The ECG will continue to be a critical component of the diagnostic cardiology arsenal, and its use in inpatient, outpatient, and home settings is expanding.
FREMONT, CA: Advanced technologies such as artificial intelligence and wearables are envisioned as the future of ECG, and with reason, given ongoing legislative changes, public interest, and R&D innovation. Additionally, the heart issues associated with COVID-19 support the ECG's use and importance in diagnostic decision-making.
Notably, FDA approval of ECG-capable wearables and advancements in remote cardiac care has shifted the industry's perception of what is achievable with at-home monitoring. The continued search of optimized algorithms is assisting in improving those devices' past inadequacies. Additional COVID-19 data have provided fresh insights and concerns for cardiovascular disease patients. Nonetheless, significant peculiarities arose in 2021 that now inform the estimates for 2022. Here are a list of trends to watch out for:
ECG Smartwatchesthat areFDA-Approved
While the FDA approval competition for ECG-capable smartwatches began in 2018 with the Apple Watch and has since accelerated with the addition of three additional devices in 2020 and 2021, the coming year may be the most active yet. This is due to two rising trends in the wearable space: good public attitude, which facilitates wider user adoption, and improvements that lend clinical validity to the technology.
On the consumer side, the excitement surrounding ECG-capable smartwatches has piqued public interest, aided in no little part by wearables' inclusion in holiday gift suggestions for 2021. Enhancements to the aestheticsmake health wearables appear less like medical gadgets and more like fashionable accessories.
Clinically, ECG smartwatches are improving in sophistication due to algorithmic advancements. Such developments in the future may increase sensitivity and aid in detecting atrial arrhythmias that other platforms, such as the Apple Watch may miss. Additionally, wearable manufacturers are increasingly requesting physician input, which, while one consumer group labeled this as a "con," undoubtedly has clinical benefits for the future of ECG.
Additional COVID-19 Factors to Consider
Another year of COVID-19 has helped cardiologists better comprehend the disease's effect on the heart muscle. Notably, research published in 2021 refuted an earlier theory that the SARS-CoV-2 virus causes direct harm to the heart. Rather than that, the American College of Cardiology suggests that the heart may be a "bystander of harm."
By 2022, this discovery will impact the workup of patients with and without underlying heart issues. The ECG will remain crucial for the former group, even more so given the requirement to validate elevated troponin readings with waveforms or imaging. For patients without known underlying heart disease, the possible long-term cardiac effects of a past COVID-19 infection will further support surveillance in this increasing population.
Additionally, uncertainty surrounding future variants in 2022, such as the omicron variant, which is now being evaluated, may affect cardiac monitoring and interventions, particularly if vaccination immunity does not protect against these probable mutations. For example, the delta variant nearly quadrupled the chance of hospitalization compared to the alpha variant, which was especially problematic for individuals with underlying diseases, such as cardiovascular disease.
Increasing Comfort with Remote Cardiac Care
As the pandemic's demand for virtual care grows, the intersections of telehealth and cardiology will become increasingly prominent in 2022.
For example, telehealth has proven crucial for remote cardiac monitoring, which is gaining traction due to algorithmic advancements in artificial intelligence. As with smartwatches, these advancements may dramatically improve the predictive values and sensitivity of ambulatory ECG monitors, thereby boosting physician trust in at-home surveillance.
Notably, boosting telehealth and increasing access to care will be critical healthcare issues in 2022.