Can Patients Self-Acquire Diagnostic Quality Electrocardiograms for Acute Coronary Syndrome?: A Feasibility Study of Remote Cardiac Monitoring and Symptom Reporting

BACKGROUND: Acute coronary syndrome (ACS), one of the leading causes of death in the United States, requires rapid evaluation, diagnosis, and therapy initiation to reduce morbidity and mortality. Delayed care-seeking remains the primary reason that patients with ACS fail to receive timely treatment. Remote cardiac monitoring may supplement individuals' symptom appraisal and reduce delays. However, ACS patients' ability to remotely self-acquire an electrocardiogram (ECG) is unknown. OBJECTIVE: To evaluate whether hospitalized patients with suspected ACS can acquire a derived 12-lead (L) ECG using a KardiaMobile 6L remote cardiac monitoring device. METHODS: Participants were hospitalized patients aged >21 years at high risk for ischemic events (ACS diagnosis with a History, ECG, Age, Risk factors, and Troponin score >3, ie, moderate to high risk for cardiac event) who owned an iPhone. Research assistants trained participants to use mobile applications to (1) acquire an ECG at least once daily during their hospitalization and (2) document symptoms using the ACS Symptom Checklist. A cardiologist blinded to clinical data compared ischemic markers (eg, ST-elevation, ST-depression, and T-wave inversion) on KardiaMobile 6L derived 12L ECGs with hospital-based 12L ECGs. RESULTS: We enrolled 30 participants (mean age 64.2 ± 11.2 years, 30.0% female, 73.3% White). All participants acquired at least 1 remote cardiac device ECG. A cardiologist classified 88.9% as clean and interpretable; the remainder were noisy but interpretable. Ischemic markers were present on both patient-acquired and hospital-based ECGs. All participants submitted at least 1 Symptom Checklist. CONCLUSIONS: Hospitalized patients with suspected ACS can self-acquire a 6L ECG and self-report symptoms, and derived 12L ECGs can detect signs of ischemia (eg, ST-elevation). Future studies should examine ECG acquisition and transmission from home and remote evaluation for early ischemia detection and response.