Interpretation of Electrocardiogram Heartbeat by CNN and GRU.

The diagnosis of electrocardiogram (ECG) is extremely onerous and inefficient, so it is necessary to use a computer-aided diagnosis of ECG signals. However, it is still a challenging problem to design high-accuracy ECG algorithms suitable for the medical field. In this paper, a classification method is proposed to classify ECG signals. Firstly, wavelet transform is used to denoise the original data, and data enhancement technology is used to overcome the problem of an unbalanced dataset. Secondly, an integrated convolutional neural network (CNN) and gated recurrent unit (GRU) classifier is proposed. The proposed network consists of a convolution layer, followed by 6 local feature extraction modules (LFEM), a GRU, and a Dense layer and a Softmax layer. Finally, the processed data were input into the CNN-GRU network into five categories: nonectopic beats, supraventricular ectopic beats, ventricular ectopic beats, fusion beats, and unknown beats. The MIT-BIH arrhythmia database was used to evaluate the approach, and the average sensitivity, accuracy, and F1-score of the network for 5 types of ECG were 99.33%, 99.61%, and 99.42%. The evaluation criteria of the proposed method are superior to other state-of-the-art methods, and this model can be applied to wearable devices to achieve high-precision monitoring of ECG.

Impact of COVID-19 on the incidence of cardiac arrhythmias in implantable cardioverter defibrillator recipients followed by remote monitoring.

BACKGROUND: The coronavirus disease 2019 (COVID-19) has been a fast-growing worldwide pandemic. AIMS: We aimed to investigate the incidence of cardiac arrhythmias among a large French cohort of implantable cardioverter defibrillator recipients over the first 5 months of 2020. METHODS: Five thousand nine hundred and fifty-four implantable cardioverter defibrillator recipients were followed by remote monitoring during the COVID-19 period (from 01 January to 31 May 2020). Data were obtained from automated remote follow-up of implantable cardioverter defibrillators utilizing the Implicity® platform. For all patients, the type of arrhythmia (atrial fibrillation, ventricular tachycardia or ventricular fibrillation), the number of ventricular arrhythmia episodes and the type of implantable cardioverter defibrillator-delivered therapy were recorded. RESULTS: A total of 472 (7.9%) patients presented 4917 ventricular arrhythmia events. An increase in ventricular arrhythmia incidence was observed after the first COVID-19 case in France, and especially during weeks #10 and #11, at the time of major governmental measures, with an increase in the incidence of antitachycardia pacing delivered therapy. During the 11 weeks before the lockdown order, the curve of the percentage of live-stream television coverage of COVID-19 information matched the ventricular arrhythmia incidence. During the lockdown, the incidence of ventricular arrhythmia decreased significantly compared with baseline (0.05±0.7 vs. 0.09±1.2 episodes per patient per week, respectively; P<0.001). Importantly, no correlation was observed between ventricular arrhythmia incidence and the curve of COVID-19 incidence. No changes were observed regarding atrial fibrillation/atrial tachycardia episodes over time. CONCLUSIONS: An increase in ventricular arrhythmia incidence was observed in the 2 weeks before the lockdown order, at the time of major governmental measures. Ventricular arrhythmia incidence decreased dramatically during the lockdown.

Gain in real-world cardiac resynchronization therapy efficacy with SyncAV dynamic optimization: Heart failure hospitalizations and costs.

