation. Long-term use of an insertable cardiac monitor (loop recorder) has been reported in one horse earlier, but its accurate role as a diagnostic tool is still unclear. The aim of the present study was to investigate the long-term applicability of the Reveal XT cardiac monitor for recording cardiac arrhythmias in adult horses. The Reveal XT cardiac monitor was implanted in 12 horses under sedation in standing position. Median duration of data recording calculated for the population was 1,169 days. The number of false positive detections of asystole and bradycardia was extremely high in all horses. For atrial fibrillation, false positive detection occurred in five and false negative detection occurred in one horse. The present study showed that the long-term use of the Reveal XT cardiac monitor is feasible, well-tolerated and the devices work reliably, without complications. The human algorithm could not be used for automatic detection of arrhythmic episodes in the study population. The device could detect atrial fibrillation in horses, but the recorded AF burden was inaccurate and the stored ECGs had to be manually interpreted. Because the human analyser algorithm of this cardiac monitor fails to identify bradyarrhythmias in horses based on our results, this instrument is not capable for accurately determining the aetiology of episodic collapse in this species.

New insertable cardiac monitors show high diagnostic yield and good safety profile in real-world clinical practice: results from the international prospective observational SMART Registry.

AIMS: Insertable cardiac monitors (ICMs) are indicated for long-term monitoring of unexplained syncope or palpitations, and for detection of bradycardia, ventricular tachycardia, and/or atrial fibrillation (AF). The aim of our study was to evaluate the safety and clinical value associated with a new generation ICM (Confirm Rx™, Abbott, Illinois, USA), featuring a new remote monitoring system based on smartphone patient applications. METHODS AND RESULTS: The SMART Registry is an international prospective observational study. The main endpoints were ICM safety (incidence of serious adverse device and procedure-related events (SADEs) at 1 month), ICM clinical value (incidence of device-detected true arrhythmias and of clinical diagnoses and interventions), and patient-reported experience measurements (PREMs). A total of 1400 subjects were enrolled. ICM indications included syncope (49.1%), AF (18.8%), unexplained palpitations (13.6%), risk of ventricular arrhythmia (6.6%), and cryptogenic stroke (6.0%). Freedom from SADEs at 1 month was 99.4% (95% Confidence Interval: 98.8-99.7%). In the 6-month monitoring period, the ICM detected true cardiac arrhythmias in 45.7% of patients and led to clinical interventions in a relevant proportion of patients; in particular, a pacemaker implant was performed after bradycardia detection in 8.9% of subjects who received an ICM for syncope and oral anticoagulation therapy was indicated after AF detection in 15.7% of subjects with cryptogenic stroke. PREMs showed that 78.2% of subjects were satisfied with the remote monitoring patient app. CONCLUSION: The evaluated ICM is associated with an excellent safety profile and high diagnostic yield. Patients reported positive experiences associated with the use of their smartphone for the device remote monitoring.

Bioenergetic consequences of repeated catch-and-release fisheries interactions on adult steelhead across a range of ecologically relevant water temperatures.

The biological consequences of catch-and-release angling have been studied for decades, yet little is known about the compounding effects of repeated recreational fisheries recaptures on the physiology and behaviour of angled fish. Using heart rate biologgers and behavioural assays, this study investigated the physiological and behavioural consequences of multiple simulated angling events (i.e., repeated stressors) on female steelhead (Oncorhynchus mykiss), under current (6 °C) and future (11 °C) water temperature scenarios. While steelhead in the warmer water temperature scenario demonstrated alterations in cardiac function (e.g., increases in maximum heart rate and scope of heart rate) and evidence of behavioural impairments (e.g., decreases in chase activity and landing time) over the course of two simulated angling events, cold water treated fish had negligible change. Fish subjected to two simulated angling events under warm water temperature conditions tended to demonstrate an increase in recovery time and scope for heart rate, and a decrease in resting heart rate. A second experiment was conducted to test for sex-specific differences in the heart rate response of steelhead subjected to an increase in water temperature. Females demonstrated a higher scope for heart rate when compared to males during the event and during recovery. More work is needed to better understand the interaction between multiple angling events and recovery from these events at various water temperatures, and the biological basis for sex-specific differences in cardiac function and response to challenges. This study contributes to a growing body of evidence on the effects of repeated stressors on wild fish.

