{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T04:26:33Z","timestamp":1772252793054,"version":"3.50.1"},"reference-count":12,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2021,2,6]],"date-time":"2021-02-06T00:00:00Z","timestamp":1612569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NHS Research Scotland","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The Investigation of Palpitations in the ED (IPED) study showed that a smartphone-based event recorder increased the number of patients in whom an electrocardiogram (ECG) was captured during symptoms over five-fold to more than 55% at 90 days compared to standard care and concluded that this safe, non-invasive and easy-to-use device should be considered part of on-going care to all patients presenting acutely with unexplained palpitations or pre-syncope. This study reports the process of establishing a smartphone palpitation and pre-syncope ambulatory care Clinic (SPACC) service. Materials and Methods: A clinical standard operating procedure (SOP) was devised, and funding was secured through a business case for the purchase of 40 AliveCor devices in the first instance. The clinic was launched on 22 July 2019. Results: Between 22 July 2019 and 31 October 2019, 68 patients seen in the emergency departments (EDs) with palpitations or pre-syncope were referred to SPACC. Of those, 30 were male and 38 were female, and the mean age was 45.8 years old (SD 15.1) with a range from 18 years old to 80 years old. A total of 50 (74%) patients underwent full investigation. On the first assessment, seven (10%) patients were deemed to have non-cardiac palpitations and were not fitted with the device. All patients who underwent full investigation achieved symptomatic rhythm correlation most with sinus rhythm, ventricular ectopics, or bigeminy. A symptomatic cardiac dysrhythmia was detected in six (8.8%) patients. Three patients had supraventricular tachycardia (4%), two had atrial fibrillation (3%), and one had atrial flutter (2%). Qualitative feedback from the SPACC team suggested several areas where improvement to the clinic could be made. Conclusion: We believe a smartphone palpitation service based on ambulatory care is simple to implement and is effective at detecting cardiac dysrhythmia in ED palpitation patients.<\/jats:p>","DOI":"10.3390\/medicina57020147","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T23:38:44Z","timestamp":1613173124000},"page":"147","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Establishing a Smartphone Ambulatory ECG Service for Patients Presenting to the Emergency Department with Pre-Syncope and Palpitations"],"prefix":"10.3390","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1308-4824","authenticated-orcid":false,"given":"Matthew J.","family":"Reed","sequence":"first","affiliation":[{"name":"Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK"},{"name":"Acute Care Group, Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Nine Edinburgh BioQuarter, 9 Little France Road, Edinburgh EH16 4UX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9317-7512","authenticated-orcid":false,"given":"Alexandra","family":"Muir","sequence":"additional","affiliation":[{"name":"Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4435-4754","authenticated-orcid":false,"given":"Julia","family":"Cullen","sequence":"additional","affiliation":[{"name":"Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK"},{"name":"Acute Medicine, NHS Lothian, Edinburgh EH16 4SA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ross","family":"Murphy","sequence":"additional","affiliation":[{"name":"Acute Medicine, NHS Lothian, Edinburgh EH16 4SA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valery","family":"Pollard","sequence":"additional","affiliation":[{"name":"Acute Medicine, NHS Lothian, Edinburgh EH16 4SA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Goran","family":"Zangana","sequence":"additional","affiliation":[{"name":"Acute Medicine, NHS Lothian, Edinburgh EH16 4SA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean","family":"Krupej","sequence":"additional","affiliation":[{"name":"Acute Medicine, NHS Lothian, Edinburgh EH16 4SA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sylvia","family":"Askham","sequence":"additional","affiliation":[{"name":"Acute Medicine, NHS Lothian, Edinburgh EH16 4SA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Holdsworth","sequence":"additional","affiliation":[{"name":"Acute Medicine, NHS Lothian, Edinburgh EH16 4SA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren","family":"Davies","sequence":"additional","affiliation":[{"name":"Acute Medicine, NHS Lothian, Edinburgh EH16 4SA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.annemergmed.2014.07.452","article-title":"Outcomes in Presyncope Patients: A Prospective Cohort Study","volume":"65","author":"Thiruganasambandamoorthy","year":"2015","journal-title":"Ann. Emerg. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1016\/j.amjcard.2014.02.020","article-title":"Analysis of emergency department visits for palpitations (from the National Hospital Ambulatory Medical Care Survey)","volume":"113","author":"Probst","year":"2014","journal-title":"Am. J. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1093\/europace\/eur130","article-title":"Management of patients with palpitations: A position paper from the European Heart Rhythm Association","volume":"13","author":"Raviele","year":"2011","journal-title":"Europace"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"319","DOI":"10.2217\/fca.14.24","article-title":"Comparing 14-day adhesive patch with 24-h Holter monitoring","volume":"10","author":"Cheung","year":"2014","journal-title":"Future Cardiol."},{"key":"ref_5","unstructured":"National Institute for Health and Care Excellence (2021, January 03). AliveCor Heart Monitor and AliveECG App (Kardia Mobile) for Detecting Atrial Fibrillation. NICE Advice MIB35. Available online: https:\/\/www.nice.org.uk\/advice\/mib232."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.eclinm.2019.02.005","article-title":"Multi-centre randomised controlled trial of a smartphone-based event recorder alongside standard care versus standard care for patients presenting to the Emergency Department with palpitations and pre-syncope: The IPED (Investigation of Palpitations in the ED) study","volume":"8","author":"Reed","year":"2019","journal-title":"EClinicalMedicine"},{"key":"ref_7","unstructured":"Reed, M.J., Grubb, N.R., Lang, C.C., Murphy, R., Pollard, V., Zangana, G., Krupej, S., Askham, S., Holdsworth, P., and Davies, L. (2021, January 03). For How Long Should We Monitor ED Palpitation Patients in the Outpatient Setting? Oral Presentation to RCEM ASC 2019 Gateshead. Available online: https:\/\/emj.bmj.com\/content\/36\/12\/787.2.abstract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2013A metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J. Biomed. Inform."},{"key":"ref_9","unstructured":"(2021, January 03). REDCap. Available online: https:\/\/projectredcap.org."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Reed, M.J., Grubb, N.R., Lang, C.C., O\u2019Brien, R., Simpson, K., Padarenga, M., Grant, A., Tuck, S., Keating, L., and Coffey, F. (2021, January 03). Clinician Prediction of Cardiac Arrhythmia in Patients Presenting to the ED with Palpitation or Pre-Syncope. Oral Presentation to RCEM ASC 2019 Gateshead. Available online: https:\/\/emj.bmj.com\/content\/36\/12\/783.2.","DOI":"10.1136\/emermed-2019-RCEM.18"},{"key":"ref_11","unstructured":"(2021, January 03). Emergency Department\/ AMU RIE, Smartphone Palpitation Service. Available online: https:\/\/www.emergeresearch.org\/wp-content\/uploads\/2015\/12\/Palpitation-Ambulatory-care-pathway-v3-13-07-2020-FULL-VERSION.pdf."},{"key":"ref_12","unstructured":"(2021, January 03). Topic Exploration Report. Available online: https:\/\/www.healthtechnology.wales\/reports-guidance\/alivecor-kardiamobile-device\/."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/2\/147\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:20:29Z","timestamp":1760160029000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/2\/147"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,6]]},"references-count":12,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["medicina57020147"],"URL":"https:\/\/doi.org\/10.3390\/medicina57020147","relation":{"has-preprint":[{"id-type":"doi","id":"10.20944\/preprints202101.0315.v1","asserted-by":"object"}]},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,6]]}}}