BACKGROUND: SyncAV, a device-based cardiac resynchronization therapy (CRT) algorithm, promotes electrical optimization by dynamically adjusting atrioventricular intervals. OBJECTIVE: The purpose of this study was to evaluate the impact of SyncAV on heart failure hospitalizations (HFHs) and related costs in a real-world CRT cohort. METHODS: Patients with SyncAV-capable CRT devices followed by remote monitoring and enrolled in Medicare fee-for-service for at least 1 year preimplant and up to 2 years postimplant were studied. Patients with SyncAV OFF were 4:1 matched to those with SyncAV ON on preimplant HFH rate, demographics, comorbidities, disease etiology, and left bundle branch block. HFHs were determined from the primary diagnosis of inpatient hospitalizations, and the cost for each event was the sum of Medicare, supplemental insurance, and patient payment. RESULTS: After 4:1 propensity score matching, 3630 patients were studied (mean age 75 ± 8 years; 1386 [38%] female), including 726 (25%) patients with SyncAV ON. The pre-CRT HFH rate was 0.338 HFH events per patient-year. Overall, CRT diminished the HFH rate to 0.204 events per patient-year (P < .001). SyncAV elicited a larger reduction in HFH rate (SyncAV ON: hazard ratio [HR] 0.52; 95% confidence interval [CI] 0.41-0.66; P < .001 and SyncAV OFF: HR 0.68; 95% CI 0.59-0.77; P < .001). After 2 years, the HFH rate was lower in the SyncAV ON group than in the SyncAV OFF group (0.143 HFHs per patient-year vs 0.193 HFHs per patient-year; HR 0.70; 95% CI 0.55-0.89; P = .003) and fewer HFHs were followed by 30-day HFH readmissions (4.41% vs 7.68%; P = .003) and 30-day all-cause hospital readmissions (7.04% vs 10.01%; P = .010). The total 2-year HFH-associated costs per patient were lower with SyncAV ON (difference $1135; 90% CI $93-$2109; P = .038). CONCLUSION: This large, real-world, propensity score-matched study demonstrates that SyncAV CRT is associated with significantly reduced HFHs and associated costs, incremental to standard CRT.

The Promise of Remote Patient Monitoring: Lessons Learned During the COVID-19 Surge in New York City.

The coronavirus pandemic catalyzed a digital health transformation, placing renewed focus on using remote monitoring technologies to care for patients outside of hospitals. At NewYork-Presbyterian, the authors expanded remote monitoring infrastructure and developed a COVID-19 Hypoxia Monitoring program-a critical means through which discharged COVID-19 patients were followed and assessed, enabling the organization to maximize inpatient capacity at a time of acute bed shortage. The pandemic tested existing remote monitoring efforts, revealing numerous operating challenges including device management, centralized escalation protocols, and health equity concerns. The continuation of these programs required addressing these concerns while expanding monitoring efforts in ambulatory and transitions of care settings. Building on these experiences, this article offers insights and strategies for implementing remote monitoring programs at scale and improving the sustainability of these efforts. As virtual care becomes a patient expectation, the authors hope hospitals recognize the promise that remote monitoring holds in reenvisioning health care delivery.

Wearable Wireless Body Area Networks for Medical Applications.

In recent times, there has been a significant growth in networks known as the wireless body area networks (WBANs). A WBAN connects distributed nodes throughout the human body, which can be placed on the skin, under the skin, or on clothing and can use the human body's electromagnetic waves. An approach to reduce the size of different telecommunication equipment is constantly being sought; this allows these devices to be closer to the body or even glued and embedded within the skin without making the user feel uncomfortable or posing as a danger for the user. These networks promise new medical applications; however, these are always based on the freedom of movement and the comfort they offer. Among the advantages of these networks is that they can significantly increase user's quality of life. For example, a person can carry a WBAN with built-in sensors that calculate the user's heart rate at any given time and send these data over the internet to user's doctor. This study provides a systematic review of WBAN, describing the applications and trends that have been developed with this type of network and, in addition, the protocols and standards that must be considered.

Early prognostication of COVID-19 to guide hospitalisation versus outpatient monitoring using a point-of-test risk prediction score.

INTRODUCTION: Risk factors of adverse outcomes in COVID-19 are defined but stratification of mortality using non-laboratory measured scores, particularly at the time of prehospital SARS-CoV-2 testing, is lacking. METHODS: Multivariate regression with bootstrapping was used to identify independent mortality predictors in patients admitted to an acute hospital with a confirmed diagnosis of COVID-19. Predictions were externally validated in a large random sample of the ISARIC cohort (N=14 231) and a smaller cohort from Aintree (N=290). RESULTS: 983 patients (median age 70, IQR 53-83; in-hospital mortality 29.9%) were recruited over an 11-week study period. Through sequential modelling, a five-predictor score termed SOARS (SpO2, Obesity, Age, Respiratory rate, Stroke history) was developed to correlate COVID-19 severity across low, moderate and high strata of mortality risk. The score discriminated well for in-hospital death, with area under the receiver operating characteristic values of 0.82, 0.80 and 0.74 in the derivation, Aintree and ISARIC validation cohorts, respectively. Its predictive accuracy (calibration) in both external cohorts was consistently higher in patients with milder disease (SOARS 0-1), the same individuals who could be identified for safe outpatient monitoring. Prediction of a non-fatal outcome in this group was accompanied by high score sensitivity (99.2%) and negative predictive value (95.9%). CONCLUSION: The SOARS score uses constitutive and readily assessed individual characteristics to predict the risk of COVID-19 death. Deployment of the score could potentially inform clinical triage in preadmission settings where expedient and reliable decision-making is key. The resurgence of SARS-CoV-2 transmission provides an opportunity to further validate and update its performance.