Measurements of pulse rate using facial video cameras from smart devices in patients diagnosed with atrial fibrillation.

Clinical applications of passive long-term heart rate (HR) monitoring in patients with cardiac arrhythmias include adequate drug titration of atrioventricular (AV) nodal drugs and assessment of medical compliance with treatment. A majority of patients treated with beta-blockers, especially patients with atrial fibrillation (AF), require some degree of drug titration during the first 6 months of treatment to ensure that adequate HR control and medicine compliance has been achieved. Failing to achieve adequate rate control in patients with AF can lead to worsening symptoms, heart failure exacerbations, and potentially tachycardia-induced cardiomyopathy. Enabling video-based monitoring during telehealth patient visits could facilitate providers to measure heart rate (HR) without the need for a dedicated home device (smartwatch, SPO2 device, or others). Videoplethysmography (VPG) is a monitoring technology that measures pulse rate by utilizing front-facing cameras embedded in smart devices. VPG provides a remote and contactless cardiac monitoring solution. We conducted a clinical experiment to evaluate the accuracy of VPG in measuring HR while running on two portable devices: Samsung S10 smartphones and S3 tablets. We used a single­lead ECG to measure the heart rate at the time of the VPG recordings in AF patients. We employed the Bland-Altman method to measure the level of agreement between videoplethysmography and ECG-based measurements of HR. The findings reveal that the mean difference in videoplethysmography and ECG-based heart rate was inferior to 1 bpm across the 2 devices with confidence intervals ranging from 3 to 12 BPM. Our facial video-based HR monitoring solution could assist providers in measuring heart rates in their patients with AF during remote telehealth visits.

Remote Monitoring of Cardiac Implantable Electronic Devices: What is the Evidence?

PURPOSE OF REVIEW: This review offers an overview of the evidence in diagnostic and therapeutic applications of remote monitoring implantable devices. RECENT FINDINGS: Remote monitoring of cardiac implantable devices has become more and more popular in recent years as healthcare is moving towards a more patient centralized system. For heart failure patients with an ICD or pacemaker, there is controversial evidence regarding improvements in the clinical outcome, e.g., reduction of hospitalization rates or overall mortality. New developments as hemodynamic remote monitoring via measurement of the pulmonary artery pressure are promising technical achievements showing encouraging results. In cardiac remote monitoring of syncope and arrhythmias, implantable loop recorder plays an important role in diagnostic algorithms. Although there is controversial evidence according to remote monitoring of implantable devices, its use is rapidly expanding, giving healthcare providers the opportunity to react promptly to worsening of their patients. Adequate evaluation of the data created by remote monitoring systems remains an unsolved challenge of contemporary healthcare services.

First Ex Vivo Animal Study of a Biological Heart Valve Prosthesis Sensorized with Intravalvular Impedance.

IntraValvular Impedance (IVI) sensing is an innovative concept for monitoring heart valve prostheses after implant. We recently demonstrated IVI sensing feasible in vitro for biological heart valves (BHVs). In this study, for the first time, we investigate ex vivo the IVI sensing applied to a BHV when it is surrounded by biological tissue, similar to a real implant condition. A commercial model of BHV was sensorized with three miniaturized electrodes embedded in the commissures of the valve leaflets and connected to an external impedance measurement unit. To perform ex vivo animal tests, the sensorized BHV was implanted in the aortic position of an explanted porcine heart, which was connected to a cardiac BioSimulator platform. The IVI signal was recorded in different dynamic cardiac conditions reproduced with the BioSimulator, varying the cardiac cycle rate and the stroke volume. For each condition, the maximum percent variation in the IVI signal was evaluated and compared. The IVI signal was also processed to calculate its first derivative (dIVI/dt), which should reflect the rate of the valve leaflets opening/closing. The results demonstrated that the IVI signal is well detectable when the sensorized BHV is surrounded by biological tissue, maintaining the similar increasing/decreasing trend that was found during in vitro experiments. The signal can also be informative on the rate of valve opening/closing, as indicated by the changes in dIVI/dt in different dynamic cardiac conditions.

