The Diagnostic and Clinical Utility of Extended ECG Monitoring for Risk Stratification in Virtual Cardiac Rehabilitation

ABSTRACT

Background: The COVID-19 pandemic resulted in a necessary transition from centre-based cardiac rehabilitation to virtual cardiac rehabilitation (VCR) to continue delivery of effective and high-quality care. To enhance risk stratification, an extended duration electrocardiographic (ECG) patch monitor was added to the intake protocol for patient's enrolled in a virtual only cardiac rehabilitation program. Method(s) The objectives of this study were to assess the diagnostic yield of extended ECG patch monitoring (DR400 3-channel monitor, NorthEast Monitoring, Inc., Maynard MA;5-day duration) and the effect on clinical management in a tertiary cardiac rehabilitation population. A retrospective analysis of consecutive patients enrolled in VCR at a single site was performed. All patients who were enrolled in VCR and underwent extended ECG patch monitoring as part of their intake assessment were included. Risk was defined by the AACVPR 2020 risk categorization. Extended patch monitor diagnoses were reviewed for accuracy and classified as a new or known diagnosis. Impact on clinical management was defined as any medication adjustment, procedure requirement/recommendation, or exercise prescription modification. Patient characteristics, cardiac testing results, and risk categorization were described using basic descriptive methods including frequency distributions, and means and SDs. Result(s) Two-hundred and sixty-nine patients [mean age 61.7 years (SD 12.0) 63% male] out of 286 patients enrolled in VCR between August 13, 2020 and October 26, 2021 met inclusion criteria (Table 1). Two percent of patients were classified as high risk, 41% as moderate risk, and 57% as low risk. Thirty (11%) new arrythmia diagnoses were obtained from extended ECG patch monitoring. Diagnoses included one patient with atrial flutter and high-grade AV block, one patient with paroxysmal atrial fibrillation, and 28 patients with non-sustained ventricular tachycardia (NSVT) (4-48 beats;11% symptomatic). Fifty-seven percent (n=17) of diagnoses were evident on the first 24-hours of monitoring and 43% (n=13) required extended duration monitoring for diagnosis. Thirteen patients with known atrial fibrillation or flutter were noted to have this arrhythmia present. Of those with a new diagnosis, 6 (20%) resulted in a change in clinical management (Figure 1). Conclusion(s) Extended duration ECG patch monitoring appears diagnostically and clinically useful when utilized as a component of intake evaluation for VCR. Furthermore, added benefit of extended (i.e., 5 day) versus the initial 24-hour period of monitoring was observed. Further evaluation is required to determine the optimal duration and clinical utility of asynchronous ECG monitoring as a component of risk stratification for VCR programs.