Deployment of remote advanced electrocardiography for improved cardiovascular risk assessment in career firefighters

Firefighters perform strenuous muscular work while wearing heavy, encapsulating personal protective equipment in high temperature environments, under chaotic and emotionally stressful conditions. These factors can precipitate sudden cardiac events in firefighters with underlying cardiovascular disease. The purpose of this pilot study was to deploy and explore the feasibility of the resting "advanced" 12-lead electrocardiogram (A-ECG) as a remote firefighter risk assessment tool for improved assessment of cardiac risk.

Conventional 12-lead resting electrocardiograms (ECGs) were collected for 5 min by using high-fidelity PC-based ECG hardware and software while subjects (n=21) rested comfortably. Raw data from the ECG system were securely transported via a secure network to a server where they were archived and processed. Authorized personnel performed both conventional ECG and A-ECG analyses from each digital recording, generating A-ECG "scores" in a blinded fashion. A separate cohort of firefighters (n=6) was trained to administer the A-ECG and rated the system's usability and frequency of technical problems.

Of the 21 uniformed personnel who completed testing, only 1 had a positive A-ECG score for coronary artery disease, which was subsequently confirmed by a cardiologist. All other subjects were classified as healthy by A-ECG. Firefighters trained to administer the A-ECG responded favorably in rating the usability of the system.

We have demonstrated that a new technology, A-ECG, can be deployed for remote firefighter risk assessment being performed by firefighters themselves and interpreted centrally. This simple, time- and cost-effective approach can help identify individuals potentially at increased risk for line-of-duty death due to underlying cardiovascular disease.