Telerhythmics, Author at Telerhythmics Telerhythmics

The future of cardiac monitoring – what’s changing and what you need to do about it

Since the 1990s, cardiac monitoring devices have evolved from transmitting data via a phone line, to wirelessly, to now leveraging Bluetooth and cellular technology. Although the process of cardiac monitoring hasn’t changed significantly, the devices are much smaller, have fewer pieces, and are more comfortable for patients to use. Let’s take a look at where cardiac monitoring is headed and what the future holds.

Back to the future…

The most recent trend in cardiac monitoring relies on a tried-and-true method from the past – Holter monitoring. Many cardiologists and physicians have started using long-term Holter monitoring as a way to capture more data and improve diagnostic accuracy.

The release of a Medicare code for an extended Holter has made it a viable alternative to newer, long-term monitoring options that are not yet guaranteed for reimbursement. Wearing a Holter for up to a week dramatically increases the amount of diagnostic data that is captured and is proving to be much more useful than a traditional 24- or 48-hour Holter.

Where cardiac monitoring is headed

While Holter monitoring remains popular, manufacturers and developers are using technology to redefine the future of cardiac monitoring.

The future of cardiac monitoring hardware development is centering around the creation of a one-piece monitoring system that has a transmission component built into the form factor. Additionally, given the challenges with returning and maintaining inventory, it’s likely that cardiac monitors of the future will evolve into a cost-effective and disposable version that patients simply throw away when the monitoring period is complete.

On the software side, today’s new platforms are cloud-based, which allows for more power and greater capabilities. The cloud offers more algorithm computation power as compared to the device. This power provides improved specificity, accuracy, and sensitivity. In the future, manufacturers will be able to push updates directly to a network of devices from the cloud and automatically upgrade subscribers to the most current software version.

Everyday personal wearable devices that include monitoring, like the Apple Watch or Fitbit, will also undoubtedly play a role in cardiac monitoring. In the future, apps will accurately provide two-way communication between physicians and their patients. It’s not far-fetched to think that a watch or similar device could recognize a cardiac abnormality and lay the foundation for more targeted cardiac tests.

The limitations of technology

While technology has and will continue to drive the size and capability of cardiac monitoring, it hasn’t been able to automate or improve on the art of reading test results, which still requires an educated and highly trained staff.

While advanced software and algorithms are crucial in improving healthcare, without skilled cardiac trained registered nurses to read the data, alert doctors to authentic abnormalities, and communicate the appropriate urgency, it doesn’t matter how or to what degree it’s been captured. The human side of cardiac monitoring remains vital in the diagnostic process.

In time…

It’s undeniable that technology will continue to impact the future of cardiac monitoring. Smarter software and algorithms combined with cheaper and more accurate devices will continue to improve results. For truly futuristic advances, accuracy and reliability are significant factors that need improvement. However, science, technology, and innovation are continually working together, and these possibilities will, in time, become a reality.

How do Mobile Cardiac Telemetry systems work?

Mobile cardiac telemetry (MCT) is a cardiac monitoring method that uses a small portable device to monitors a patient’s cardiac activity. It records the patient’s heartbeat as they run errands, exercise, and sleep. How exactly does it work, though? How is the data captured and what happens if their heart starts beating too fast, or they feel a few palpitations? We’ve put together a summary of what happens when a physician prescribes an MCT monitor:

The setup

When a physician orders an MCT device for a patient, they’ll also register the patient with their cardiac monitoring provider. The patient will either have the electrodes connected while they are in the office, or the MCT device will be delivered to the patient’s home and the patient will connect the electrodes themselves. The process is not difficult and easy to understand instructions accompany the device.

Once the patient is ready, the monitoring system’s office will activate the MCT device. A baseline test will be collected from the patient, and the information will be sent wirelessly across the mobile network. As soon as the test results are successfully received and confirmed, the patient is free to go about their day.

Beat-to-beat analysis

Some MCT systems feature beat-to-beat analysis, which captures every heartbeat that aggregates over a 24-hour period. No data is ever lost, even when the patient wanders out of the network’s range. In that case, the device will store the data until the patient enters back into range. With access to this level of data, physicians are able to make the most accurate and confident diagnosis.

The mobile cardiac telemetry device is also able to record patient-activated or symptomatic tests, where the patient is able to manually push a button and enter the symptoms when they feel them. The device also auto-triggers for bradycardia, tachycardia, pauses, or atrial fibrillation (AFib).

The data collected through the continuous electrocardiogram is being transmitted to the monitoring center and is reviewed by professionally trained staff, who are looking for any abnormalities as they occur.

