People that need to have their hearts monitored fall into three main categories: those with pacemakers, those with occasional arrhythmias and those with implanted defibrillators at risk for heart failure. There are various methods to accomplishing the heart monitoring, with each varying in effectiveness.
Transtelephonic Monitor (TTM)
For heart arrhythmia patients, they usually wear a monitor where they push a button when they experience an arrhythmia, and the device records the heart rhythm. After the cardiac event has occurred, the patient transmits the information from the device over the phone.
In the case of pacemaker patients using transtelephonic monitoring devices, the patients place the device over the heart and then the phone receiver over the device. They then push a button to activate the device, and the heart rhythm information goes over the phone line.
Defibrillator with Wireless Monitoring System
Another type of remote monitoring consists of an implanted defibrillator in the patient’s chest which has an antennae attached that transmits data to a wireless system in the patient’s home. Data from the wireless system is automatically uploaded to a server that can be accessed by the physician anytime and anywhere. The system records the data before, during and after an arrhythmia. It also has a weight scale and a blood pressure monitor to monitor patient’s vital signs, which can be important in avoiding heart failure.
Heart Monitoring Device with Bedside Monitor
A variation on the aforementioned wireless system is not just for implanted defibrillator patients but can also be used for patients with pacemakers and implantable heart monitors. The patient has to be within 3 meters of the bedside monitor, at which time data from the heart device transmits automatically to the bedside monitor, which then transmits over the phone line to a secure server. Patients also have the ability to make manual transmissions. A drawback of the system is the requirement for the patient to have a phone landline, and it cannot be a digital landline which is incompatible with the system.
A remote system made by a German company solves the telephone problem by transmitting data from the implanted cardiac device via a GSM network to be evaluated, instead of using a phone landline system.
Continuous Remote Monitoring with a Smartphone
A newer method of heart monitoring uses smartphones with analytical software and electrodes to deliver real-time heart rhythm results with automated reporting. At any time while the patient’s heart is being monitored, the patient’s physician can order a report that is transmitted by SMS or email. At the end of the review period, the smartphone automatically transmits a report to the patient’s doctor. The heart monitoring occurs 24 hours a day and 7 days a week up to 90 days.
Effectiveness of the Methods
The Journal of the American College of Cardiology published a study on pacemaker patients comparing remote monitoring to transtelephonic monitoring. The results were that clinically relevant events were diagnosed significantly sooner with remote monitoring and many more cardiac events were recorded remotely (66%) versus transtelephonically (2%).
A remote monitoring system for patients in Calgary, Alberta, Canada has decreased needed clinic visits from every three months to once per year.
An additional reason for decreased clinic visits is many of the current pacemakers and implantable cardiac devices are able to perform checks for battery status, lead impedances, or sensing and capture thresholds that used to have to be performed manually in the clinic.
Remote Monitoring vs. In-office Care
Several small and large studies have determined that remote monitoring is safe and effective regarding patients with implanted cardiac devices (pacemakers and defibrillators). Safety and quality of care was equivalent or better than in-office care. The risk of missing a clinical event that required a clinical visit was calculated at between 0.1 and 0.46%. The number of clinical visits by patients being remotely monitored decreased by 50-75%. The time spent by physicians in pacemaker device monitoring during the visit decreased by 40-70% as compared to conventional visits. Additionally, the reaction time for major events was less than half of those monitored conventionally ie. The reaction time for major events was 3.0 days for the remotely-monitored patients vs. 6.6 for the conventionally monitored patients.
This is a guest post from contributing author Charlie Oszvald. Charlie is writing for Everist Genomics, a personalized medicine company which develops and commercializes medically unique diagnostics, prognostics and therapeutic selection technologies.