Indications and yield of ambulatory EEG recordings.

To study the yield of prolonged ambulatory electroencephalogram (aEEG). A retrospective chart review of all patients who underwent aEEG studies between 2013 and 2017 was performed. Reasons for aEEG were classified into five categories: detection of interictal epileptiform discharges (IEDs), capturing clinical events, detection of unrecognized seizures, monitoring IEDs during treatment, and unclassifiable. Ambulatory EEG reports were reviewed to evaluate whether the study answered the clinical question. A total of 1,264 patients were included. Forty studies were excluded for incomplete data and 234 for being a repeat study. The average number of recording days was 1.57 ± 0.73. Based on initial clinical evaluation, patients carried the following presumptive diagnosis: 61% epilepsy, 11% single unprovoked or acute symptomatic seizure and 28% non-epileptic paroxysmal events (PEs). Overall, focal IEDs were seen in 16.1% of studies, generalized IEDs in 10.8%, focal seizures in 4.1%, and generalized seizures in 1.9%. The most frequent reason for ordering aEEG was to detect IEDs for diagnostic purposes (48.1%). For this indication, additional information was provided by the aEEG in 19.1% of cases (58.6% focal IEDs, 33.5% generalized IEDs, 7.9% seizures without IEDs). Ambulatory EEG was ordered with the intent to capture and characterize clinical events in 18.9%, mostly in patients who reported daily or weekly events. In these, aEEG captured either epileptic seizures or PEs in 102 (42.7%) of the studies (83.3% PEs, 16.7% epileptic seizures). Ambulatory EEG was ordered to evaluate unrecognized seizures in 17.8% of patients, and electrographic seizures were identified in 13.3% of these studies. The yield of aEEG varies based on the indication for the study. Ambulatory EEG can be a useful tool for recording IEDs in the outpatient setting and in a select group of patients to capture clinical events or unrecognized seizures.

Reducing cost and time to diagnosis and treatment of obstructive sleep apnea using ambulatory sleep study: a Singapore sleep centre experience.

PURPOSE: The current gold standard for diagnosis of obstructive sleep apnea (OSA) is overnight in laboratory polysomnography (PSG). However, PSGs are expensive, labor-intensive, and have long wait times. An ambulatory sleep study device, the WatchPAT, has been shown to have high correlation for sleep indices measured compared with PSG (AASM, 2016). Use of the WatchPAT could potentially lead to shorter waiting times and earlier diagnosis of OSA (Lancet Resp Med 3:310-8, 2015). Our study aimed to investigate if WatchPAT reduces time to diagnosis and treatment of OSA in a tertiary healthcare setting. A secondary aim was to investigate the cost-benefit of an ambulatory sleep study. METHODS: All patients who underwent diagnostic sleep studies in a single tertiary institution from 2014 to 2017 were retrospectively reviewed. Baseline characteristics and time from ordering of sleep study to prescription of continuous positive airway pressure were recorded. Data were categorized into two groups by type of diagnostic sleep study, PSG, and WatchPAT. The time to treatment and cost for diagnosis of OSA were compared between groups with the Paired T test/Wilcoxon signed-rank test. RESULTS: Of 1898 patients who had diagnostic sleep studies over a 4-year period, 1660 patients (88%) underwent PSG and 238 patients (12%) underwent WatchPAT. Patients in the WatchPAT group had a shorter time to diagnosis (21 days versus 79.8 days, p < 0.001) and treatment (46.3 days versus 118.4 days, p < 0.001) compared to the PSG group. Cost-benefit calculation showed that this earlier treatment led to cost-saving of US $1179.50 per patient. CONCLUSION: An ambulatory sleep study is an option for earlier access to diagnosis and treatment of OSA with the potential of considerable cost savings.

The effect of in-lab polysomnography and home sleep polygraphy on sleep position.

