September 1, 2019Journal of Innovations in Cardiac Rhythm ManagementOpen Access

Feasibility and Usability of Patch-based Continuous Cardiac Rhythm Monitoring in Comparison with Traditional Telemetry in Noncritically Ill Hospitalized Patients

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Why the study?

Traditional cardiac telemetry causes excessive alarms from lead failures and noise, whereas patch-based continuous cardiac rhythm monitoring has improved recording fidelity in ambulatory settings.

Does patch-based continuous cardiac rhythm monitoring improve arrhythmia detection compared to traditional telemetry in non-ICU hospitalized patients?

Structured PICO

Does patch-based continuous cardiac rhythm monitoring improve arrhythmia detection compared to traditional telemetry in non-ICU hospitalized patients?

Population

11 non-ICU hospitalized patients (mean age 66.8, 55% male) at a single center in the US. Excluded: pediatric patients, pregnant individuals, patients with internal or external defibrillators, patients with extensive skin damage or fresh surgical incisions on the chest, and patients in critical care areas.

Intervention

Patch-based continuous cardiac rhythm monitoring (Vital Signs Patch) applied simultaneously with traditional telemetry.

Comparator

Traditional cardiac telemetry monitoring using an off-site central monitoring unit (CMU).

Outcome

Feasibility, usability, and agreement of arrhythmia detections between the patch-based continuous cardiac rhythm monitoring system and traditional telemetry.

Patch-based continuous cardiac rhythm monitoring in hospitalized patients is feasible but currently limited by noise artifacts compared to traditional telemetry, though it may detect some arrhythmias missed by standard methods.

Limitations

Small feasibility sample size (n=11 instead of proposed 25 because the device was withdrawn from the market)
Single-center study, limiting generalizability

Implication

Should not replace inpatient telemetry yet; leaves open whether noise-reduced patch CCRM can catch events traditional systems miss.

Abstract

Research on traditional cardiac telemetry demonstrates that excessive alarms are related to lead failures and noise-related interruptions. Patch-based continuous cardiac rhythm monitoring (CCRM) has emerged in outpatient ambulatory monitoring situations as a means to improve recording fidelity. In this study, patients hospitalized but not in the intensive care unit were simultaneously monitored via telemetry in parallel with the use of the Vital Signs Patch™ (VSP) CCRM system (LifeWatch Services, Rosemont, IL, USA), applying standardized monitoring and notifications provided by an off-site central monitoring unit (CMU). Among 11 patients (55% male; age: 66.8 ± 12.5 years), there were 42 CMU detections and 98 VSP detections. The VSP device was successfully applied by nursing with connectivity established in all 11 patients (100%). There were no VSP device-related adverse events or skin eruptions during the study. The CMU agreed with 59 (60%) of 98 VSP detections. Among those detections marked by disagreement 30 (77%) of 39 VSP detections were related to clinically meaningful arrhythmias (atrial: n = 9; ventricular: n = 7; brady-: n = 14) undetected by VSP due to noise. In two patients (18%), there were four clinically meaningful atrial fibrillation detections not recorded by the CMU. In conclusion, patch-based CCRM requires further development and review to replace traditional cardiac telemetry monitoring but could evolve into an appropriate method to detect clinically meaningful events missed by traditional methods if noise issues can be mitigated.