Remote ECG monitoring to reduce complications following transcatheter aortic valve implantations: the Redirect TAVI study.

AIMS: The optimal strategy of monitoring for conduction disturbances in patients undergoing transcatheter aortic valve implantation (TAVI) is uncertain. We evaluated a pre- and post-TAVI remote ambulatory cardiac monitoring (rACM) strategy for identification of conduction disturbances and to reduce unplanned pre-discharge post-TAVI permanent pacemaker implantation (PPMI). METHODS AND RESULTS: REdireCT TAVI (NCT0381820) was a prospective cohort study of patients referred for outpatient TAVI. Patients with prior PPMI were excluded. Remote ambulatory cardiac monitoring consisted of 2 weeks of continuous electrocardiogram (ECG) monitoring (Pocket-ECGTM) both before and after TAVI. Compliance to monitoring, frequency of notifications, unplanned PPMI post-TAVI, and length of hospitalization were measured. Between June 2018 and March 2020, in 192 undergoing TAVI (mean age: 81.8 years; female sex 46%; balloon-expandable valve 95.3%), compliance to rACM was 91.7% pre-TAVI (mean duration: 12.8 days), and 87.5% post-TAVI (mean duration: 12.9 days). There were 24 (12.5%) rACM notifications (13 pre-TAVI; 11 post-TAVI) resulting in 14 (7.3%) planned PPMI: seven pre-TAVI [due to sinus pauses n = 2 or atrio-ventricular block (AVB) n = 5] and seven post-TAVI [due to sinus pauses n = 1 or AVB n = 5 or ventricular tachycardia (VT) n = 1]. In addition, nine (4.7%) patients received pre-TAVI PPMI due to high-risk baseline ECG (right bundle branch block with hemi-block or prolonged PR interval). Unplanned PPMI post-TAVI during index hospitalization occurred in six (3.1%) patients due to AVB and in one patient readmitted with AVB. The median length of stay post-TAVI was 1 day. CONCLUSION: A strategy of routine rACM was feasible and frequently led to PPMI. Our approach of 2-week rACM both pre- and post-TAVI achieves both high patient compliance and sufficient surveillance. CLINICAL TRIAL REGISTRATION: Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03810820.

Thromboembolic and bleeding risks in edoxaban patients with pacemaker and cardiac monitoring procedures: Outcomes of the Global EMIT program.

INTRODUCTION: Limited data were published on the management of direct oral anticoagulants in the insertion of pacemaker and cardiac monitoring devices. This study describes the management and outcomes of edoxaban, a direct oral factor Xa inhibitor, in patients undergoing pacemaker or monitoring device implantation in routine clinical practice. METHODS AND RESULTS: EMIT-AF/VTE collected data of patients from Europe, Korea, and Taiwan. Timing and duration of periprocedural interruption of edoxaban were at the treating physician's discretion. Pacemakers or monitoring devices were implanted into 136 patients who were evaluated from 5 days pre- until 30 days post-procedure. The primary outcomes were the incidences of acute thromboembolic events (ATE), ischemic events, and International Society on Thrombosis and Haemostasis-defined Major Bleeding; secondary outcomes included incidence of clinically relevant non-major bleeding (CRNMB) and perioperative edoxaban interruption times. Conformance with European Heart Rhythm Association (EHRA) Guidance on interruption of direct oral anticoagulant therapy was variable: of the cardiac monitoring device patients, where no interruption of therapy would be expected, nonetheless, 62.5% had interruption of treatment, whereas in pacemaker procedures, where interruption would be expected, 23.4% had no interruption. No ATE or ischemic events occurred. One case of CRNMB and two of minor bleeding occurred. All bleedings occurred more than 3 days after the procedure. CONCLUSION/RELEVANCE: The periprocedural complication risk for edoxaban treated patients undergoing pacemaker or invasive cardiac monitoring implantation was low. This population of patients was well managed in routine practice.

