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Practice Guideline
. 2021 Mar;26(2):e12795.
doi: 10.1111/anec.12795. Epub 2021 Jan 29.

2021 ISHNE/ HRS/ EHRA/ APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society

Niraj Varma  1 , Iwona Cygankiewicz  2 , Mintu Turakhia  3 , Hein Heidbuchel  4 , Yufeng Hu  5 , Lin Yee Chen  6 , Jean-Philippe Couderc  7 , Edmond M Cronin  8 , Jerry D Estep  1 , Lars Grieten  9 , Deirdre A Lane  10 , Reena Mehra  1 , Alex Page  7 , Rod Passman  11 , Jonathan Piccini  12 , Ewa Piotrowicz  13 , Ryszard Piotrowicz  13 , Pyotr G Platonov  14 , Antonio Luiz Ribeiro  15 , Robert E Rich  1 , Andrea M Russo  16 , David Slotwiner  17 , Jonathan S Steinberg  7 , Emma Svennberg  18
Affiliations
Practice Guideline

2021 ISHNE/ HRS/ EHRA/ APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society

Niraj Varma et al. Ann Noninvasive Electrocardiol. 2021 Mar.

Abstract

This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/ Heart Rhythm Society/ European Heart Rhythm Association/ Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.

Keywords: arrhythmias; atrial fibrillation; comorbidities; digital medicine; heart rhythm; mHealth.

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Figures

Figure 1
Figure 1
Application of digital health technologies in arrhythmias (Many of these sectors are interconnected).
Figure 2
Figure 2
mHealth devices for arrhythmia monitoring according to indications. Traditional wearable monitors are used for defined, short periods of time. Advantages are continuous monitoring and ability to use multiple leads that may be important for arrhythmia differentiation. These have been used historically for evaluation of palpitations, syncope, and defining QRS morphology. mHealth extends monitoring time indefinitely, to be defined by the user, and to the possibility of monitoring other parameters simultaneously with the ECG and linking to machine learning. Typically, mHealth utilizes single‐channel ECG or derived heart rate, and discontinuous monitoring. AF—atrial fibrillation, BP—blood pressure, BrS—Brugada syndrome, HF—heart failure, HR—heart rate, ILR—implantable loop recorder, LQT—long QT.
Figure 3
Figure 3
ECG mobile applications. Left—fingertip recordings; Right—card pressed to the chest.
Figure 4
Figure 4
Apple Watch.
Figure 5
Figure 5
mHealth and AF. Applications include screening for AF in general or high‐risk populations, managing comorbidities and lifestyles important for prevention and control, as well as managing treatment of known AF. AF—atrial fibrillation, DM—diabetes, HTN—hypertension, NSR—normal sinus rhythm.
Figure 6
Figure 6
Digital applications can integrate patient relayed information of sensor and clinical information with automatic remote analysis, but also permit patients to receive advice and treatment adjustments from physicians directly.
Figure 7
Figure 7
Connectivity and Questions. Multiple levels of cooperation among a variety of stakeholders are needed to capitalize fully on the vast potential of mHealth, but many questions remain unanswered. Healthy consumers (increasing) predominate among mhealth users. Only a minority of patients are prescribed these digital tools. Potential health benefits of mHealth may be realized when manufacturer participates with clinic for validation in defined disease states. Parties responsible for data control—and therby predictive analytics—need to be defined. Ultimately, the payor and physician need to be convinced of benefits before digital tools are firmly embedded in clinical practice.
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