Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

All 3 of the experts were familiar with or had used this technology before.

Level of innovation

All experts acknowledged that this technology was not as innovative as other ambulatory cardiac monitors available. One expert said that the device was a novel solution during the COVID‑19 pandemic to manage diagnostic waits for cardiac monitors. Two experts said that device would be more comfortable for people to use than standard care which uses Holter monitors. This is because Holter monitors uses standard electrocardiogram (ECG) electrodes with wires connecting to a recording box. The experts agreed the patch‑type devices are less intrusive than standard ambulatory monitors and are becoming more widely used in the NHS.

Potential patient impact

Two experts said that when compared with Holter monitors, these patch‑type devices are less intrusive because there is no need for cables and they are smaller and water resistant (and so does not need to be removed when showering). One expert said that longer monitoring is also likely to improve diagnostic yield, especially in those with relatively infrequent symptoms. If diagnostic yield is improved it is also likely to reduce the need for more invasive procedures. Two experts noted that the device can be sent via post and be self-applied by the patient and then posted back after the monitoring period. This could be more convenient than other monitoring options available and reduce the need for hospital visits. One expert further commented that this will also benefit people with poor mobility, where attending hospital appointments may be more difficult.

Potential system impact

One expert said that the diagnostic pathway is unlikely to change. However, because of improved comfort compared with Holter monitors, people are more likely to use the device for the entire monitoring period. This could lead to increased diagnostic yield through having a longer, continuous, monitoring period. The device could also reduce in-hospital work through reports being done externally and could lead to time savings for device preparation because of the device being single use. One expert said that the cost of the device is likely to be offset by an improved diagnostic yield, which can reduce need for repeat testing or repeat appointments. It could also reduce hospital physiologist time needed for data analysis and reporting, if the assessment was done externally. One expert further said that this would reduce hospital waiting times for cardiac monitoring. Applying the device at home and posting it back would also reduce the hospital time needed. One expert said that the training would be simple and similar to other technologies and that further training would be supported by the company. One expert also said that the instructions to use the device are simple and the patch is easy to apply. Another expert said that familiarisation was needed for registering patients onto the device portal and that some training would be needed for trusts wanting to use their own technicians to analyse data.

General comments

One expert stated that this is a very low risk technology and any risks would be shared by other ECG monitors. The most common adverse reaction to these devices is a skin reaction to the adhesive material, although they say the incidence of this is low. One expert said that it would be useful to have a 14-day monitoring study comparing other similar patch-type devices used in the NHS. One expert said that larger population studies would be needed. One expert said that cost compared with Holter monitors would be a barrier to wider uptake of the device. They said that there would be a reduction in capital cost but an increase in consumables cost if the device replaced Holter monitoring.