Diagnosing a cardiac cause for palpitations: Five-year service evaluation of a smartphone ambulatory ECG pathway for Emergency Department patients.
- 1Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK; Acute Care Edinburgh, Usher Institute, University of Edinburg
Abstract
Background: Capturing an electrocardiogram (ECG) during transient symptoms remains challenging in emergency department (ED) patients with palpitations. Following the IPED trial, a smartphone-based ambulatory ECG event recorder pathway was integrated into NHS care. We evaluated this service over five years, assessing diagnostic yield, management, one-year outcomes and predictors of cardiac arrhythmia. Methods: Single-centre service evaluation of consecutive patients referred with palpitations to a smartphone-based ambulatory ECG event recorder clinic between 24th July 2019 and 24th July 2024. Patients underwent event-triggered ECG monitoring using the single-lead Kardia Mobile (AliveCor, Inc.) or their own smartwatch with ECG capability. Clinical characteristics, rhythm recordings, investigations, one-year outcomes and management changes were recorded. Multivariable logistic regression identified independent predictors of one-year cardiac arrhythmia diagnosis. Results: 1750 patients attended the clinic, mean age 44.3 +/- 16.1 years, 58.2% female. 1176 patients (67.2%) underwent monitoring with a cardiac arrhythmia directly captured in 67 patients (5.7% of monitored), including atrial fibrillation (n=39), supraventricular tachycardia (13), atrial flutter (9), atrial tachycardia (5) and ventricular tachycardia (1). By one year, 84 (7.1%) who underwent monitoring received a cardiac diagnosis with 79.8% (67/84) established directly via clinic monitoring. Across the entire cohort (n=1750), 114 (6.5%) had a cardiac cause at one year, 1472 (84.2%) had non-cardiac aetiology and 1569 (89.1%) were discharged back to primary care. Medication changes were initiated in 106 patients (6.1%). Independent predictors of a one-year cardiac diagnosis were increasing age (aOR 1.04 per 1-year increase), prior atrial fibrillation/flutter (aOR 5.57) and a presenting symptom of irregular beating (aOR 2.65). Conclusion: Our service provides an effective model for evaluating ED patients with palpitations. Over five years the service reliably detected actionable cardiac arrhythmias while safely discharging nearly 90% of patients to primary care. Clinical characteristics may guide patient selection to maximise clinic efficiency.
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BibTeX
@misc{morran2026diagnosing,
title = {{Diagnosing a cardiac cause for palpitations: Five-year service evaluation of a smartphone ambulatory ECG pathway for Emergency Department patients.}},
author = {C. Morran and P. Srinivasan and R. Andrew and E. A. Pow and L. Padovani and Y. Thackray and R. Murphy and G. Zangana and S. Krupej and M. I'Anson and L. Findlay and J. Millar and F. Watts and M. Moni and M. J. Reed},
howpublished = {medRxiv},
year = {2026},
month = nov,
doi = {10.64898/2026.11.05.26367104},
url = {https://www.medrxiv.org/content/10.64898/2026.11.05.26367104v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Diagnosing a cardiac cause for palpitations: Five-year service evaluation of a smartphone ambulatory ECG pathway for Emergency Department patients.
AU - C. Morran
AU - P. Srinivasan
AU - R. Andrew
AU - E. A. Pow
AU - L. Padovani
AU - Y. Thackray
AU - R. Murphy
AU - G. Zangana
AU - S. Krupej
AU - M. I'Anson
AU - L. Findlay
AU - J. Millar
AU - F. Watts
AU - M. Moni
AU - M. J. Reed
PY - 2026
DA - 2026/11/05
PB - medRxiv
DO - 10.64898/2026.11.05.26367104
UR - https://www.medrxiv.org/content/10.64898/2026.11.05.26367104v1
AB - Background: Capturing an electrocardiogram (ECG) during transient symptoms remains challenging in emergency department (ED) patients with palpitations. Following the IPED trial, a smartphone-based ambulatory ECG event recorder pathway was integrated into NHS care. We evaluated this service over five years, assessing diagnostic yield, management, one-year outcomes and predictors of cardiac arrhythmia. Methods: Single-centre service evaluation of consecutive patients referred with palpitations to a smartphone-based ambulatory ECG event recorder clinic between 24th July 2019 and 24th July 2024. Patients underwent event-triggered ECG monitoring using the single-lead Kardia Mobile (AliveCor, Inc.) or their own smartwatch with ECG capability. Clinical characteristics, rhythm recordings, investigations, one-year outcomes and management changes were recorded. Multivariable logistic regression identified independent predictors of one-year cardiac arrhythmia diagnosis. Results: 1750 patients attended the clinic, mean age 44.3 +/- 16.1 years, 58.2% female. 1176 patients (67.2%) underwent monitoring with a cardiac arrhythmia directly captured in 67 patients (5.7% of monitored), including atrial fibrillation (n=39), supraventricular tachycardia (13), atrial flutter (9), atrial tachycardia (5) and ventricular tachycardia (1). By one year, 84 (7.1%) who underwent monitoring received a cardiac diagnosis with 79.8% (67/84) established directly via clinic monitoring. Across the entire cohort (n=1750), 114 (6.5%) had a cardiac cause at one year, 1472 (84.2%) had non-cardiac aetiology and 1569 (89.1%) were discharged back to primary care. Medication changes were initiated in 106 patients (6.1%). Independent predictors of a one-year cardiac diagnosis were increasing age (aOR 1.04 per 1-year increase), prior atrial fibrillation/flutter (aOR 5.57) and a presenting symptom of irregular beating (aOR 2.65). Conclusion: Our service provides an effective model for evaluating ED patients with palpitations. Over five years the service reliably detected actionable cardiac arrhythmias while safely discharging nearly 90% of patients to primary care. Clinical characteristics may guide patient selection to maximise clinic efficiency.
ER -