At-Home Continuous Ambulatory ECG Monitoring Found to Provide Quality Data

Man wearing holter monitor
Portable heart monitor. Man wearing a portable electrocardiograph hanging on a strap from his neck. The wires lead to 5 electrodes taped to his torso. An electrocardiograph is used to monitor the electrical activity of the heart, allowing the diagnosis of abnormal heart rhythms (arrhythmias). This portable version, called a Holter monitor, records the heart’s activity for 24 hours or more, leaving the patient free to continue normal activities. The recording is then analyzed by computer. This technique is useful for diagnosing sporadic heartbeat disturbances that could be missed by a short examination with a fixed monitor.
A home-based continuous ambulatory ECG monitoring device delivered with at-home instructions was found to be as effective for collecting quality data as in-clinic delivery and monitoring.

A home-based continuous ambulatory electrocardiogram (ECG) monitoring device delivered with at-home instructions during the coronavirus disease 2019 (COVID-19) pandemic was found to be as effective for collecting quality data as in-clinic delivery and monitoring, according to a study published in the Journal of Electrocardiology.

In this study, 47 patients (mean age, 70±14.7 years; 49% men) treated at a specialty neurology clinic following a stroke were included. Patients required ECG monitoring to identify atrial fibrillation which may occur after a stroke due to cardioembolism. Participants received a pamphlet and watched a 5-minute educational video providing instructions on applying and using a continuous ambulatory ECG monitoring device during the COVID-19 pandemic. Patients met with their physician via videoconferencing to discuss long-term ECG recording. The device was sent to the patients’ homes.

This group of patients was retrospectively compared with a cohort of 47 patients (mean age, 65±15 years; 55% men) who received the same long-term ECG recording device in the clinic prior to the onset of the pandemic. The study’s primary outcome was magnitude of noise. Atrial premature beat and hours recorded were the study’s secondary outcomes.

All of the 47 devices shipped to patients during the COVID-19 pandemic were returned following use. A total of 25 patients were able to install their device with the provided instructional materials without additional assistance, and 21 patients installed their device with help over the phone.

The average noise magnitudes for mailed and in-clinic devices were 22±21% and 26±14%, respectively (P =.052). The atrial premature beat burden per recorded hours was similar among patients with home vs in-clinic devices (37.05±95.5 vs 23.3 ±42.8, respectively; P =.465).

The mean number of hours recorded was comparable for home and in-clinic devices (240.37±78.3 vs 245.05 ±46.7 hours, respectively; P =.589). Average manual activation due to symptoms were 10 and 8 for at-home and in-clinic devices, respectively.

A potential limitation of this study is the small number of patients from a single stroke clinic.

 “Using simple instructions, as well as a standard constructed single phone prompt, and as-needed contact, patients were able to properly use the device to acquire symptom–rhythm correlation and ECG recordings equivalently between home delivery and clinic application,” concluded the study authors.


Benjamin H, Bischof M, Goldshtein D, Fecteau P, Newman D. A pandemic response to home delivery for ambulatory ECG monitoring: Development and validation. Published online November 18, 2020. J Electrocardiol. doi:10.1016/j.jelectrocard.2020.11.003