PURPOSE: Little is known regarding the influence of in-laboratory polysomnography (PSG) equipment on sleep position, especially on the prevalence of supine positioning, which in many cases may lead to a more severe sleep apnea diagnosis. The aim of this study was to assess the percentage of supine sleep during an in-laboratory PSG compared to that seen during a home sleep apnea test (HSAT). METHODS: This was a retrospective cohort study comparing in-laboratory PSG and HSAT using a peripheral arterial tone (PAT) technology device. RESULTS: Of 445 PSG and 416 HSAT studies analyzed, there was no significant difference in the proportion of supine sleep time between PSG (44%) and HSAT (45%, p = 0.53). Analysis of the differences in sleep position (supine versus non-supine), analyzed by sex, BMI (≥ 30 kg/m2 versus < 30 kg/m2), and age (≥ 60 years versus < 60 years), was significant only for women, who had more supine sleep during HSAT at 61 ± 24% than during PSG at 45 ± 26% (p < 0.001). CONCLUSION: Overall there was no difference in the percentage of supine sleep when comparing in-laboratory PSG to HSAT. However, women had more supine sleep with HSAT than with PSG.

Remote FEV1 Monitoring in Asthma Patients: A Pilot Study.

Forced expiratory volume in one second (FEV1 ) is a critical parameter for the assessment of lung function for both clinical care and research in patients with asthma. While asthma is defined by variable airflow obstruction, FEV1 is typically assessed during clinic visits. Mobile spirometry (mSpirometry) allows more frequent measurements of FEV1 , resulting in a more continuous assessment of lung function over time and its variability. Twelve patients with moderate asthma were recruited in a single-center study and were instructed to perform pulmonary function tests at home twice daily for 28 days and weekly in the clinic. Daily and mean subject compliances were summarized. The agreement between clinic and mobile FEV1 was assessed using correlation and Bland-Altman analyses. The test-retest reliability for clinic and mSpirometry was assessed by interclass correlation coefficient (ICC). Simulation was conducted to explore if mSpirometry could improve statistical power over clinic counterparts. The mean subject compliance with mSpirometry was 70% for twice-daily and 85% for at least once-daily. The mSpirometry FEV1 were highly correlated and agreed with clinic ones from the same morning (r = 0.993) and the same afternoon (r = 0.988) with smaller mean difference for the afternoon (0.0019 L) than morning (0.0126 L) measurements. The test-retest reliability of mobile (ICC = 0.932) and clinic (ICC = 0.942) spirometry were comparable. Our simulation analysis indicated greater power using dense mSpirometry than sparse clinic measurements. Overall, we have demonstrated good compliance for repeated at-home mSpirometry, high agreement and comparable test-retest reliability with clinic counterparts, greater statistical power, suggesting a potential for use in asthma clinical research.

Seizure symptoms and ambulatory EEG findings: incidence of epileptiform discharges.

AIMS: Ambulatory video-EEG monitoring has been utilized as a cost-effective alternative to inpatient video-EEG monitoring for non-surgical diagnostic evaluation of symptoms suggestive of epileptic seizures. We aimed to assess incidence of epileptiform discharges in ambulatory video-EEG recordings according to seizure symptom history obtained during clinical evaluation. METHODS: This was a retrospective cohort study. We queried seizure symptoms from 9,221 consecutive ambulatory video-EEG studies in 35 states over one calendar year. We assessed incidence of epileptiform discharges for each symptom, including symptoms that conformed to a category heading, even if not included in the ILAE 2017 symptom list. We report incidences, odds ratios, and corresponding p values using Fisher's exact test and univariate logistic regression. We applied multivariable logistic regression to generate odds ratios for the six symptom categories that are controlled for the presence of other symptoms. RESULTS: History that included motor symptoms (OR=1.53) or automatisms (OR=1.42) was associated with increased occurrence of epileptiform discharges, whereas history of sensory symptoms (OR=0.76) predicted lack of epileptiform discharges. Patient-reported symptoms that were associated with increased occurrence of epileptiform discharges included lip-smacking, moaning, verbal automatism, aggression, eye-blinking, déjà vu, muscle pain, urinary incontinence, choking and jerking. On the other hand, auditory hallucination memory deficits, lightheadedness, syncope, giddiness, fibromyalgia and chronic pain predicted absence of epileptiform discharges. The majority of epileptiform discharges consisted only of interictal sharp waves or spikes. CONCLUSIONS: Our study shows that the use of ILAE 2017 symptom categories may help guide ambulatory video-EEG studies.

High-resolution Manometry can Characterize Esophagogastric Junction Morphology and Predict Esophageal Reflux Burden.

