FAPO-2: Cardiac Patient Monitoring Tool for Clinical Observation and Arrhythmia Detection

Overview

The FAPO-2 study (Patient Monitoring Tool for Clinical Observation and Arrhythmia Detection) is a prospective, interventional, non-randomized study designed to evaluate the feasibility, usability, clinical effectiveness, and cost-efficiency of a wearable-enabled remote monitoring strategy in adult cardiac patients. The intervention consists of active clinical management of patients via teleconsultations, triggered by automated alerts generated through wearable data integrated into a centralized digital platform. FAPO-2 will include patients with chronic cardiovascular conditions and those undergoing recent minimally invasive interventions. The central objective is to validate a structured model for early arrhythmia detection, remote risk stratification, and timely clinical action. A total of 520 patients aged ≥22 years will be enrolled, stratified by sex (1:1), and followed at the Heart Institute (InCor) of the University of São Paulo. Participants will be allocated into one of four protocol groups: Group 1 - Pilot (n=15): Healthy volunteers monitored for \~14±3 days using both the smartwatch and a portable holter system to validate usability, skin tolerability, signal integrity, and data flow within the platform. Group 2 - Extensive Outpatient Monitoring (n=150): Patients with chronic cardiovascular diseases monitored over a 45-day period. During 30 days, monitoring will be performed using a smartwatch to capture blood pressure, oxygen saturation, heart rate, and single-lead ECG. For 15 days, participants will use both the smartwatch (for HR and ECG) and a portable holter system. Group 3 - Extensive Post-Intervention Monitoring (n=50): Patients recently undergoing procedures such as angioplasty, TAVI, or ablation, following the same monitoring protocol as Group 2. Group 4 - Optimized Outpatient Monitoring (n=305): Patients with stable chronic cardiac disease monitored for 15±3 days, using both devices simultaneously for HR and ECG (smartwatch) and portable holter system.

Interventions

• Device Smartwatch - all data
  Single-lead ECG, blood pressure (BP), oxygen saturation (SpO2), and continuous heart rate (HR).
• Device Portable holter system
  continuous ECG monitoring for 14 days for comparison with the data from the smartwatch
• Procedure Telemonitoring
  Remote consultations triggered by critical alerts based on predefined thresholds.
• Other AI Model Development
  Data analysis using artificial intelligence for prioritization of patients based on health data collected from wearables.
• Device Smartwatch - ECG and HR
  Single-lead ECG and continuous heart rate (HR)

Primary outcome measures

• Incidence and number of Atrial Fibrillation (AF) events detected [Time frame: During the monitoring period for each group, as specified (14-45 days depending on group)]
• Number of critical health alerts generated by the FAPO-SI³ platform [Time frame: During the monitoring period for each group, as specified (14-45 days depending on group)]
• Patient risk classification generated by the AI model [Time frame: During the monitoring period for each group, as specified (14-45 days depending on group)]

Secondary outcome measures (2)

• Patient risk classification generated by the AI model [Time frame: During the monitoring period for each group, as specified (14-45 days depending on group)]
• Adverse events related to device use [Time frame: From enrollment through the monitoring period, up to 45 days depending on study group]

Eligibility criteria

Inclusion criteria

• Patients diagnosed with cardiovascular disease, of both sexes, aged over 22 years;
• Provision of informed consent through signature of the Informed Consent Form (ICF);
• Assentation to adhere to study procedures and requirements;
• Patients indicated for outpatient follow-up due to a cardiovascular condition, or with clinical parameters indicating the need for conventional surgical or catheter-based interventions (e.g., catheter ablation for arrhythmias, transcatheter aortic valve implantation, percutaneous coronary intervention, etc.);
• Low or no risk of skin injury, based on Braden Scale clinical criteria or clinical team assessment

Exclusion criteria

• Presence of skin conditions, such as vitiligo, lupus, or atopic dermatitis, as well as tattoos on the wrist that may interfere with the smartwatch's optical sensor readings;
• Known sensitivity or history of allergic reactions to components of the wearable devices or related items, such as adhesives or electrodes;
• Inability to properly use the wearable monitoring devices due to physical, cognitive, or technological limitations;
• Presence of a peripherally inserted central catheter (PICC) or arteriovenous fistula;
• Presence of implanted cardiac devices, such as pacemakers, defibrillators, or cardiac resynchronization devices, which prevent ECG acquisition via smartwatch;
• Diagnosis of conditions associated with narrowing or obstruction of the aorta and subclavian arteries (e.g., Stanford Type A chronic aortic dissection, Takayasu arteritis, Subclavian Steal Syndrome, or Kawasaki disease), which may cause discrepancies in blood pressure between upper limbs and interfere with study assessments.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Non-randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Health services research

Study locations

Brazil · 1 center

• Instituto do Coracao, HCFMUSP — São Paulo

Identifiers

NCT: NCT07174206 · 80963624.2.0000.0068

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