Comparative Analysis of the Equivital EQ02 Lifemonitor with Holter Ambulatory ECG Device for Continuous Measurement of ECG, Heart Rate, and Heart Rate Variability: A Validation Study for Precision and Accuracy

Abstract

Background: The Equivital (EQ02) is a multi-parameter telemetric device offering both real-time and/or retrospective, synchronized monitoring of ECG, HR, and HRV, respiration, activity, and temperature. Unlike the Holter, which is the gold standard for continuous ECG measurement, EQO2 continuously monitors ECG via electrodes interwoven in the textile of a wearable belt.Objective: To compare EQ02 with the Holter for continuous home measurement of ECG, heart rate (HR), and heart rate variability (HRV).Methods: Eighteen healthy participants wore, simultaneously for 24 h, the Holter and EQ02 monitors. Per participant, averaged HR, and HRV per 5 min from the two devices were compared using Pearson correlation, paired T-test, and Bland-Altman analyses. Accuracy and precision metrics included mean absolute relative difference (MARD).Results: Artifact content of EQ02 data varied widely between (range 1.93–56.45%) and within (range 0.75–9.61%) participants. Comparing the EQ02 to the Holter, the Pearson correlations were respectively 0.724, 0.955, and 0.997 for datasets containing all data and data with < 50 or < 20% artifacts respectively. For datasets containing respectively all data, data with < 50, or < 20% artifacts, bias estimated by Bland-Altman analysis was −2.8, −1.0, and −0.8 beats per minute and 24 h MARD was 7.08, 3.01, and 1.5. After selecting a 3-h stretch of data containing 1.15% artifacts, Pearson correlation was 0.786 for HRV measured as standard deviation of NN intervals (SDNN).Conclusions: Although the EQ02 can accurately measure ECG and HRV, its accuracy and precision is highly dependent on artifact content. This is a limitation for clinical use in individual patients. However, the advantages of the EQ02 (ability to simultaneously monitor several physiologic parameters) may outweigh its disadvantages (higher artifact load) for research purposes and/ or for home monitoring in larger groups of study participants. Further studies can be aimed at minimizing the artifacts.

Can Wearable Devices Accurately Measure Heart Rate Variability? A Systematic Review

“…17 Akintola et al (2016) used a chest wearable device detecting ECG and HRV and reported enormous amount of artifacts during daily activities in 18 healthy subjects and they concluded that this is a limitation of the wearable device used. 13 In agreement with all of the above, another study showed that the limits of agreement were deteriorating as the exercise was intensifi ed, implying an infl uence of adrenergic input, respiratory effort and unreliable algorithm detection and recording RR ability. 19 In contrast to the many negative results reported during intense exercise, there are other researchers who reported an overall stronger agreement.…”

“…11 Also, one study examined children. 12 In most of the articles (n=16), a chest device was used, [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] while a fi nger device was used in two studies 26,27 . Sixteen of the studies utilized a similar to ECG -HRV technology [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] and the remaining two integrated PPG -PRV technologies 26,27 .…”

Entropy Analysis of Short-Term Heartbeat Interval Time Series during Regular Walking

“…Ambulatory HRV monitoring, however, appears to attracted increasing attention nowadays [9]. The long-term ambulatory measurement facilitates the track of HRV changes with activities of free living (e.g., exercise) [10].…”

Wearable Sensor System to Monitor Physical Activity and the Physiological Effects of Heat Exposure

“…When compared to other available systems, such as the Equivital LifeMonitor TM , the presented armband device offers the easy adaptability for individualized comfort. Though the Equivital offers accurate measurements of heart rate and heart rate variability via ECG, it is still susceptible to motion artifacts [29]. Proprietary software, Vivosense, can handle these artifacts, but at additional cost.…”