At the time of our ECG trends forecast in December 2020, a confluence of factors had been taking shape that would set the scene for predictions about the future of ECG in 2021. As we look at the trends a year later, where were we right, and where were we off? And what might current trends indicate about ECG in 2022?

Looking Back on 2021

To be certain, all three trends discussed in the 2021 forecast (wearables, AI, and COVID-19) were exactly on target. Advanced technologies such as AI and wearables were seen as the future of ECG, and rightly so, given ongoing developments in regulatory movement, public enthusiasm, and R&D innovation. Further, the heart complications surrounding COVID-19 continue to validate ECG's application and value in diagnostic decision-making.

Still, some nuances have emerged in 2021 that now inform 2022's predictions. Notably, FDA approval of ECG-capable wearables as well as innovations in remote cardiac care have evolved the industry's understanding of what's possible in at-home monitoring, and the ongoing pursuit of optimized algorithms is helping to improve those technologies' prior shortcomings. Additionally, more data from COVID-19 has revealed new insights and considerations for patients with cardiovascular disease.

Trends in 2022

In light of the ECG developments we've seen in 2021, here's what to look for in 2022:

1. FDA-Approved ECG Smartwatches

While the FDA approval race for ECG-capable smartwatches began in 2018 with the Apple Watch—and later intensified with three other approvals in 2020 and 20211—the year ahead could be the most active one yet. This is thanks to two emerging developments in the wearable space: positive public sentiment, which enables widespread user adoption, and advancements that give the technologies more clinical legitimacy.

On the consumer side, buzz related to ECG-capable smartwatches has catalyzed public interest, particularly through wearables' inclusion on 2021 holiday gift guides. Aesthetic upgrades, such as those seen with the FDA-approved Withings ScanWatch, make health wearables seem less like medical devices and more like stylish accessories.2

Clinically, ECG smartwatches are becoming more advanced thanks to algorithmic innovations. In the future, such advancements could boost sensitivity and help to identify atrial arrhythmias that other platforms, such as the Apple Watch, may miss.3 Moreover, wearable manufacturers are increasingly requiring physician involvement, and while one consumer group cited that as a "con,"2 it most certainly has its clinical advantages with respect to the future of ECG.

2. Even More COVID-19 Considerations

Another year of COVID-19 has added to cardiologists' understanding of the disease's impact on the heart muscle. Importantly, 2021 research corrected an earlier hypothesis that the SARS-CoV-2 virus directly damages the heart. Instead, the heart may be a "bystander of injury," according to the American College of Cardiology (ACC).4

For 2022, this discovery has bearing on the workup of patients with underlying heart conditions as well as those without them. For the former group, ECG will continue to be a critical tool, especially given the need to corroborate high troponin values with waveforms or imaging. For patients without known underlying heart conditions, the potential long-term cardiac effects of a previous COVID-19 infection will continue to validate surveillance in this growing group.

Additionally, uncertainties surrounding future variants in 2022, such as the omicron variant, which is currently under evaluation, could impact cardiac monitoring and interventions, especially if vaccine immunity does not hold up to these possible mutations. For example, the delta variant more than doubled the risk of hospitalization compared to the alpha variant and was particularly concerning for people with underlying disease, including cardiovascular disease.5

3. Growing Confidence in Remote Cardiac Care

As the pandemic continues increasing the need for virtual care,6 the intersections between telehealth and cardiology will become more prominent in 2022.

For instance, telehealth has been critical to remote cardiac monitoring, which is gaining ground thanks to algorithmic innovations in AI. As with the smartwatches, these improvements could support significantly better predictive values and sensitivities of ambulatory ECG devices, potentially helping to boost clinicians' confidence in at-home surveillance.

Notably, the broadening of telehealth and expanding access to care will continue to be important healthcare themes in 2022.7

Stay on top of cardiology trends and best practices by browsing our Diagnostic ECG Clinical Insights Center.

Year After Year, ECG Is a Vital Tool

2021 ushered in many new developments and discoveries, and 2022 will undoubtedly bring additional insights concerning wearables, remote care, and COVID-19. ECG will remain a vital tool in the diagnostic cardiology toolbox, and its presence is expanding across inpatient, outpatient, and home settings.

REFERENCES

1. Lovett, L. Withings scores FDA clearance for smartwatch ECG and SpO2 monitoring. MobiHealthNews.com. https://www.mobihealthnews.com/news/withings-scores-fda-clearance-smartwatch-ecg-and-spo2-monitoring. Accessed December 6, 2021.

2. Duffy, J. Withings ScanWatch. PCMAG. https://www.pcmag.com/reviews/withings-scanwatch. Accessed December 6, 2021.

3. Diagnostic and Interventional Cardiology. New study shows Cardiologs' deep learning AI outperforms the Apple Watch ECG algorithm in detecting atrial arrhythmias. Dicardiology.com. https://www.dicardiology.com/content/new-study-shows-cardiologs-deep-learning-ai-outperforms-apple-watch-ecg-algorithm-detecting. Accessed December 6, 2021.

4. Chilazi M, Duffy E, Thakkar A, et al. Intermediate and long-term impact of COVID-19 on cardiovascular disease. American College of Cardiology. April 2021. https://www.acc.org/latest-in-cardiology/articles/2021/04/21/13/08/intermediate-and-long-term-impact-of-covid-19-on-cardiovascular-disease. Accessed December 6, 2021.

5. Twohig KA, Nyberg T, Zaidi A, et al. Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern: a cohort study. The Lancet Infectious Diseases. August 2021. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00475-8/fulltext.

6. Maxwell YL. Who is using telehealth for cardiology care during COVID-19? TCTMD.com. https://www.tctmd.com/news/who-using-telehealth-cardiology-care-during-covid-19. Accessed December 6, 2021.

7. Crotty BH, Hyun N, Polovneff A, et al. Analysis of clinician and patient factors and completion of telemedicine appointments using video. JAMA Network Open. 2021;4(11):e2132917. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2785800.

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