Wrist-worn arrhythmia monitoring devices are well accepted for long-term rhythm assessment by the elderly
Authors: Vehkaoja A , Saarinen H , Halkola T , Korpi K , Virtanen V 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): This study was funded by PulseOn Oy.

Background
Wearable devices such as patch ECG monitors and wrist-worn intermittent ECG devices have recently emerged to fill the gap between Holter monitors and implantable loop recorders in diagnosing paroxysmal cardiac arrhythmias. Unlike patch ECG, wrist-worn devices require active participation of the patient, for example, for taking the ECG recordings. The incidence of cardiac arrhythmias increases with age, so it is important that the devices are easy enough to use also for older people.

Purpose
We evaluated the usability of a wrist-worn arrhythmia monitoring device among elderly. The device is exclusively targeted for health care providers to be handed out to patients for planned monitoring period instead of being targeted directly to consumers. Another purpose was to obtain feedback on the comfortability of wearing the device and possible skin irritation caused by continuous wearing.

Methods
We recruited 200 subjects of at least 65 years of age (average 71, range 65-92) with no previous atrial fibrillation diagnosis through a newspaper advertisement. The subjects came for a visit in a local cardiac clinic where they received a short introduction for using the wrist device. The monitoring period was defined as two weeks. The participants were instructed to take four scheduled ECG measurements daily and every time they had arrhythmia symptoms or if the continuous photoplethysmography-based rhythm monitoring of the device detected irregular rhythm and notified the user. The subjects had to recharge the device once during the monitoring period using the accompanied charging dock. The subjects were instructed to keep a diary on the device usage. The subjects also filled a feedback questionnaire regarding device usability at the end of the monitoring period.

Results
On a scale of 1 to 5, the overall easiness of using the device obtained an average score of 4.4 (standard deviation 0.7), the easiness of taking the ECG recordings 4.7 (std 0.6), and the easiness of device charging 4.8 (std 0.6). All except one study subject were capable of using the device in the correct way for the whole monitoring period. Average score for the device causing skin irritation was 1.6 (std 1.0) when score 1 was considered ‘no irritation’. However, one subject had to stop using the device prematurely due to skin irritation. Three of the previously undiagnosed subjects had paroxysmal AF episode during the monitoring period and another eleven subjects had other atrial tachycardia events.

Conclusion
Based on the obtained feedback, the studied wrist-worn arrhythmia monitor was found easy to use and was well received by the study participants. The studied wrist-worn monitoring device seems thus suitable for arrhythmia diagnosis in elderly patients. A wearable device, being immediately available at the wrist for taking ECG measurements, additionally provides the benefit of being able to record also short-lasting atrial tachycardia episodes.