Key result
WCD alarms affect ~71% of patients, predominantly from artefacts, without reducing daily wear adherence.
Why the study?
Wearable cardioverter-defibrillators use surface electrodes to detect arrhythmia before initiating treatment but are prone to inappropriate detection from artefacts, so the study assessed alarm burden and its impact on clinical outcomes.
Does the alarm burden of wearable cardioverter-defibrillators impact adherence and clinical outcomes in patients at high risk for sudden cardiac death?
Observational (n=456)
Yes
Does the alarm burden of wearable cardioverter-defibrillators impact adherence and clinical outcomes in patients at high risk for sudden cardiac death?
Answers are grounded in this paper and cite their sources.
WCDs frequently emit false alarms mostly due to artefacts, particularly in obese patients, though this does not appear to compromise overall patient adherence to wearing the device.
Background: The wearable cardioverter defibrillator (WCD) uses surface electrodes to detect arrhythmia before initiating a treatment sequence. However, it is also prone to inappropriate detection due to artefacts. Objective: The aim of this study is to assess the alarm burden in patients and its impact on clinical outcomes. Methods: Patients from the nationwide Swiss WCD Registry were included. Clinical characteristics and data were obtained from the WCDs. Arrhythmia recordings ≥30 s in length were analysed and categorized as VT/VF, atrial fibrillation (AF), supraventricular tachycardia (SVT) or artefact. Results: A total of 10653 device alarms were documented in 324 of 456 patients (71.1%) over a mean WCD wear-time of 2.0 ± 1.6 months. Episode duration was 30 s or more in 2996 alarms (28.2%). One hundred and eleven (3.7%) were VT/VF episodes. The remaining recordings were inappropriate detections (2736 (91%) due to artefacts; 117 (3.7%) AF; 48 (1.6%) SVT). Two-hundred and seven patients (45%) had three or more alarms per month. Obesity was significantly associated with three or more alarms per month (p = 0.01, 27.7% vs. 15.9%). High alarm burden was not associated with a lower average daily wear time (20.8 h vs. 20.7 h, p = 0.785) or a decreased implantable cardioverter defibrillator implantation rate after stopping WCD use (48% vs. 47.3%, p = 0.156). Conclusions: In patients using WCDs, alarms emitted by the device and impending inappropriate shocks were frequent and most commonly caused by artefacts. A high alarm burden was associated with obesity but did not lead to a decreased adherence.
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Kovacs et al. (2021) conducted an observational in Patients with heart disease at high risk for sudden cardiac death (n=456). Wearable cardioverter-defibrillator (WCD) was evaluated on Alarm burden (frequency and cause of device alarms) and its impact on device adherence. In patients using WCDs, 71.1% experienced alarms, with high alarm burden associated with obesity but not reducing daily wear adherence.
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