The missing link: Unlocking the power of cardiac rhythm monitoring device based QT interval detection.

BACKGROUND: The QT interval is of high clinical value as QT prolongation can lead to Torsades de Pointes (TdP) and sudden cardiac death. Insertable cardiac monitors (ICMs) have the capability of detecting both absolute and relative changes in QT interval. In order to determine feasibility for long-term ICM based QT detection, we developed and validated an algorithm for continuous long-term QT monitoring in patients with ICM. METHODS: The QT detection algorithm, intended for use in ICMs, is designed to detect T-waves and determine the beat-to-beat QT and QTc intervals. The algorithm was developed and validated using real-world ICM data. The performance of the algorithm was evaluated by comparing the algorithm detected QT interval with the manually annotated QT interval using Pearson's correlation coefficient and Bland Altman plot. RESULTS: The QT detection algorithm was developed using 144 ICM ECG episodes from 46 patients and obtained a Pearson's coefficient of 0.89. The validation data set consisted of 136 ICM recorded ECG segments from 76 patients with unexplained syncope and 104 ICM recorded nightly ECG segments from 10 patients with diabetes and Long QT syndrome. The QT estimated by the algorithm was highly correlated with the truth data with a Pearson's coefficient of 0.93 (p < .001), with the mean difference between annotated and algorithm computed QT intervals of -7 ms. CONCLUSIONS: Long-term monitoring of QT intervals using ICM is feasible. Proof of concept development and validation of an ICM QT algorithm reveals a high degree of accuracy between algorithm and manually derived QT intervals.

Use of Prolonged Cardiac Rhythm Monitoring to Identify Atrial Fibrillation After Cryptogenic Stroke.

PURPOSE OF REVIEW: Prolonged cardiac monitoring (PCM) improves detection of atrial fibrillation (AF) after cryptogenic stroke. We summarize current research supporting the use of PCM as part of the cryptogenic stroke evaluation, while highlighting areas that require more investigation. RECENT FINDINGS: Despite increased AF detection with longer durations of PCM, more definitive research is needed to demonstrate how PCM improves clinical outcomes. The optimal type, timing, and length of cardiac monitoring after cryptogenic stoke remains unknown. Clinical calculators will be important to risk stratify which cryptogenic stroke patients are most likely to benefit from PCM. Currently, AF detection after cryptogenic stroke should prompt consideration of anticoagulation, but it is unclear if all durations and timing of AF after stroke should be treated the same. PCM remains an important part of the cryptogenic stroke work up, and detection of AF allows for anticoagulation initiation. Additional research is needed to further refine our application of PCM to cryptogenic stroke.

Assessment of a new KoMaWo electrode-patch configuration accuracy and review of the literature.

INTRODUCTION: Standard 12­lead electrocardiogram (ECG) is a basic element of routine everyday clinical practice. Traditional cardiac monitoring devices are associated with considerable limitations. Adhesive patches, novel digital solutions, may become a useful diagnostic tool for several cardiovascular diseases. MATERIALS AND METHODS: We propose a new variation of ECG electrodes positioning called KoMaWo. 15 consecutive patients presenting with ST segment deviations due to coronary artery disease were enrolled. The accuracy and utility of the new configuration was assessed and compared with the Mason-Likar configuration, as well as with a standard 12­lead ECG recording. The scans were blinded and interpreted by two independent cardiologists. RESULTS: There were no statistically significant differences in morphology, as well as in the duration of individual waves, complexes, segments, and intervals between the scans obtained using all three methods. In a subgroup analysis, with regard to age, body mass and left ventricle ejection fraction (LVEF), KoMaWo was non-inferior to standard ECG with a 0.2 mm margin. DISCUSSION: The role of traditional cardiac monitoring devices is recognized as the gold standard of patient management. However, certain limitations should be considered. Adhesive patches are light-weight, well-tolerated and do not interfere with daily activities of patients. These novel devices allow for extended monitoring, facilitating increased diagnostic accuracy, regarding cardiac arrhythmias. CONCLUSIONS: The KoMaWo configuration is not inferior to standard electrode placement, nor to Mason-Likar configuration, including its ability to capture ST segment deviations. Adhesive patches may become a valid alternative for traditional cardiac monitoring methods.

