Key result
QTc Tracker app linked to ~98% reduction in QTc diagnosis turnaround time vs routine ECG workflow.
Why the study?
Regular ECG assessments to monitor cardiotoxic antineoplastic drugs and prevent LQTS cause patient discomfort and need timely cardiologist support, prompting evaluation of a smartphone app for more efficient, comfortable monitoring.
Does the QTc Tracker smartphone app reduce turnaround time and improve user satisfaction for QTc monitoring in breast cancer patients on ribociclib compared to routine ECG workflow?
Observational (n=122)
Yes
Does the QTc Tracker smartphone app reduce turnaround time and improve user satisfaction for QTc monitoring in breast cancer patients on ribociclib compared to routine ECG workflow?
Effect estimate: 98% reduction (95% CI 1.72-2.67)
Absolute Event Rate: 2.67% vs 130.56%
Implementation of a smartphone-based single-lead ECG app with tele-cardiology support significantly reduced turnaround time for QTc monitoring and improved satisfaction among oncology patients and nurses.
May streamline QTc monitoring for ribociclib patients; hypothesis-generating for app-based workflows pending randomized trials.
BACKGROUND: Numerous antineoplastic drugs such as chemotherapeutics have cardiotoxic side effects and can lead to long QT syndrome (LQTS). When diagnosed and treated in time, the potentially fatal outcomes of LQTS can be prevented. Therefore, regular electrocardiogram (ECG) assessments are critical to ensure patient safety. However, these assessments are associated with patient discomfort and require timely support of the attending oncologist by a cardiologist. OBJECTIVE: This study aimed to examine whether this approach can be made more efficient and comfortable by a smartphone app (QTc Tracker), supporting single-lead ECG records on site and transferring to a tele-cardiologist for an immediate diagnosis. METHODS: To evaluate the QTc Tracker, it was implemented in 54 cancer centers in Germany. In total, 266 corrected QT interval (QTc) diagnoses of 122 patients were recorded. Moreover, a questionnaire on routine ECG workflow, turnaround time, and satisfaction (1=best, 6=worst) was answered by the centers before and after the implementation of the QTc Tracker. RESULTS: Compared to the routine ECG workflow, the QTc Tracker enabled a substantial turnaround time reduction of 98% (mean 2.67, 95% CI 1.72-2.67 h) and even further time efficiency in combination with a cardiologic on-call service (mean 12.10, 95% CI 5.67-18.67 min). Additionally, nurses and patients reported higher satisfaction when using the QTc Tracker. In particular, patients' satisfaction sharply improved from 2.59 (95% CI 2.41-2.88) for the routine ECG workflow to 1.25 (95% CI 0.99-1.51) for the QTc Tracker workflow. CONCLUSIONS: These results reveal a significant improvement regarding reduced turnaround time and increased user satisfaction. Best patient care might be guaranteed as the exposure of patients with an uncontrolled risk of QTc prolongations can be avoided by using the fast and easy QTc Tracker. In particular, as regular side-effect monitoring, the QTc Tracker app promises more convenience for patients and their physicians. Finally, future studies are needed to empirically test the usability and validity of such mobile ECG assessment methods. TRIAL REGISTRATION: ClinicalTrials.gov NCT04055493; https://classic.clinicaltrials.gov/ct2/show/NCT04055493.
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Klier et al. (2023) conducted an observational in Early breast cancer (n=122). QTc Tracker app vs. Routine ECG workflow was evaluated on Mean turnaround time for QTc diagnosis (hours) (98% reduction, 95% CI 1.72-2.67). The QTc Tracker app reduced the mean turnaround time for QTc diagnosis by 98% (from 5.44 days to 2.67 hours) compared to the routine ECG workflow.
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