Original Article: Randomised open label cross-over pilot study comparing feasibility of S-patch vs 24 hour holter in Frail Older People with Falls (Preprint)
Bibliographic record
Abstract
Background: Falls commonly cause injuries in older adults and can present with syncope or presyncope. Typically, frail older adults with cognitive impairment are underrepresented in research and experience difficulty tolerating conventional ECG monitoring devices. S-Patch is a novel, lightweight dual-lead device designed to provide continuous ECG monitoring for up to 72 hours with minimal interference to daily activities. Objective: This study aimed primarily to evaluate the feasibility, tolerability, and adherence of the S-Patch compared with standard 24-hour Holter monitoring in older adults (aged ≥60 years) presenting with unwitnessed falls, syncope, or near-syncope, as assessed by wear duration, completion rates, and patient-reported experience. The secondary objective of this study was to assess device usability and compare arrhythmia detection rates between the devices in a real-world setting. Methods: This prospective, single-center, randomized, open-label, crossover feasibility pilot study was conducted from March 8, 2020, to February 28, 2023. Participants were randomized 1:1 into group A (Holter followed by S-Patch) or group B (S-Patch followed by Holter), enabling up to 4 days of continuous monitoring. Results: Seventy patients were enrolled, of whom 32 (45.7%) had cognitive impairment, and the majority were frail. Group A participants were older (86.9 vs 82.9 years) with higher use of dementia medications (6/35, 17.1% vs 3/35, 8.6%). Frailty was highly prevalent across the cohort, and fear of falling was significantly greater among frail patients (P=.04). Both devices were well tolerated, with no difference in overall device preference, but S-Patch enabled substantially longer monitoring durations compared to Holter. Mean S-Patch wear time exceeded 60 hours and was significantly longer when the device was applied first (68.8 vs 62.9 h; P=.04), suggesting acceptance and adherence. Importantly, tolerability was maintained in frail patients with cognitive impairment. Arrhythmia detection rates were observed as comparable, with both devices identifying one clinically significant arrhythmia, resulting in pacemaker implantation. Conclusions: S-Patch is a feasible, well-tolerated cardiac monitoring device in frail older adults and those with cognitive impairment. Compared with Holter, S-Patch supported longer continuous monitoring without compromising patient acceptability, an important consideration in real-world clinical practice.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.021 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".