The Utility of Real-Time Remote Cardiac Auscultation Using a Bluetooth-Connected Electronic Stethoscope: Open-Label Randomized Controlled Pilot Trial (Preprint)
Authors: Hirosawa Takanobu , Harada Yukinori , Ikenoya Kohei , Kakimoto Shintaro , Shimizu Taro 
Published: January 2021

BACKGROUND

With the coronavirus disease 2019 pandemic, the need for telemedicine is rapidly growing worldwide. The development and improvement of remote physical examination systems, especially remote auscultation, are required to facilitate telemedicine. A Bluetooth system combined with an electronic stethoscope is a promising option for remote auscultation in clinics and hospitals. In our previous work, we demonstrated that the utility of a Bluetooth-connected real-time remote auscultation system for the lung simulator is comparable to that of classical direct auscultation. However, the utility of such systems remains unknown for cardiac auscultation.

OBJECTIVE

This study was conducted to evaluate the utility of real-time auscultation using a Bluetooth-connected electronic stethoscope compared to that of classical auscultation using a cardiology patient simulator.

METHODS

This was an open-label randomized controlled trial, including senior residents and faculty members in the Department of General Internal Medicine of a university hospital. The only exclusion criterion was a refusal to participate. All participants attended a tutorial session, in which they listened to 15 heart sounds on the cardiology patient simulator using a traditional stethoscope and were told the correct classification. Thereafter, participants were randomly assigned to either the real-time remote auscultation group (intervention group) or the classical auscultation group (control group) for test sessions. In the test sessions, participants had to classify a series of ten heart sounds. The intervention group remotely listened to the heart sounds using an electronic stethoscope, a Bluetooth transmitter, and a wireless, noise-canceling, stereo headset. The control group listened to the heart sounds directly using a classic stethoscope. The primary outcome was the test score. The secondary outcomes were the rates of correct answers for each heart sound. The two groups were compared using Fisher’s exact test.

RESULTS

In total, 20 participants were included; six and 14 were assigned to the intervention and control groups, respectively. There was no difference in age (P=.99), sex (P=.99), or years from graduation (P=.78) between the two groups. The overall test score in the intervention group (50/60, 83.3%) was not different from that in the control group (119/140, 85.0%) (P=.77). There was no heart sound for which the correct answer rate differed between groups.

CONCLUSIONS

This study demonstrated that the utility of a real-time remote cardiac auscultation system using a Bluetooth-connected electronic stethoscope was comparable to that of direct auscultation using a classic stethoscope. This implies that the real world’s essential heart sounds could be classified by a real-time remote cardiac auscultation system using a Bluetooth-connected electronic stethoscope.

CLINICALTRIAL

UMIN-CTR UMIN000041601; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000047136