Changes in Forcecardiography Heartbeat Morphology Induced by Cardio-Respiratory Interactions.

The cardiac function is influenced by respiration. In particular, various parameters such as cardiac time intervals and the stroke volume are modulated by respiratory activity. It has long been recognized that cardio-respiratory interactions modify the morphology of cardio-mechanical signals, e.g., phonocardiogram, seismocardiogram (SCG), and ballistocardiogram. Forcecardiography (FCG) records the weak forces induced on the chest wall by the mechanical activity of the heart and lungs and relies on specific force sensors that are capable of monitoring respiration, infrasonic cardiac vibrations, and heart sounds, all simultaneously from a single site on the chest. This study addressed the changes in FCG heartbeat morphology caused by respiration. Two respiratory-modulated parameters were considered, namely the left ventricular ejection time (LVET) and a morphological similarity index (MSi) between heartbeats. The time trends of these parameters were extracted from FCG signals and further analyzed to evaluate their consistency within the respiratory cycle in order to assess their relationship with the breathing activity. The respiratory acts were localized in the time trends of the LVET and MSi and compared with a reference respiratory signal by computing the sensitivity and positive predictive value (PPV). In addition, the agreement between the inter-breath intervals estimated from the LVET and MSi and those estimated from the reference respiratory signal was assessed via linear regression and Bland-Altman analyses. The results of this study clearly showed a tight relationship between the respiratory activity and the considered respiratory-modulated parameters. Both the LVET and MSi exhibited cyclic time trends that remarkably matched the reference respiratory signal. In addition, they achieved a very high sensitivity and PPV (LVET: 94.7% and 95.7%, respectively; MSi: 99.3% and 95.3%, respectively). The linear regression analysis reported almost unit slopes for both the LVET (R2 = 0.86) and MSi (R2 = 0.97); the Bland-Altman analysis reported a non-significant bias for both the LVET and MSi as well as limits of agreement of ±1.68 s and ±0.771 s, respectively. In summary, the results obtained were substantially in line with previous findings on SCG signals, adding to the evidence that FCG and SCG signals share a similar information content.

Investigating Cardiorespiratory Interaction Using Ballistocardiography and Seismocardiography-A Narrative Review.

Ballistocardiography (BCG) and seismocardiography (SCG) are non-invasive techniques used to record the micromovements induced by cardiovascular activity at the body's center of mass and on the chest, respectively. Since their inception, their potential for evaluating cardiovascular health has been studied. However, both BCG and SCG are impacted by respiration, leading to a periodic modulation of these signals. As a result, data processing algorithms have been developed to exclude the respiratory signals, or recording protocols have been designed to limit the respiratory bias. Reviewing the present status of the literature reveals an increasing interest in applying these techniques to extract respiratory information, as well as cardiac information. The possibility of simultaneous monitoring of respiratory and cardiovascular signals via BCG or SCG enables the monitoring of vital signs during activities that require considerable mental concentration, in extreme environments, or during sleep, where data acquisition must occur without introducing recording bias due to irritating monitoring equipment. This work aims to provide a theoretical and practical overview of cardiopulmonary interaction based on BCG and SCG signals. It covers the recent improvements in extracting respiratory signals, computing markers of the cardiorespiratory interaction with practical applications, and investigating sleep breathing disorders, as well as a comparison of different sensors used for these applications. According to the results of this review, recent studies have mainly concentrated on a few domains, especially sleep studies and heart rate variability computation. Even in those instances, the study population is not always large or diversified. Furthermore, BCG and SCG are prone to movement artifacts and are relatively subject dependent. However, the growing tendency toward artificial intelligence may help achieve a more accurate and efficient diagnosis. These encouraging results bring hope that, in the near future, such compact, lightweight BCG and SCG devices will offer a good proxy for the gold standard methods for assessing cardiorespiratory function, with the added benefit of being able to perform measurements in real-world situations, outside of the clinic, and thus decrease costs and time.