Reporting heart behavior

Any symptomatic or auto-triggered events are analyzed as they are received by the monitoring center. In addition, the patient’s full disclosure data is reviewed for onsets and offsets of elusive arrhythmias that may not have been felt by the patient, or any other anomalies. They also quantify AFibs and pauses, calculating the percentages of tachycardia, bradycardia, and compiling a comprehensive list of calculations. Once the study is complete, an end of study report is created and sent to the physician.

MCT is one of the most effective methods of cardiac monitoring. The ability to analyze every heartbeat with little interference to the patient’s normal day, and the opportunity to initiate an immediate emergency response as needed, makes it one of the most attractive choices in today’s market. It delivers advantages to both the patient and the physician that can lead to more efficient care.

What is the best cardiac monitoring system for a small practice?

Cardiac monitoring systems come in many shapes and sizes. From Holter to telemetry to EKGs, there is a system to meet your needs whether you’re a hospital or a small practice. If you’re seeking to add cardiac monitoring, upgrade your equipment, or change providers, you’ll need to weigh a few key factors and answer some important questions before making a decision.

Payment and Ownership Options

A popular choice for smaller practices is to utilize a service where the monitors are provided without a direct expense and only billed when the equipment is used. Patients are set up with the device and the practice bills the professional component while the cardiac monitoring provider bills the technical component.

Alternately, a lease ownership model has proven to be successful for hospitals and larger facilities. It’s a substantial capital investment, and there are additional staff responsibilities that accompany the lease ownership agreement. It takes staff resources for effective management, so if the lease ownership option runs the risk of becoming a burden, it’s not the best fit for your practice.

Attention, attention!

Another issue you’ll want to consider is the level of service you need from your cardiac monitoring provider. Larger facilities may not need any additional training or extra attention, so a company that services thousands of other practices isn’t a concern for them. However, a smaller practice might want to consider a company that will take the time to set up training, answer questions, respond quickly and makes their account a priority. A smaller service company will offer more personal service, open dialogue when it comes to issues, and greater flexibility in finding solutions. Integrated practices or hospitals are able to manage multiple relationships across different vendors, but a small practice may require a cardiac monitoring provider that delivers a full range of services.

Mix it up

Even if you’re comfortable with a single monitoring method, offering a mix of modalities is a smart recommendation. Begin with what you’ve used historically and work with your service provider to add newer monitoring options into your workflow. One of the most common mistakes practices make when choosing a service provider is falling in love with the newest novelty. Like a shiny new toy, it’s the latest fad with the coolest look, in the prettiest box. Unfortunately, it may not deliver the best diagnostic capabilities and you’re back to square one.

Generally, cardiac monitoring seems to work best when practices that value personal attention work with cardiac monitoring providers who can focus on their needs. Finding a provider that meets your individual needs and makes you a priority is the smart way to make your cardiac monitoring successful.

Diagnosing Syncope: Event monitors vs. MCT

Syncope, also known as fainting, is a temporary loss of consciousness and is characterized by its quick onset and short duration. Although the majority of people can say they’ve passed out at least once in their lives, it can also be a sign of a more serious condition.

Diagnosing Syncope: Event monitors vs. MCT

In an attempt to diagnose unexplained syncope, physicians will typically choose to prescribe either an event monitor or an MCT monitor. Both have the ability to record a symptomatic episode as well as automatically trigger a non-symptomatic episode recording if the patient’s heart rate is too fast, too slow, pauses too long or is beating irregularly. The added value of MCT, however, is the beat-to-beat analysis.

What is beat-to-beat analysis?

Beat-to-beat analysis allows the physician to monitor every heartbeat over the entire period of time in which the patient is wearing the device. They are not only able to see the activity that led to syncope, but are also able to see any rhythms that could have potentially led the patient down that path, but didn’t.

The information a physician gleans from MCT’s beat-to-beat analysis can be what changes the clinical outcome for the patient. The event may fall into the “normal” category, but now you’ll be able to expand on why it happened and can help to show the patient the circumstances around the normal fluctuation. The analysis may also help determine if there’s an action to be taken. With an event monitor, you might not have the opportunity to consider these options because the information would not be available. In addition, there is no dependence upon whether an algorithm is working properly with MCT. It delivers the data with 100% certainty because it’s collecting every single beat around the clock.

The flexibility of MCT

When a patient visits your office with an issue, you want to order the most appropriate, cost-effective test. While we know that identifying elusive syncope symptoms is not its primary function, the beat-to-beat analysis of MCT is a substantial benefit to the cause. It can alleviate additional and unnecessary future testing and quickly and confidently identify the issue at hand.

Diagnosing Syncope: Event monitors vs. MCT

What is beat-to-beat analysis?

The flexibility of MCT

Are all MCT’s Created Equal?

