The IPED (Investigation of Palpitations in the ED) Study

Not Applicable

Completed

Conditions: Arrhythmias, Cardiac
Presyncope
Tachycardia, Supraventricular
Atrial Fibrillation

Interventions: Device: AliveCor Heart Monitor

Registration Number: NCT02783898

Lead Sponsor: NHS Lothian

Brief Summary: Palpitations (noticeable pounding, fluttering or irregular heart beat) and pre-syncope (near blackout) are common ED problems sometimes due to an abnormal cardiac rhythm. This is difficult to diagnose as examination and electrocardiogram (ECG) are commonly normal and symptoms have usually resolved by the time the patient arrives in the ED. Diagnosing an abnormal heart rhythm as the cause of symptoms rests on capturing it on an ECG and patients are usually discharged with advice to return to the ED again for a 12-lead ECG should symptoms recur. The investigators will recruit 242 adult participants to either study or control arms. All study arm participants will be given an AliveCor Heart Monitor and trained in the use of the device. Control arm participants will receive standard care only. Both groups will be followed-up at 90 days. The investigators believe a smart phone based event recorder will allow better and earlier diagnosis in patients with a compatible smart phone or tablet, and revolutionise ED care in this area.

Detailed Description: Palpitations (noticeable pounding, fluttering or irregular heart beat) and pre syncope (near blackout) are common ED problems sometimes due to an abnormal heart rhythm. Diagnosis is difficult as examination and electrocardiogram (ECG) are commonly normal and symptoms have usually resolved by the time the patient arrives in the ED. Diagnosing an abnormal heart rhythm as the cause of symptoms rests on capturing it on an ECG and patients are usually advised to return to the ED for a 12-lead ECG should symptoms recur. The investigators will recruit 242 participants aged 16 years or over presenting to the ED or Medical Assessment Unit of the Royal Infirmary of Edinburgh with an episode of palpitations or pre-syncope and who remain undiagnosed after ED assessment. The investigators will randomise and allocate participants to either study or control arms. All study arm participants will be given an AliveCor Heart Monitor and trained in the use of the device. Control arm participants will receive standard care only. If a participant allocated to the study arm has palpitations or pre-syncope during the 90-day study period, the participant can record an ECG using the AliveCor Monitor which can be viewed by the study team. Participants will be asked to log symptoms and whether the participant was able to record an ECG during the symptoms in a participant symptom diary, which the participant will return to the research team along with the Participant satisfaction and compliance questionnaire, and smart phone based event recorder at the end of the 90 days in a pre-paid stamped, addressed envelope. Participants will be phoned at 90 days to remind the participant to complete the Participant satisfaction and compliance questionnaire and to return this with the symptom diary and smart phone based event recorder. The investigators believe a smart phone based event recorder will allow better and earlier diagnosis in patients.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 243

Inclusion Criteria

Participant aged 16 years or over
Participant presenting with an episode of palpitations or pre-syncope
Participant's underlying ECG rhythm during these episodes remains undiagnosed after clinical assessment.

Exclusion Criteria

Prior diagnostic ECG
Palpitations or pre-syncope present during an admission ECG
Frequent episodes (i.e. at least once a day)
Participants under 16 years of age
Previous participation in the study
Inability or unwilling to give informed consent.
Participants with recent (i.e. within 3 months) myocardial infarction, severe heart failure (NYHA class 4) or unstable angina
Participants unwilling or unable to use the AliveCor Heart Monitor and AliveECG app
Participants without a compatible smart phone or tablet
Participants with cardiac pacemakers or other implanted electronic devices
No telephone number for follow-up
Participant in custody

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Study	AliveCor Heart Monitor	All STUDY arm participants will be given an AliveCor Heart Monitor and trained in the use of the device. They will be followed up at 90 days. If a participants allocated to the Study arm, gets an episode of palpitations or pre-syncope and is able to record an AliveCor Heart Monitor ECG during the episode, the participant will email the ECG recorded by the AliveCor app directly to the study team. The study team will review the ECG. If specialist follow-up is not required the study team will inform the participant of this and ask them to arrange general practitioner follow up. If the participant records a serious significant arrhythmia during the study period, the study team will alert the participant immediately and refer them to the cardiac electrophysiology service.

Primary Outcome Measures

Name	Time	Method
Number of Participants With Symptomatic Rhythm Detection up to 90 Days	90 days	Symptomatic rhythm detection rate of a smart phone based event recorder for symptomatic rhythm detection versus standard care.

Secondary Outcome Measures

Name	Time	Method
Number of Participants With Symptomatic Cardiac Rhythm Detection up to 90 Days	90 days	Symptomatic rhythm detection rate of a smart phone based event recorder for cardiac arrhythmia detection versus standard care
Number of Participants Treated or (Planned for Treatment) for Cardiac Arrhythmia	90 days	Number of participants treated or (planned for treatment) for cardiac arrhythmia in participants using a smart phone based event recorder versus standard care
Number of Participants Finding the AliveCor Heart Monitor Easy to Use	90 days	Number of Participants answering the participant questionnaire and finding the AliveCor heart monitor easy to use
Number of Participants Completing Questionnaire	90 days	Measure of questionnaire compliance - Number of participants completing questionnaire
Time to Detection of Symptomatic Rhythm	90 days	Time to detection of symptomatic rhythm using a smart phone based event recorder versus standard care
Number of Participants With Serious Outcome up to 90 Days	90 days	Number of patients with all cause death and/or major adverse cardiac events (MACE; myocardial infarction, life threatening arrhythmia, insertion of pacemaker or internal cardiac defibrillator, insertion of pacing wire).
Financial Cost Per Diagnosis of Symptomatic Rhythm	90 days	Financial cost per diagnosis of symptomatic rhythm using smart phone based event recorder versus standard care.
Time to Detection of Cardiac Arrhythmia Rhythm	90 days	Time to detection of cardiac arrhythmia rhythm using a smart phone based event recorder versus standard care

Trial Locations

Locations (10): Royal Infirmary of Edinburgh
🇬🇧
Edinburgh, Midlothian, United Kingdom
Chesterfield
🇬🇧
Chesterfield, United Kingdom
Leicester Royal Infirmary
🇬🇧
Leicester, United Kingdom
Royal Devon and Exeter Hospital
🇬🇧
Exeter, United Kingdom
Royal London Hospital, Barts NHS Trust
🇬🇧
London, United Kingdom
Whipps Cross Hospital, Barts NHS Trust
🇬🇧
London, United Kingdom
Derriford Hospital
🇬🇧
Plymouth, United Kingdom
Royal Berkshire Hospital
🇬🇧
Reading, United Kingdom
Musgrove Park Hospital
🇬🇧
Taunton, United Kingdom
Nottingham University Hospital
🇬🇧
Nottingham, United Kingdom