ECG Monitors

Elizabeth Briand

As medical technology continues to evolve, in-home devices to monitor and detect health conditions are becoming more available and affordable for consumers. That includes portable ECG systems, which can be found by the dozens at pharmacies and online, for as little as $99. Wearable devices such as Apple Watches and Fitbits are also tracking heart rates and irregular heart rhythms.

“A lot of people are using these devices and physicians are recommending them,” said Craig Beavers, PharmD, adjunct associate professor at the University of Kentucky College of Pharmacy. “I equate them to blood pressure cuffs to monitor disease state. They’re a tool to help people understand their conditions.”

Effective uses

At-home ECGs can be used for a variety of conditions and concerns, including monitoring of heart rate and rhythm, assessing risks for a worsening of heart conditions, and helping in the detection of issues such as AFib and long QT syndrome. They can be used to monitor heart rates and rhythms during daily exercise and during pregnancies.

While these products promise a wealth of data and health-related benefits, they may not be as reliable as suggested. “There are chances of false positives and reader error,” said Beavers. There is also the fact that the majority of these at-home systems only offer one lead for monitoring versus the 12 leads that ECGs in medical settings provide.

Ideally, the systems should be used in tandem with a physician’s guidance. “It’s important for patients to understand what the aims and purpose of their use are and for their clinician to set a mutual goal,” Beavers said. He gave the example of looking for an abnormal heart rhythm. In that case, the physician would explain exactly what they are using the device to find and how the patient could most accurately capture any episodes or irregularities of concern.

The devices “are helpful and useful,” said Beavers, especially if they make people more engaged in their overall health. Because they are portable and relatively easy to use, they can provide an ongoing snapshot, even if it is limited in scope. Overall, Beavers said, the devices are “good at ruling things out but not always 100% accurate at ruling them in.”

Smaller devices, such as wearables, can help patients take note of concerns they may want to share with their physician, including indications of abnormal rhythms. In a February 24, 2020, letter published in Circulation, researchers reported on the accuracy of the Apple Watch, specifically related to AFib detection. Out of nearly 300 rhythm assessments obtained, AFib was correctly identified in 34 of 90 instances, yielding a sensitivity of 41%.

Five years later, the technology for wearables continues to improve. “They’re starting to factor in more,” said Beavers. “They demonstrate that there may be patients who have an abnormal rhythm. If they see a trend, they can try to capture it. The watches allow patients to introduce this into their conversations with their doctors.”

Being in the know

Because pharmacists are such a trusted source of knowledge, they can support patients by staying up to date on today’s at-home ECG devices. “They should be aware of what is available, how they work, what to do with the data, and how to work with clinical teams,” said Beavers. “Refamiliarizing themselves with basic heart rhythms can also be valuable.” And simply being able to share with patients some of the pros and cons of the different systems could also be valuable.

As more and more devices become available and improve in their quality in the months and years ahead, they no doubt will play an even larger role in the monitoring and diagnosing
of heart conditions, serving as valuable tools for health care providers and patients alike.  ■