BACKGROUND: High-resolution manometry (HRM) allows characterization of esophagogastric junction (EGJ) morphology and identification of hiatus hernia using novel software tools. AIM: The main purpose of this study was to determine the impact of HRM-based EGJ and lower esophageal sphincter (LES) metrics in predicting abnormal reflux burden. METHODS: Total, upright, and supine acid exposure times (AETs) were extracted from ambulatory reflux monitoring performed off therapy in 482 patients (54.2±0.6 y, 63.3% female patients). EGJ morphology was categorized into type 1 (superimposed LES and crural diaphragm), type 2 (<3 cm separation between LES and crural diaphragm), and type 3 (≥3 cm separation). EGJ-contractile integral (EGJ-CI) and distal contractile integral (DCI) were extracted. Conventional EGJ and LES metrics, including basal and end-expiratory LES pressure, and LES length were also analyzed. Univariate and multivariate analyses were performed to determine the value of HRM parameters in predicting abnormal esophageal reflux burden. RESULTS: Type 1 EGJ was noted in 298 (61.8%), type 2 in 125 (25.9%), and type 3 in 59 (12.2%); EGJ-CI and mean DCI were lower with abnormal EGJ morphology. Mean AET, and proportions with abnormal AET increased as EGJ morphology became progressively disrupted (P<0.0001 across groups); low EGJ-CI was additive in predicting abnormal AET. All HRM parameters assessed (EGJ morphology, EGJ-CI, and DCI) were independent predictors for abnormal AET (P≤0.02). Conventional LES and EGJ metrics were also associated with abnormal reflux burden, but intra-abdominal LES length, and hiatus hernia size did not independently predict total AET. CONCLUSIONS: HRM-based EGJ morphology and EGJ barrier assessment independently predict esophageal reflux burden.

Effectiveness of telemonitoring-enhanced support over structured telephone support in reducing heart failure-related healthcare utilization in a multi-ethnic Asian setting.

AIMS: Our study aimed to compare the effectiveness of telemonitoring over structured telephone support in reducing heart failure-related healthcare utilization. METHODS: This was a non-randomised controlled study comparing 150 recently discharged heart failure patients enrolled into telemonitoring and 55 patients who only received structured telephone support after rejecting telemonitoring. Patient activation, knowledge and self-management levels were measured at baseline and the one year upon programme completion using the Patient Activation Measure, the Dutch Heart Failure Knowledge Scale and the Self-Care of Heart Failure Index respectively. Differences in heart failure-related and all-cause hospitalization rates, total bed days and mortality rates at 180 days and at one year, knowledge and self-management scores and total cost of care between groups at one year were analysed. RESULTS: Average age of telemonitoring was 57.9 years and 63.9 years for structured telephone support. Significant difference in adjusted 180-day all-cause bed days (telemonitoring: five days versus structured telephone support: 9.8 days), heart failure-related bed days (telemonitoring: 1.2 days versus structured telephone support: six days) and adjusted one-year heart failure-related bed days (telemonitoring: 2.2 days versus structured telephone support: 6.6 days) were observed. Telemonitoring was associated with reduced all-cause one-year mortality (hazard ratio 0.32, p = 0.02). Estimated mean maintenance and confidence scores were significantly higher in the telemonitoring group at one year. No differences in all-cause and HF-related readmission rates and knowledge levels were observed. The one-year total cost of care was predicted to be Singapore dollars (SG$) 2774.4 lower (p = 0.07) in telemonitoring. CONCLUSION: In conclusion, telemonitoring was associated with lower all-cause and heart failure-related total bed days at 180 days, lower heart failure-related total bed days and total cost of care at one year as compared with structured telephone support.

The Association Between Negative and Positive Affect and Alcohol Use: An Ambulatory Study.

OBJECTIVE: Negative and positive affect are proposed to play a crucial role in alcohol use and the development of alcohol use disorder. Results from ambulatory studies that measure momentary affect and subsequent alcohol use have been mixed, particularly regarding negative affect. We attempted to identify within-person moderators (i.e., time between assessments, prior blood alcohol content) that might explain mixed results. METHOD: We examined the association between self-reported affect and an objective measure of alcohol consumption (measured via a transdermal ankle bracelet) in a sample of heavy social drinkers across 7 days of ambulatory assessment. RESULTS: Our results showed that negative affect was negatively related to later drinking, whereas positive affect was positively related to later drinking. The results showed that these effects were stronger for amount consumed when affect was assessed closer rather than farther in time. CONCLUSIONS: These findings are important for understanding affect as an antecedent to alcohol use, which may ultimately have implications for the development of alcohol use disorder.

