Zhongguo quanke yixue (Jan 2023)
Diagnostic Accuracies of Three Schemes for Arrhythmia Screening Using a Wearable Single-lead ECG Monitoring System: a Real-world Community-based Study
Abstract
Background Arrhythmia has a high incidence, and is a serious threat to human health. However, due to concealed symptoms and unpredictability of onset, it is difficult for traditional ECG equipment to capture the ECG data at the onset of the arrhythmic events, so it could be misdiagnosed and under-treated. Fortunately, the diagnosis rate of arrhythmia could be greatly enhanced by analyzing the uploaded real-time ECG data of individuals measured at home using the wearable single-lead ECG monitoring system under the guidance of community doctors, but there is a lack of relevant evidence from real-world studies. Objective To assess the diagnostic accuracies of three schemes for screening arrhythmia in the community using a wearable single-lead ECG monitoring system. Methods A real-world, community-based study design was used for comparing three schemes for screening arrhythmia using a wearable single-lead ECG monitoring system: scheme 1 was used for collecting 24-hour ECG data on any three nonconsecutive days in two weeks, scheme 2 was used for collecting 24-hour ECG data on any day and at least three 1-hour ECG data in two weeks, and scheme 3 was adopted for collecting 72-hour ECG data on any three consecutive days and at least one 1-hour ECG data on any one day in two weeks. Subjects were 435 community-living residents, who were recruited from Yinchuan from September 2020 to September 2021. They were divided into male group (177 cases) , female group (258 cases) ; young group (135 cases) , middle-aged group (200 cases) and elderly group (100 cases) by age; primary school group (77 cases) , middle school group (165 cases) and university group (193 cases) by educational level; arrhythmia group (233 cases) and non-arrhythmia group (202 cases) by the history of arrhythmia. Subjects measured the ECG either at the onset time of perceived arrhythmia or not using any one of the three screening schemes chosen voluntarily with the wearable single-lead ECG monitoring system, then uploaded the measurement results to the cloud platform. The number of participants using each of the three screening schemes was counted. The correlation of age, education level or history of arrhythmia with scheme selection was analyzed. And detection rates of the three screening schemes were compared. Results The number of subjects who selected the three screening schemes was 321, 40 and 74, respectively. The average age of the subjects was significantly different (P=0.047) . There was no correlation between gender, education level, medical history and protocol selection (χ2=0.670, P=0.715; χ2=2.994, P=0.559; χ2=2.225, P=0.893) . There was a significant correlation between different age groups and protocol selection (χ2=9.939, P=0.041) . The arrhythmia detection rates of the three screening protocols were 85.67%, 82.50% and 85.14%, respectively, and the difference was not statistically significant (χ2=0.286, P=0.867) . There was no significant difference in the arrhythmia detection rate between the male group and the female group (χ2=0.966, P=0.707; χ2=0.917, P=0.678) . There was no significant difference in the detection rate of arrhythmia among young group, middle-aged group and elderly group (χ2=2.102, P=0.350; χ2=0.871, P=0.706; χ2=1.063, P=0.622) . There was no significant difference in the detection rate of arrhythmia among the three screening schemes in primary school group, middle school group and university group (χ2=2.421, P=0.271; χ2=1.115, P=0.633; χ2=2.181, P=0.353) . There was no significant difference in the arrhythmia detection rate between the three screening protocols in the history group and the no history group (χ2=1.442, P=0.507; χ2=0.548, P=0.818) . The frequency of 1-hour ECG data collection in protocol 2 was positively correlated with arrhythmia detection rate (rs=0.912, P=0.011) . The frequency of 1-hour ECG data collection in protocol 3 was positively correlated with arrhythmia detection rate (rs=0.852, P=0.026) . In protocol 2, the detection rate of arrhythmia in 24-hour ECG data was 72.5%, and that in 1-hour ECG data was 77.5%. There was a strong consistency between the two kinds of long-term ECG data (Kappa=0.601, P=0.001) . In protocol 3, the arrhythmia detection rate of 72-hour ECG data was 82.4%, and the arrhythmia detection rate of 1-hour ECG data was 63.5%. There was a medium consistency between the two kinds of long-term ECG data (Kappa=0.410, P<0.001) . In protocol 2, there was a strong consistency between the diagnosis results of 1-hour ECG data and the total protocol (Kappa=0.844, P<0.001) . There was a strong consistency between 24-hour ECG data diagnosis and total protocol diagnosis (Kappa=0.717, P<0.001) . In protocol 3, there was a moderate consistency between the 1-hour ECG data diagnosis and the total protocol diagnosis (Kappa=0.466, P<0.001) , and the consistency strength was general. The results of 72-hour diagnosis were strongly consistent with those of the total protocol (Kappa=0.901, P<0.001) . Conclusion There is no significant difference in the arrhythmia detection rate among the three arrhythmia screening schemes based on community mobile health care, which can be used regardless of whether there are symptoms or not. Subjects of different ages have different tendencies to choose the three screening schemes, and the frequency of 1-hour ECG data collection is positively correlated with the arrhythmia detection rate, which suggests that the community doctors should select the optimal compliance screening scheme according to patients' age, occupational characteristics, economic income and other factors, so as to truly enable the screening and management of arrhythmia in the community using mobile technologies.
Keywords
