Diagnosing a cardiac cause for palpitations: Five-year service evaluation of a smartphone ambulatory ECG pathway for Emergency Department patients.

In a five-year single-centre ED palpitations pathway, smartphone ambulatory ECG monitoring captured a cardiac arrhythmia in 5.7% of 1176 monitored patients.

• Why it matters: Transient symptoms in ED palpitations make ECG capture difficult, and the NHS needed evidence that a smartphone-based pathway can detect clinically relevant rhythms and guide safe discharge.
• What they did: From 24th July 2019 to 24th July 2024, 1750 consecutive patients were assessed using event-triggered monitoring with single-lead Kardia Mobile or an ECG-capable smartwatch, with one-year outcomes analyzed using multivariable logistic regression.
• The result: By one year, 114/1750 (6.5%) had a cardiac cause, with 79.8% (67/84) of those diagnoses established directly via clinic monitoring, and nearly 90% (89.1%) discharged to primary care.

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