Associations between occupational relative aerobic workload and resting blood pressure among different age groups: a cross-sectional analysis in the DPhacto study.

OBJECTIVE: High levels of occupational physical activity (OPA) increase heart rate, blood pressure (BP) and the risk of hypertension. Older workers may be more vulnerable to high levels of OPA due to age-related degeneration of the cardiovascular system and cardiorespiratory fitness. This study investigates the association of relative aerobic workload (RAW) with resting BP and examines if this relation is moderated by age. DESIGN: Cross-sectional epidemiological study. SETTING: Data were collected among employees of 15 Danish companies in the cleaning, manufacturing and transport sectors. PARTICIPANTS: 2107 employees were invited for participation, of these 1087 accepted and 562 (42% female and 4% non-Westerns) were included in the analysis based on the criteria of being non-pregnant, no allergy to bandages, sufficient amount of heart rate data corresponding to ≥4 work hours per workday or 75% of average work hours, and no missing outcome and confounder values. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was BP. RESULTS: Heart rate reserve was estimated from ambulatory 24-hour heart rate measures covering 2.5 workdays per participant (SD 1.0 day). Age significantly moderated the association between RAW and BP. Mean intensity and duration of high RAW (≥30% heart rate reserve) showed positive associations with diastolic BP and negative associations with pulse pressure (PP) among participants ≥47 years old. Tendencies towards negative associations between RAW and BP were seen among participants <47 years old. CONCLUSIONS: Mean intensity and duration of RAW increased diastolic BP among participants ≥47 years old. Negative associations with PP may be due to healthy worker selection bias. Prevention of hypertension should consider reductions in RAW for ageing workers.

Chronic kidney disease monitoring in Australian general practice.

BACKGROUND AND OBJECTIVES: Kidney Health Australia recommends regular monitoring of patients with chronic kidney disease (CKD) to reduce progression and prevent complications such as cardiovascular disease. The objective of this study was to examine how practice aligns with the recommendations in Kidney Health Australia's CKD guidelines. METHOD: Australian general practice data from the NPS MedicineWise MedicineInsight program (1 January 2013 - 1 June 2016) for 19,712 adults with laboratory evidence of stage 3 CKD were analysed. Complete monitoring in these individuals was defined as having at least one recorded assessment of blood pressure, urine albumin-to-creatinine ratio, estimated glomerular filtration rate and serum lipids over an 18-month period. RESULTS: Complete monitoring was performed for 25% of the cohort; 54.9% among patients with concomitant diabetes and 14.1% among patients without diabetes. Patients with diabetes, hypertension and a documented diagnosis of CKD were more likely to have complete monitoring. DISCUSSION: There is room for improvement in monitoring of patients with stage 3 CKD, particularly for albuminuria, which was monitored in fewer than 50% of these patients.

Use, utility and methods of telehealth for patients with COPD in England and Wales: a healthcare provider survey.

Introduction: Although the effectiveness of domiciliary monitoring (telehealth) to improve outcomes in chronic obstructive pulmonary disease (COPD) is controversial, it is being used in the National Health Service (NHS). Aim: To explore the use of teleheath for COPD across England and Wales, to assess the perceptions of clinicians employing telehealth in COPD and to summarise the techniques that have been used by healthcare providers to personalise alarm limits for patients with COPD enrolled in telehealth programmes. Methods: A cross-sectional survey consisting of 14 questions was sent to 230 COPD community services in England and Wales. Questions were designed to cover five aspects of telehealth in COPD: purpose of use, equipment type, clinician perceptions, variables monitored and personalisation of alarm limits. Results: 65 participants completed the survey from 52 different NHS Trusts. 46% of Trusts had used telehealth for COPD, and currently, 31% still provided telehealth services to patients with COPD. Telehealth is most commonly used for baseline monitoring and to allow early detection of exacerbations, with 54% believing it to be effective. The three most commonly monitored variables were oxygen saturation, heart rate and breathlessness. A variety of methods were used to set alarm limits with the majority of respondents believing that at least 40% of alarms were false. Conclusion: Around one-third of responded community COPD services are using telehealth, believing it to be effective without robust evidence, with a variety of variables monitored, a variety of hardware and varying techniques to set alarm limits with high false alarm frequencies.