Cardiac Remote Monitoring Devices and Technologies: A Review for the Perioperative Physician and Telemedicine Providers

Cardiovascular complications are a major cause of morbidity and mortality after surgery, necessitating adequate and thorough preoperative risk stratification and screening. Several technological advances in cardiac remote monitoring have improved the assessment and diagnosis of cardiovascular disease in patients before and after surgery. These devices perform measurements of physiological function, including vital signs, and more advanced functions, such as electrocardiograms and heart sound recordings. Some of the currently available devices include Fitbit® (Google LLC, Mountain View, CA, USA), BodyGuardian® (Preventive Inc., Rochester, MN, USA), ZephyrTM Performance Systems (Zephyr Inc., Annapolis, MD, USA), Sensium® (The Surgical Company, Amersfoort, UT, The Netherlands), KardiaMobile® (AliveCor, Mountain View, CA, USA), Coala® Heart Monitor (Coala Life Inc., Uppsala, Sweden), Smartex® Wearable Wellness System (Smartex, Porto, LX, Portugal), Eko® CORE and DUO (Eko Health, Emeryville, CA, USA), and TytoCareTM (TytoCare Ltd., New York, USA). Early studies have applied these devices to asymptomatic individuals and those with known cardiovascular disease with good sensitivity and specificity for electrophysiologic diagnosis. These devices carry several technical and other limitations, somewhat restricting the generalization of their use to all patients. However, information gathered from these devices can further guide anesthetic technique, operative timing, and postoperative follow-up, among other variables. As telehealth becomes more prevalent and comprehensive, it is paramount for the perioperative physician to be familiar with the available cardiac remote monitoring technologies.