As cardiac monitoring technology has developed, mobile cardiac telemetry (MCT) has proven to be the most effective method for identifying and managing patients with asymptomatic arrhythmias, complete syncope, medication titration, post CABG, and post ablation. But are all MCT devices the same? The short answer is no.

The next generation of MCT

The Telerhythmics TCAT3 is a mobile cardiac telemetry device that incorporates the most industry advanced features and is supported by a staff of seasoned clinical experts. The device includes onboard patient compliance technology, is flexible, single component, and easy to use. The clinical features include Beat-to-Beat Analysis and Full Disclosure.

The TCAT3 Advantage

While there are many MCT systems available, the TCAT 3 has several advantages, including:

A higher diagnostic yield, particularly when compared to holter or event monitoring.
Improved outcomes when managing patients on antiarrhythmic drugs.
Substantial cost savings in the hospital for ablation, CABG, heart/pericardium, and valve/septa procedures.
Immediate access to potentially dangerous cardiac rhythms.
The accurate and continuous capture of ECG information and the relay of critical data to the physician promptly and without the need for patient participation.

A Closer Look at MCT Features

Mobile cardiac telemetry devices and providers offer widely different features, and it’s important to know what type of MCT is being used before making a decision. Items such as Beat-to-Beat Analysis percentage, type of disclosure, and patient compliance requirements will all affect the net results. The chart below compares four types of MCT solutions and highlights the options you have.

MCT (Mobile Cardiac Telemetry) device comparison chart

How to compare cardiac monitoring options

Cardiac monitoring is focused on the collection and interpretation of a patient’s heart rhythm. Different technologies have been developed to accomplish this goal, each with different features and methods for collecting the data. These methods include:

Holter

A Holter monitor is a short-term, continuous monitoring device that tracks the heart rhythm of a patient with small electrodes that attach to the skin. The devices are typically worn for 24–48 hours and then returned for download and analysis.

Event

Event monitors offer longer term monitoring in which the patient can trigger a recording if they are feeling symptomatic. Some event monitors can auto trigger based on internal algorithms for tachycardia, bradycardia, pause, or atrial fibrillation.

Mobile Cardiac Telemetry

Mobile Cardiac Telemetry, or MCT, allows for longer term monitoring with the ability for patient or auto-triggered events based on algorithms. Generally speaking, MCT devices “sample” or “trend” ECG samples periodically throughout the day.

TCAT3

The TCAT3 is a TELErhythmics Cardiac Ambulatory Telemetry device, which is designed for longer term monitoring. It collects every heartbeat in order to detect elusive arrhythmias. The patient can trigger recordings or the device can auto trigger based on internal algorithms for tachycardia, bradycardia, pause, or atrial fibrillation. Data is transmitted wirelessly for near real-time analysis.

Comparing Cardiac Monitoring Options

There are countless devices that allow physicians to offer cardiac monitoring services. To help you understand the differences between the various methods, we’ve compared the technologies in the chart below.

cardiac-monitoring-options-compare-chart

Key differences between Holter Monitors and Telemetry

Both Holter monitors and mobile cardiac telemetry (MCT) provide ways to monitor a patient’s electrocardiogram for an extended period of time. Their main purpose is to determine the cause of a transient event by recording a patient’s heart rate and rhythm during normal activity. Although similar, Holter monitors and MCT devices have distinctive differences and meet different needs, which impacts the physician’s choice of monitoring method. We’ve outlined some of the differences below:

Monitoring Period

A Holter monitor typically records cardiac activity for an uninterrupted 24-48 hours, although some are prescribed for up to 14 days. It is ideal for the patient who is experiencing symptoms on a more frequent or regular basis and whose condition does not require continuous monitoring.

Mobile cardiac telemetry is prescribed for a period up to 30 days. It is typically prescribed for patients with rare or intermittent episodes, or those who may be asymptomatic. The extended wear time allows for the opportunity to capture an arrhythmia that may not occur during a shortened wear time and is also helpful in identifying a silent pattern of irregular cardiac activity.

Recording Methods

Holter monitors are designed to continuously record data. While their limited wear time reduces the inconvenience for patients, it’s also one of the reasons a Holter may be returned as non-diagnostic, or benign. Most often, this is because symptoms may not reappear during the time in which the Holter is monitoring the patient’s heart rhythm.

Telemetry devices offer a variety of recording methods. Many MCT devices are continually listening, recording every heartbeat for up to 30 days, and provide atrial fibrillation burden assessment.

Data Storage

Devices can store their data either locally or in the cloud. The data collected from a Holter monitor is stored on an internal chip and is limited in terms of space, but sufficient for the prescribed wear time.

