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Mobile Cardiac Outpatient Telemetry for Unexplained Syncope

Primary Purpose

Syncope, Arrhythmia, Near Syncope

Status
Not yet recruiting
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Mobile Cardiac Outpatient Telemetry Device (MCOT)
Sponsored by
Carilion Clinic
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional diagnostic trial for Syncope focused on measuring Cardiac monitoring, Syncope, Unexplained syncope

Eligibility Criteria

50 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: ED presentation for syncope or near syncope without identified cause of syncope during ED evaluation Willingness to enroll in the trial greater than or equal to 50 years of age cell phone coverage at their primary residence home or cell phone service for follow up calls ability to answer questionnaires without assistance English language speaker Exclusion Criteria: unwillingness to participate in the study unable to consent on their own seizure as presumptive cause of loss of consciousness stroke, or transient ischemic attack as presumptive loss of consciousness loss of consciousness following head trauma confusion from baseline mental status (altered mental status) intoxication (alcohol or other drugs) medical or electrical intervention required to restore consciousness hypoglycemia as presumptive cause of loss of consciousness inability to provide follow up via telephone (phone that is not regularly in service) lack of permanent address (e.g. not a homeless shelter, half-way house, psychiatric treatment facility, or correctional facility) Lack of continuous cellular phone service with ATT, Verizon, or T-Mobile for MCOT relay known pregnancy Illiteracy

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    No Intervention

    Arm Label

    Mobile Cardiac Outpatient Telemetry Device (MCOT)

    Standard Treatment Group

    Arm Description

    These participants will be randomized into receiving the Philips/BioTel MCOT device in addition to usual care.

    These participants will be randomized into only receiving usual care and will not receive the MCOT device.

    Outcomes

    Primary Outcome Measures

    Time to arrhythmia diagnosis for unexplained syncope
    Comparison of time to arrhythmia diagnosis for intervention vs. control group
    Time to medical intervention following unexplained syncope
    Comparison of time to medical intervention for intervention vs. control group

    Secondary Outcome Measures

    Full Information

    First Posted
    July 14, 2023
    Last Updated
    July 14, 2023
    Sponsor
    Carilion Clinic
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05957315
    Brief Title
    Mobile Cardiac Outpatient Telemetry for Unexplained Syncope
    Official Title
    Mobile Cardiac Outpatient Telemetry for Unexplained Syncope: Time to Treatment, Arrhythmia Diagnosis and Outcome
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    July 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    September 1, 2023 (Anticipated)
    Primary Completion Date
    October 1, 2025 (Anticipated)
    Study Completion Date
    October 1, 2025 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Carilion Clinic

