By Stuart Long
Cardiac monitoring technology has changed exponentially since a rolled-up newspaper was used as the first stethoscope more than 200 years ago.
Fortunately, the first cardiac monitoring device was more sophisticated. Invented in 1947 by Dr. Ben Holter, the initial iteration of the Holter monitor resembled an apparatus from early science fiction novels.
Eventually, the Holter monitor was reduced to the size of a deck of cards, making it wearable and portable. This major medical technology breakthrough helped save an untold number of lives for decades.
Today, the latest and most-advanced cardiac monitors are helping doctors track and diagnose cardiac events earlier than ever before.
Technological advances including data storage, artificial intelligence and secure, HIPAA-compliant telecommunications have converged to make cardiac monitoring faster, less invasive and more convenient for both patients and doctors to review medical data.
These advancements are especially timely given the country’s aging population. The U.S. Census Bureau’s 2017 National Population Projections shows that by 2030, all baby boomers will be over age 65 and 1 in 5 people will be retirement age. For the third consecutive year, U.S. life expectancy has dropped, with heart disease and cancer accounting for 2.8 million deaths in 2017 and 44 percent of deaths overall.
Digital health advancements have the potential to change these statistics. The latest advancements in remote cardiac monitoring in particular are disrupting healthcare by:
- Replicating inpatient telemetry in a mobile setting;
- Monitoring and detecting arrhythmias including onset and offset data to capture symptomatic and asymptomatic events;
- Transmitting high-value, full-disclosure data directly to the healthcare provider, securely and in near real-time;
- Saving valuable time for both physicians and patients by allowing practices to bypass third-party independent diagnostic and testing facilities (IDTFs);
- Encouraging higher patient compliance due to ease of use, and;
- Fostering higher patient engagement with their physicians and their own health, stimulating valuable lifestyle changes.
According to the Centers for Disease Control and Prevention, 47 percent of sudden cardiac deaths occur outside a hospital. Clinical studies on remote cardiac monitoring have shown that it reduces 1) time needed to detect clinical events1, 2) hospitalizations2, 3) all-cause mortality over three years3, and; 4) healthcare costs.3
Patients typically require fewer follow-up visits1, are admitted to the hospital far less1 and have shorter stays when they are admitted.4
Limitations of Older Technologies
Until recently, cardiologists trying to diagnose and treat arrhythmias had to deal with technological limitations in data transmission, storage and analysis. Clinicians were forced to rely IDTFs to read remote cardiac monitoring data and then phone, fax or email the medical events back to the practicing physician.
Even more significantly, 95 percent or more of the data is deleted or not reviewed during the processing and interpretation phase of the exam. IDTFs may catch an arrhythmia during the monitoring period and send the physician a short 20-or 30-second strip. It means that all too often, the cardiologist never saw the critical onset and offset data in the minutes immediately prior to and after the arrhythmia—making it impossible to correlate activities or symptoms with rhythmic events.
Remote cardiac monitors help doctors detect and diagnose cardiac arrhythmias, which are irregular electrical activities in the heart that cause it to beat too rapidly, too slowly or erratically.
Standard cardiac tests such as the electrocardiogram (ECG) show a patient’s heart activity at rest and at a specific point in time. However, abnormal heart rhythms and symptoms of cardiac events aren’t consistent and can occur without the patient even being aware of them. This means physicians may not have enough data to make effective decisions or diagnoses.
It’s a different story with the newest remote cardiac monitors. Through any internet-connected device, cardiologists can securely monitor every heartbeat over extended periods of time and identify potentially dangerous arrhythmias as they happen. If a patient is experiencing symptoms, the cardiologist can quickly see up-to-the-minute data and make a critical cardiac arrhythmia diagnosis instantly.
One of the most common arrhythmias is atrial fibrillation (AFib), an irregular heart rhythm that causes the upper chambers of the heart to contract abnormally. Studies show that AFib quintuples the risk of stroke and doubles the risk of early death. About 35 percent of AFib patients will have a stroke during their lifetime and the prevalence increases with age, doubling each decade after the age of 55, according to a widely cited study in the Annals of Thoracic Surgery.
By the year 2030, more than 12 million people in the U.S. will have AFib, largely due to an aging population and increases in obesity, heart failure and sleep apnea. Multiple studies indicate that remote cardiac monitoring is more likely to identify AFib, its triggers and symptoms.
Overall, the ability to interpret and diagnose cardiac events in near real-time is a game changer for cardiac patients.
About the Author
Stuart Long is the CEO of InfoBionic, a Boston-based digital health company that developed and manufactures the MoMe® Kardia ambulatory cardiac monitoring platform. Formerly the CEO of Monarch Medical Systems, Long has over 20 years of leadership experience in the medical device industry, holds dual registries in non-invasive diagnostic echocardiography and has held leadership positions in hospital-based radiology and non-invasive cardiology settings.
1. Mabo, P., Victor, F., Bazin, P., Ahres, S., Babuty. D., Da Costa, A., … Dauber, J. C., & COMPAS Trial Investigators. (2012). COMPAS Trial Investigators. A randomized trial of long-term remote monitoring of pacemaker recipients (the COMPAS trial). European Heart Journal, 33, 1105-1111. http://dx.doi.org/10.1093/eurheartj/ehr419
2. Sutton, B., Zigler, J., Gopinathannair, R., Deam, G., & Graver, R. (2013). Improved health outcomes and cost-savings with remote monitoring of cardiac implantable electronic devices. Presented at the meeting of the Heart Rhythm Society, Denver, CO. Retrospective claims analysis of Medicare 5% sample Limited Data Set Standard Analytical Files claims and enrollment data across all manufacturers.
3. Varma N, Piccini JP, Snell J, Fischer A, Dalal N and Mittal S. Relationship Between Level of Adherence to Automatic Wireless Remote Monitoring and Survival in Pacemaker and Defibrillator Patients. J Am Coll Cardiol. 2015. 65(24):2601-2610.http://dx.doi.org/10.1016/j.jacc.2015.04.033
4. Varma, N., Epstein, A. E., Irimpen, A., Schweikert, R., Love, C., & TRUST Investigators. Efficacy and safety of automatic remote monitoring for implantable cardioverter defibrillator follow-up: The Lumos-T Safely Reduces Routine Office Device Follow-Up (TRUST) trial. Circulation, 122, 325-332. http://dx.doi.org/10.1161/circulationaha.110.937409