State of the art of mobile health technologies use in clinical arrhythmia care

Abstract

The rapid growth in consumer-facing mobile and sensor technologies has created tremendous opportunities for patient-driven personalized health management. The diagnosis and management of cardiac arrhythmias are particularly well suited to benefit from these easily accessible consumer health technologies. In particular, smartphone-based and wrist-worn wearable electrocardiogram (ECG) and photoplethysmography (PPG) technology can facilitate relatively inexpensive, long-term rhythm monitoring. Here we review the practical utility of the currently available and emerging mobile health technologies relevant to cardiac arrhythmia care. We discuss the applications of these tools, which vary with respect to diagnostic performance, target populations, and indications. We also highlight that requirements for successful integration into clinical practice require adaptations to regulatory approval, data management, electronic medical record integration, quality oversight, and efforts to minimize the additional burden to health care professionals.

Fig. 1. Cardiac rate and rhythm monitoring sensor technologies.

We can broadly divide the cardiac monitoring technologies into electrical activity sensors which include electrocardiograms, and non-electrical cardiac activity sensors which essentially sense the mechanical impulse generated by the heart either centrally or peripherally. ECG electrocardiogram, PPG photoplethysmography.

Fig. 2. Incorporating mHealth technologies in AF management.

Mobile technologies can aid the clinicians caring for AF patients in multiple ways including burden assessment, symptom correlation, treatment response monitoring, and drug loading. AF atrial fibrillation.

Fig. 3. Role of mHealth technologies in the prevention and management of sudden cardiac arrest.

This figure illustrates the various ways in which mHealth technology can be utilized in the prevention and management of sudden cardiac arrest. It showcases the use of ML and AI analysis to identify novel patterns, the application of wearable technologies and bio-sensor data for early detection, and the enhancement of response time and quality of resuscitation through innovative methods such as citizen-responder systems and drone delivery of AEDs. ICD implantable cardioverter defibrillator, CPR cardiopulmonary resuscitation, AED automated external defibrillator.

Fig. 4. Enhancing clinical trials with mobile technologies.

Integrating mobile technologies in clinical trials offers a range of benefits, from enabling frequent monitoring to increasing access for remote populations. These technologies facilitate quick data transfer, enhance patient safety through rapid alert notifications, and reduce costs associated with transportation and device expenses. Additionally, centralized data monitoring ensures uniform quality control and supports the globalization of clinical trials.

Fig. 5. Limitations and barriers to wide clinical adoption of digital health technologies.

The integration of digital health technologies in the care of arrhythmia patients presents a myriad of challenges across different stakeholders. Healthcare providers face hurdles such as a lack of understanding of device functionalities, limited confidence in their use, and concerns about liability issues. For consumers and patients, challenges include varying levels of digital literacy, socioeconomic disparities affecting access, potential anxiety from test results, and the need for additional testing. Operational challenges encompass inadequate investment in workflows to accommodate the increasing number of devices, cybersecurity risks, data storage issues, and the integration of device data into electronic medical records. Moreover, the lack of clear guidance on legal responsibilities and reimbursement processes further complicates the adoption of these technologies in the healthcare landscape. EMR electronic medical record.

Fig. 6. Future of mHealth driven arrhythmia care.

Innovation and development considerations for the different stakeholders. The figure illustrates a comprehensive roadmap for advancing mHealth technology in arrhythmia care through collaboration among different stakeholders. It emphasizes the importance of setting standards for cross-platform consistency, engaging with clinicians, researchers, and patients to address specific technological needs, providing clear labeling of clinical utility, welcoming mobile technologies in clinical trials, and investing in education and infrastructure to support data integration and management. The roadmap also highlights the significance of developing evidence-based strategies, ensuring regulatory compliance, and involving patients in decision-making processes to drive innovation in arrhythmia care. RPM remote patient monitoring.