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    Yes
    Product Manufactured in and Exported from the U.S.
    Yes
    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    This study seeks to provide evidence that use of Philips mobile cardiac outpatient telemetry (MCOT) devices may improve patient care for patients who present to emergency departments (EDs) with syncope, which is a temporary loss of consciousness also known as fainting or who present experiencing a near temporary loss of consciousness (near syncope). It is set up as a random controlled trial, which means research participants will be randomly assigned to receiving the device or usual care. Patients 50 years or older who come to the ED of Carilion Roanoke Memorial Hospital will be screened by study team members for unexplained syncope or near syncope across three ED dispositions: hospital admission, emergency department clinical decision unit admission (ED CDU) and emergency department. After consent, subjects will be enrolled and randomized, via REDCap randomization, in the study. At the time of subject discharge the MCOT device will be placed on the chest for the arm of intervention patients (for subjects who were admitted, the research study team will follow the patient's clinical course and placement of the device will occur at discharge); subjects will also receive brief instruction on the care and maintenance of the device and a patient education guide. The research team will contact the subjects for a telephone follow up at 14 and 30 days post-enrollment. The study will establish the efficacy of mobile cardiac outpatient telemetry in comparison to observation telemetry. Research objectives are to 1) Measure the time to medical intervention in patients with unexplained syncope or near syncope fitted with a Philips MCOT at the time of hospital discharge compared to patients treated with usual care for unexplained syncope or near syncope; and 2) Measure the time to arrhythmia diagnosis in patients with unexplained syncope or near syncope fitted with a Philips MCOT at the time of hospital discharge compared to patients treated with usual care for unexplained syncope or near syncope.
    Detailed Description
    The study will establish the efficacy of ED-based, post-discharge mobile cardiac outpatient telemetry for patients discharged with a diagnosis of unexplained syncope. Research objectives are to 1) Measure the time to medical intervention in patients with unexplained syncope fitted with a Philips MCOT at the time of hospital discharge compared to patients treated with usual care for unexplained syncope; and 2) Measure the time to arrhythmia diagnosis in patients with unexplained syncope fitted with a Philips MCOT at the time of hospital discharge compared to patients treated with usual care for unexplained syncope. The hypothesis for this study is that participants who receive the Philips MCOT device upon discharge will experience a shorter time to diagnosis for the cause of their episode of syncope and receive subsequent medical intervention sooner than those who do not receive an MCOT device. Medical intervention is defined as a change in medical management, escalation of diagnostic testing or device, or medical procedure that might result from diagnostic information obtained from outpatient cardiac monitoring following a syncopal episode. Change in medical management includes, but is not limited to, initiation of a new medication, lifestyle modification recommendations, referral to medical specialist such as cardiology or electrophysiology. Escalation of diagnostic device may include, but is not limited to, ordering of diagnostic studies such as a cardiac stress test, echocardiogram, other cardiac testing at the preference of the treating subspecialist, or placement of a longer duration cardiac monitor such as an implantable loop recorder or cardiac event monitor. Medical procedure is defined as cardiac pacemaker implantation, cardiac heart catheterization, or other invasive cardiac procedure felt to be medically necessary by the treating specialist or subspecialist physician. An arrhythmia is an abnormal heart rhythm. In some instances syncope/near syncope, or fainting/near fainting, may be the result of an undiagnosed abnormal heart rhythm. Abnormal heart rhythms that might result in a fainting include atrial fibrillation, supraventricular tachycardia, sinus pause, Mobitz Type II heart block, complete heart block, and ventricular tachycardia. Wearing the mobile cardiac outpatient telemetry monitor increases the likelihood of identifying fainting episodes that were caused by abnormal heart rhythms. Previous studies are variable in the number and type of arrythmias captured that would mandate medical intervention of some type that is measurable (medication, ablation, etc). All comer diagnosis and absolute diagnosis of any arrythmia is much higher than 10%. Thus, we based the pilot study size based on the lowest reported incidence in the literature for arrythmias requiring a change in a patient's medical care of 10% as the lowest suspected incidence for the Na sample size calculation. With a one-sided means test, 1-b at 0.80, and a of 0.05, 8 events in Na requiring medical intervention of some type would be required to demonstrate a 7d difference in time to intervention from the usual care group or 80 patients in the Na and 160 total. The device manufacturer is providing up to 120 devices with monitoring (up to 240 total study enrollees), which will allow for flexibility in the event of loss to follow up or to increase power. Study participants will be randomized at ED discharge into either the control group, which receives usual care (referrals to follow up with outpatient services), or the experimental group, which receives usual care AND are fitted with a Philips MCOT device and remotely monitored for 30 days along with possible referrals to follow up with outpatient services. Data will be collected from participants' medical records to determine whether additional episodes of syncope or near syncope, diagnosis, and/or treatment occurred. Additionally, participants will be contacted by the study team at 14 and 30 days post-discharge to answer questions to determine whether additional episodes of syncope or near syncope occurred, whether treatment occurred, and whether they complied with follow up referrals. To determine if there is a difference in the time to medical intervention and in time to arrhythmia diagnosis, we will conduct two-sample tests of proportions. Secondary outcome analysis will be descriptive.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Syncope, Arrhythmia, Near Syncope, Arrhythmias, Cardiac
    Keywords
    Cardiac monitoring, Syncope, Unexplained syncope

    7. Study Design

    Primary Purpose
    Diagnostic
    Study Phase
    Not Applicable
    Interventional Study Model
    Parallel Assignment
    Masking
    None (Open Label)
    Allocation
    Randomized
    Enrollment
    160 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Mobile Cardiac Outpatient Telemetry Device (MCOT)
    Arm Type
    Experimental
    Arm Description
    These participants will be randomized into receiving the Philips/BioTel MCOT device in addition to usual care.
    Arm Title
    Standard Treatment Group
    Arm Type
    No Intervention
    Arm Description
    These participants will be randomized into only receiving usual care and will not receive the MCOT device.
    Intervention Type
    Device
    Intervention Name(s)
    Mobile Cardiac Outpatient Telemetry Device (MCOT)
    Other Intervention Name(s)
    cardiac monitor, cardiac monitoring, mobile cardiac telemetry
    Intervention Description
    Application of a Philips/Biotel MCOT device
    Primary Outcome Measure Information:
    Title
    Time to arrhythmia diagnosis for unexplained syncope
    Description
    Comparison of time to arrhythmia diagnosis for intervention vs. control group
    Time Frame
    1 month
    Title
    Time to medical intervention following unexplained syncope
    Description
    Comparison of time to medical intervention for intervention vs. control group
    Time Frame
    1 month

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    50 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: ED presentation for syncope or near syncope without identified cause of syncope during ED evaluation Willingness to enroll in the trial greater than or equal to 50 years of age cell phone coverage at their primary residence home or cell phone service for follow up calls ability to answer questionnaires without assistance English language speaker Exclusion Criteria: unwillingness to participate in the study unable to consent on their own seizure as presumptive cause of loss of consciousness stroke, or transient ischemic attack as presumptive loss of consciousness loss of consciousness following head trauma confusion from baseline mental status (altered mental status) intoxication (alcohol or other drugs) medical or electrical intervention required to restore consciousness hypoglycemia as presumptive cause of loss of consciousness inability to provide follow up via telephone (phone that is not regularly in service) lack of permanent address (e.g. not a homeless shelter, half-way house, psychiatric treatment facility, or correctional facility) Lack of continuous cellular phone service with ATT, Verizon, or T-Mobile for MCOT relay known pregnancy Illiteracy
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Andrew B Moore, MD
    Phone
    540-981-7000
    Email
    abmoore1@carilionclinic.org

    12. IPD Sharing Statement

    Learn more about this trial

    Mobile Cardiac Outpatient Telemetry for Unexplained Syncope

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