Abstract

Introduction

This research is meant to establish if a patient monitored with mobile cardiac telemetry (MCT) sees different outcomes regarding diagnostic yield of arrhythmia, therapeutic management through the use of antiarrhythmic drugs, and cardiovascular costs incurred in the hospital setting when compared with more traditional monitoring devices, such as the Holter or the Event monitor.

Materials and methods

We conducted a retrospective analysis spanning 57 months of claims data from January 2007 to September 2011 pertaining to 200,000+ patients, of whom 14,000 used MCT only, 54,000 an Event monitor only, and 163,000 a Holter monitor only. Those claims came from the Truven database, an employer database that counts 2.8 million cardiovascular patients from an insured population of about 10 million members. We employed a pair-wise pre/post test-control methodology, and ensured that control patients were similar to test patients along the following dimensions: age, geographic location, type of cardiovascular diagnosis both in the inpatient and outpatient settings, and the cardiovascular drug class the patient uses.

Results

First, the diagnostic yield of patients monitored with MCT is 61%, that is significantly higher than that of patients that use the Event monitor (23%) or the Holter monitor (24%). Second, patients naive to antiarrhythmic drugs initiate drug therapy after monitoring at the following rates: 61% for patients that use MCT compared with 39% for patients that use the Event and 43% for patients that use the Holter. Third, there are very significant inpatient cardiovascular savings (in the tens of thousands of dollars) for patients that undergo ablation, coronary artery bypass graft (CABG) and valve septa. Savings are more modest but nonetheless significant when it comes to the heart/pericardium procedure.

Conclusion

Given the superior outcome of MCT regarding both patient care and hospital savings, hospitals only stand to gain by enforcing protocols that favor the MCT system over the Event or the Holter monitor.

Keywords: mobile cardiac telemetry, Holter monitor, Event monitor, diagnostic yield, arrhythmia
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Comparison with 12 Lead Clinical ECG

Wireless, pocket-sized ECG monitor: A potential tool used in the detection of Cardiovascular Disease
Debashree Ghosh; Neha Rastogi; Rahul Rastogi
ABSTRACT
Recent technological advancements in medical/healthcare and mobile computing has caught attention of researchers for remote health monitoring systems. The application of mobile technology in health monitoring enables remote monitoring of people which helps to (a) improve the communication between health care professionals and patients and (b) provide timely action in case of emergency.
Smartphones have now become the integral part of people’s lives and therefore these devices can integrate healthcare more seamlessly into everyday lives. The primary objective  was to develop a reliable and efficient remote heart monitoring system that would help healthcare professionals monitor their patients remotely. Also the users can make use of this technology in their routine lifestyle for cardiac care and get timely support anytime, anywhere in case of emergencies.
This paper presents information about accuracy of a Smartphone ECG monitor which is pocket-able, lead less, supporting up to 6 lead and having remote sharing functionality. The accuracy of measurement in terms of sensitivity and specificity is done in comparison with a typical traditional ECG machine. The possible need, usage and potential benefits of such as device from the point of view of the patients is assessed via interviewing the people.
The proposed device is mechanized by a Sanket app running on compatible iOS and Android phones that connects wirelessly via Bluetooth technology to the device. Six lead ECG can be measured anytime, anywhere and the reports can be easily downloaded and instantly shared with the healthcare professional for immediate clinical advice. The ECG reports are also saved in cloud for future reference. The device mainly consists of electronics such as sensors, comparators, filters and Bluetooth chip. In this study, the ECG variables namely Heart Rate, PR, QRSD, QT & QTc  were monitored, displayed and saved in our system. The proposed device was field tested to establish the accuracy and reliability. The test results showed that our device was able to measure the ECG variables with a high accuracy.
METHODOLOGY
This study was conducted for 1-week in a hospital at Gurgaon with 28 participants in total. Patient consent was obtained from all participants by signature on the consent form. They were educated about the objectives of the study and guidelines for using the data for publication purpose. The sample size consisted of patients who had some previous history of cardiovascular disease and patients with related symptoms of cardiovascular disease. 12 lead ECG was captured for all the 28 participants using standard 12 lead ECG machine namely GE2000 by the standard procedure of using gel and placing electrodes at appropriate position on the body while the patient is lying horizontally. Immediately, 6 lead ECG was captured using Sanket for all the participants. The Sanket device captured the signals just by touch and transmitted it over Bluetooth to the connected phone which had the app running. All the baseline ECG parameters namely HR, PR, QT, QTc, QRSD were captured using both the standard 12 lead & 6 lead ECG. The accuracy and efficiency of the ECG variables from Sanket were measured by comparison of the respective data from the GE machine. The ECGs captured by Sanket were also analyzed and interpreted by automated algorithms built in the application.
ECGs reports were analyzed for the presence of abnormal rhythm or beats. The cardiovascular diseases interpreted by 12 lead ECG machine were observed for visibility in the 6 Lead ECG by Sanket.
STATISTICAL  ANALYSIS
It was observed that in comparison with the standard 12 lead ECG machine GE 2000, Sanket was able to correlate the following cardiovascular diseases – Left Axis Deviation, Ectopic PVC beats, Hyperkalaemia , WPW, RBBB, Right Axis Deviation, Ischemia, Left Atrial Hypertrophy, LBBB, First Degree Heart Block, Myocardial Ischemia, STEMI. The ECG reports captured by Sanket were able to correlate cardiovascular diseases in 18 participants similar to standard 12 lead ECG machine which also detected cardiovascular disease in 18 patients.  Statistical analysis showed that 15 participants were true positive (i.e. cardiovascular disease was detected on both the ECG captured by 12 lead machine and Sanket). 3 participants were false positive (i.e. cardiovascular disease was detected on the ECG captured by Sanket and not by 12 lead machine). 3 participants were false negative (i.e. cardiovascular disease was detected on the ECG captured by 12 lead machine and not by Sanket. 7 participants were true negative (i.e. cardiovascular disease was not detected in either of the ECG reports captured by 12 lead machine and Sanket.