Experts urge caution on ‘over-the-counter’ heart rate monitors

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The “exponential growth” in the use of digital devices for monitoring arrhythmias has led to the development of a new international consensus document. The article, published today in European EPwill also be presented at the European Heart Rhythm Association Annual Meeting 2022 (EHRA 2022, April 3‒5, Copenhagen, Denmark).

The use of wearable technology and other digital tools has become more common in healthcare settings, with arrhythmia management being an area of ​​particular focus, particularly in light of the pandemic, which has seen a greater big push towards remote monitoring and telehealth.

“Before using any technology to monitor heart rate or rhythm, patients and the public should agree with their physician which device to use, for how long, and what to do if the device issues a warning,” the agency said. lead author Emma Svennberg (Karolinska Institute, Stockholm, Sweden). “People need to know how to react to feedback from the device. Should he rush to the emergency room or can he wait for a routine appointment? It creates confusion and uncertainty if there is no no management plan in place.

“This is the first practical guide for clinicians on the use of digital devices for heart rhythm and heart rate monitoring, an area that has grown exponentially with the advent of smartphones and wearable devices” , she continued. “The document clarifies which technologies should be used and when, and is a step towards equitable healthcare. Our co-author, patient representative, Inga Drossart, also helped us to include the lay perspective. »

Heart rhythm monitoring with digital devices is one way to detect asymptomatic arrhythmias that can be treated. For example, about one-third of patients with atrial fibrillation (AF) have no symptoms, and early diagnosis can allow appropriate treatment to reduce the risk of stroke.

The consensus document covers all new digital devices, including electrocardiogram (ECG) patches, wearables like smartwatches, forearm bands, chest straps, rings and headphones, and portable devices such as smartphones with face sensor apps or fingertip apps.

Svennberg noted that digital devices are particularly useful for people with paroxysmal arrhythmias. She said: ‘If you only have an arrhythmia twice a year it can be quite difficult to detect during a medical visit. Devices can help document these events and aid in diagnosis.

The authors recommend that abnormal results on a digital device be evaluated by a team including a cardiac arrhythmia specialist or cardiologist. Additionally, unusual readings on a consumer heart rate device (e.g. a smartwatch) are insufficient for diagnosis and ECG confirmation is mandatory.

People at high risk of ischemic stroke can use digital technologies to check for AF which could then be treated to reduce stroke risk. This could include people over 75 or over 65 with characteristics that predispose them to stroke, such as high blood pressure, heart disease, or a previous stroke. “Regardless of whether or not they have symptoms, people in these categories should discuss atrial fibrillation screening with their doctor,” Svennberg said.

On the other hand, she advised against buying an over-the-counter device that may not have regulatory approval and continuously monitor heart rate without medical imperative.

Svennberg said: “The application of digital devices in cardiac arrhythmias is a rapidly evolving field. The future will see more contactless surveillance, for example using cameras and smart speakers, which could be particularly useful in pandemic situations. In addition, more advanced statistical methods such as artificial intelligence will improve the interpretation of long-term device data. Finally, to ensure adoption and buy-in, we need to recruit patients from the start so that devices are co-designed with the user in mind. »

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