Continuous cardiac rhythm monitoring post-stroke: A feasibility study in REGARDS.

OBJECTIVES: Cardiac rhythm monitoring is increasingly used after stroke. We studied feasibility of telephone guided, mail-in ambulatory long-term cardiac rhythm monitoring in Black and White stroke survivors. MATERIALS AND METHODS;: We contacted 28 participants of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who had an ischemic stroke during follow-up. After obtaining informed consent by telephone, a noninvasive 14-day cardiac rhythm monitoring device (ZIO® XT patch; iRhythm Technologies, San Francisco, CA) was mailed to each participant. We evaluated the results of telephone consent, follow-up calls, compliance and wear time as the primary objective. Secondarily, we reported prevalence of atrial and ventricular arrhythmias. RESULTS: The majority of those contacted (20/28 = 71%) agreed to enroll in the monitoring study. Non-participation was nominally more common in Black than White participants; 6/16 (37.5%) vs. 2/12 (17%). Of those who agreed, 15 participants (75%, 6 Black, 9 White) completed ambulatory monitoring with mean wear time 12.9 ± 2.5 days. Arrhythmias were observed in two-thirds of the 15 participants: AF in 2, brief atrial tachycardia in 12, NSVT in 2, premature ventricular contractions in 3, and pause or atrioventricular block in 2. CONCLUSIONS: Non-invasive rhythm monitoring was feasible in this pilot from a large, national cohort study of stroke survivors that employed a telephone guided, mail-in monitoring system, and these preliminary results suggest a high prevalence of arrhythmias. Increased emphasis on recruitment strategies for Black stroke survivors may be required. We demonstrated a high yield of significant cardiac arrhythmias among post-stroke participants who completed monitoring.

Differences in Inpatient Insertable Cardiac Monitor Placement after Ischemic Stroke.

BACKGROUND AND PURPOSE: Cryptogenic stroke accounts for 30% of ischemic stroke and in such patients, cardiac monitoring leads to increased detection of AF, increased utilization of anticoagulation, and decreased risk of recurrent stroke. We aim to identify differences in inpatient utilization of implantable cardiac monitors (ICMs) in patients with ischemic stroke. METHODS: This is an analysis of the National Inpatient Sample. We included all ischemic stroke hospitalizations nation-wide between Jan 1st 2016 and Dec 31st 2018. We excluded patients with history of atrial fibrillation or atrial flutter. We compared survey weighted baseline demographics and characteristics between patients who received an inpatient ICM versus those who didn't using logistic regression models. RESULTS: We identified a weighted total 1,069,395 patients who met the inclusion criteria; 2.2% received an inpatient ICM. In multivariable analyses, factors associated with decreased odds of inpatient ICM placement including Black race (OR 0.76 95% CI 0.68 - 0.84, p < 0.001), residence in a micropolitan area (OR 0.79 95% CI 0.67 - 0.94, p = 0.008), hospital region [Midwest (OR 0.74 95% CI 0.61 - 0.90, p = 0.002), South (OR 0.68 95% CI 0.57 - 0.81, p < 0.001), and West (OR 0.37 95% CI 0.29 - 0.45, p < 0.001)], hospital bed size [small (OR 0.38 95% CI 0.39-0.46, p < 0.001) and medium hospital bed size (OR 0.73 95% CI 0.63 - 0.84, p < 0.001)], insurance status [Medicaid (OR 0.86 95% CI 0.76 - 0.98, p = 0.02) and self-pay (OR 0.51 95% CI 0.41 - 0.62, p < 0.001)], and non-teaching hospital (OR 0.52 95% CI 0.47 - 0.60, p < 0.001). CONCLUSIONS: There are important differences in inpatient ICM placement in patients with ischemic stroke highlighting disparities in inpatient care for patients hospitalized with ischemic stroke. More studies are needed to validate our findings.

A comparative life cycle assessment of stretchable and rigid electronics: a case study of cardiac monitoring devices.