Telemetry device storage varies. It can be stored locally or transmit the information to the cloud, as long as there is a strong cell signal present. This feature is significant because the data can be read in real time and irregularities can be addressed immediately. This difference is especially prominent when compared to the 7-14 day Holter monitors. Any irregularity identified with a Holter monitor will not be read until the monitor is returned and analyzed at the end of the prescribed wear time, which could potentially be up to 20 days later.

Device Differences

Both Holter monitors and telemetry devices require leads that are attached to the patient. Holter monitors typically require more leads and tend to be more bulky. As a result of the technology it uses, a telemetry device is smaller, sleeker and easier to wear.

There are also differences in the ways the devices are powered. Based on the amount of wear time, Holter monitors may have batteries that need to be changed. Newer telemetry device models are rechargeable. They typically include two batteries, one to wear while the other is charging.

Depending upon your symptoms, or lack thereof, your physician will prescribe the appropriate monitoring device. Both are completely painless and are considered highly effective ways to identify potential heart issues and to help determine the appropriate treatment.

Cardiac Monitoring Service: Do cardiac trained RNs make a difference?

While there are many variables to consider when partnering with a cardiac monitoring service, the reading expertise of the clinical staff is one of the most important.

Cardiac monitoring services that employ registered nurses offer an undeniably higher level of readiness to their customers and their patients. Their expertise allows them to serve as an extension of the physician as they ask critical questions, provide comprehensive care, and a more holistic approach.

In many cases, seasoned registered nurses, leveraging their experience, has been instrumental in identifying subtle but serious signs that may have easily been overlooked.

Preventing unnecessary procedures

For example, a particular case reported a patient was presenting a complete heart block, which was clearly cause to notify the physician. The patient was immediately directed to the emergency room in anticipation of surgery to implant a pacemaker.

A monitoring staff nurse who was familiar with this particular patient noticed that he had taken a double dose of a calcium channel blocker that works by relaxing the muscles of the heart and blood vessels. She notified the physician, who cancelled his prior instruction for the patient to head to the emergency room and instead, discontinued the medication. The next day, the patient returned to normal sinus rhythm.

This example was a situation where the nurse was able to provide information that helped prevent unnecessary treatment. In other instances, registered nurses are able to identify arrhythmias and triage patients who required an implantable device or other treatment, potentially eliminating an emergency response. Their expertise works both ways and across the full spectrum of care.

A full spectrum of benefits

In addition to the health considerations, the nurse who noticed the double dose of medication prevented a costly hospital visit for the patient. Even with health insurance, the patient would have most likely incurred a copayment, and the healthcare system would have incurred an unnecessary cost as well.

Most of the interactions between patients and the monitoring service take place over the phone. Cardiac trained nurses are experts at listening for shortness of breath, difficulty talking, wheezing, rales and other signs that are not instantly visible on an electrocardiogram. Combining what they can see on an EKG with the information they gain while talking to a patient can make all the difference.

All notifications from a monitoring service are potentially life saving. Given the critical nature of the data, a registered nurse who can more easily piece together a patient’s story, process it, and act quickly on that data is the highest level of care a monitoring service can provide.

How does a cardiac monitoring service work?

Cardiac monitoring providers offer physicians a way to measure a patient’s heart rhythm over a defined period of time. It is considered standard practice in diagnosing cardiac arrhythmias and is also helpful in evaluating and managing medications and their effect on a patient’s condition.

Monitoring services

Many cardiology practices choose to partner with a monitoring service center that provides equipment, supplies, and reviews EKG data. These companies actively monitor patients that are enrolled in the service and report the results to the doctor for a diagnosis. Patients enrolled in the service are typically experiencing palpitations, atrial fibrillation, atrial flutter, syncope, or a host of other heart rhythm abnormalities

Event monitoring

When a patient is wearing a mobile cardiac telemetry device, the monitoring service continuously receives and observes the patient’s electrocardiogram. If any abnormality presents itself, the monitoring clinician will alert the physician in accordance with the signed notification criteria. A signed notification criteria is a physician-signed notification statement that details the type and level of irregularity and the protocol used to address it.

When a patient has an episode that meets the notification criteria, whether the patient records it or it is automatically recorded via the auto trigger feature of the device, a clinician immediately processes the information and contacts the physician for further instruction. Those further instructions may include heading to the emergency room, the doctor’s office, or a simple adjustment to the patient’s medication.

Holter monitoring

Holter monitors typically store recorded electrocardiogram data within the device and are not evaluated until the prescribed wear-time has expired. Patients return the Holter monitor to the clinic or the doctor’s office, where the information is downloaded to a secure server, analyzed, interpreted by the monitoring service and reported back to the physician for the diagnosis.

As with event monitoring, if at any point an arrhythmia is identified, the physician is notified. However, a Holter monitor’s activity has already occurred and is being evaluated after the fact, while an event monitor’s activity is currently happening and can be addressed without delay.