Stretchable electronics is a new innovation and becoming popular in various fields, especially in the healthcare sector. Since stretchable electronics use less printed circuit boards (PCBs), it is expected that the environmental performance of a stretchable electronics-based device is better than a rigid electronics-based device that provides the same functionalities. Yet, such a study is rarely available. Thus, the main purpose of this research is to perform a comparative life cycle analysis of stretchable and rigid electronics-based devices. This research combines both the case study approach and the research review approach. For the case study, a cardiac monitoring device with both stretchable and rigid electronics is used. The ISO 14044:2006 standard's prescribed LCA approach and ReCiPe 2016 Midpoint (Hierarchist) are followed for the impact assessment using the SimaPro 9.1 software. The LCA results show that the stretchable cardiac monitoring device has better environmental performance in all eighteen impact categories. This research also shows that the manufacturing process of stretchable electronics has lower environmental impacts than those for rigid electronics. The main reasons for the improved environmental performance of stretchable electronics are lower consumption of raw material as well as decreased energy consumption during manufacturing. Based on the LCA results of a cardiac monitoring device, the study concludes that stretchable electronics and their manufacturing process have better environmental performance in comparison with the rigid electronics and their manufacturing process.

Arrhythmia Detection is Improved by 14-Day Continuous Electrocardiography Patch Monitoring and CHA2DS2-VASc Score.

BACKGROUND: Arrhythmias are not always easy to capture because they are often paroxysmal or asymptomatic. METHODS: Using the CHA2DS2-VASc score for arrhythmia risk assessment, a 14-day electrocardiography monitor patch was used to evaluate patients with no documented history of arrhythmia. RESULTS: Ninety-three patients (mean age 59.8 ± 12.0 years, 46.2% female) received 14-day electrocardiography telemonitoring, and 14 patients (15%) were diagnosed with arrhythmias during a follow-up of 1004.4 person-days (mean recorded days 10.8 ± 4.1). The patients who were detected to have arrhythmias were older and had a higher prevalence of heart failure and chronic kidney disease. The result showed that arrhythmias were more likely to develop during a 14-day monitoring period in the patients with a CHA2DS2-VASc score of ≥ 3 or ≥ 4. Atrioventricular block was more likely to be detected in the patients with a CHA2DS2-VASc score of ≥ 3 or ≥ 4 during 7-day or 14-day monitoring periods. Ventricular tachycardia was also more likely to be detected in the patients with a CHA2DS2-VASc score of ≥ 4 or ≥ 5 during a 14-day monitoring period. When evaluating the risk of arrhythmia, a CHA2DS2-VASc score of ≥ 3 or ≥ 4 was associated with a higher risk of any arrhythmias during a 14-day monitoring period, while a CHA2DS2-VASc score of ≥ 4 was associated with a higher risk of any arrhythmias during a 7-day monitoring period. CONCLUSIONS: The results may suggest that a 14-day monitoring period is more favorable to detect arrhythmias. Atrioventricular block and ventricular tachycardia were more likely to develop in the patients with a higher CHA2DS2-VASc score.

Cardiovascular Toxicity of Novel HER2-Targeted Therapies in the Treatment of Breast Cancer.

PURPOSE OF REVIEW: HER2-targeted therapies have led to improved clinical outcomes in early and advanced breast cancer (BC). We review the long-term cardiotoxicity of HER2-targeted therapy in early and advanced BC, our current knowledge of cardiotoxicity of novel HER2-targeted therapies, and propose a cardiac monitoring (CM) strategy for this population. RECENT FINDINGS: Long-term data from studies with HER2-targeted therapy in the adjuvant setting have failed to demonstrate an increase in cardiotoxicity over time, and rates of cardiotoxicity seen with novel HER2 agents remain low. Despite over a decade of experience with HER2-targeted therapy, CM in clinical practice is inconsistent in patients with early BC and almost non-existent in advanced BC. Long-term follow-up of clinical trials with HER2-targeted agents in early and advanced BC has failed to demonstrate increased rates of cardiotoxicity over time, attesting to the long-term safety of this class of drugs for the majority of patients, although the long-term cardiac safety of newer HER2 agents in the non-clinical trial setting is largely unknown. We propose CM incorporating clinical history, cardiac imaging, and biomarkers.