Estimation of patient compliance in application of adherent mobile cardiac telemetry device

Review of the Requirements for a Wearable, Low-Cost External Cardiac Loop Recorder with WBAN in Resource-Constrained Settings

Cardiovascular disease (CVD) has become the most serious health concern in India and globally. The cost of treatment for CVD is very high and in a country like India, where most of the population belongs to rural area, affording treatment is not possible. Diagnosis and treatment are further hampered due to shortage of medical expertise as well as the unavailability of the wearable device. This makes the condition worst in rural areas. As a result of delay in diagnosis, patients do not receive appropriate treatment on time, thus risking lives. Hence, early detection of physiological abnormalities in patients is the best solution to avoid sudden death. In India, the majority of ECG diagnosis is done using a standard ECG machine or Holter monitor, which are not adequate to detect transient or infrequent arrhythmia as the window of detection is 30 s or up to 48 h. So, for arrhythmia diagnosis or syncope and palpitation, external cardiac loop recorder (ECLR) is preferred. ECLR is a monitoring device which records cardiac activities and detects infrequent arrhythmias with syncope and palpitation of a subject for longer period continuously. Due to recent improvements in technology, such as flexible electronics and wireless body area network (WBAN), wearable medical devices are progressively assisting people to monitor their health status while doing their day-to-day activities and furnishing more information to clinicians for early diagnosis and treatment. Flexible electronics allows to develop an electronic circuit on a flexible substrate hence making the device bendable and stretchable. WBAN is a wireless communication between different nodes like sensors and processors that are located at different points on the body. By incorporating technologies such as miniaturization of electronics, making flexible electronics and WBAN concept in ECLR, the device can be made wearable so as to not interfere with the patient's day-to-day activities. This review paper discusses the limitations of existing standard ECG machines as well as how to make the existing ECLR devices more robust, more advanced, more comfortable and also affordable.

Cardiac monitoring for patients with palpitations

Palpitations are one of the most common reasons for medical consultation. They tend to worry patients and can affect their quality of life. They are often a symptom associated with cardiac rhythm disorders, although there are other etiologies. For diagnosis, it is essential to be able to reliably correlate the symptoms with an electrocardiographic record allowing the identification or ruling out of a possible rhythm disorder. However, reaching a diagnosis is not always simple, given that they tend to be transitory symptoms and the patient is frequently asymptomatic at the time of assessment. In recent years, electrocardiographic monitoring systems have incorporated many technical improvements that solve several of the 24-h Holter monitor limitations. The objective of this review is to provide an update on the different monitoring methods currently available, remarking their indications and limitations, to help healthcare professionals to appropriately select and use them in the work-up of patients with palpitations.

Smart Wearables for Cardiac Monitoring-Real-World Use beyond Atrial Fibrillation

The possibilities and implementation of wearable cardiac monitoring beyond atrial fibrillation are increasing continuously. This review focuses on the real-world use and evolution of these devices for other arrhythmias, cardiovascular diseases and some of their risk factors beyond atrial fibrillation. The management of nonatrial fibrillation arrhythmias represents a broad field of wearable technologies in cardiology using Holter, event recorder, electrocardiogram (ECG) patches, wristbands and textiles. Implementation in other patient cohorts, such as ST-elevation myocardial infarction (STEMI), heart failure or sleep apnea, is feasible and expanding. In addition to appropriate accuracy, clinical studies must address the validation of clinical pathways including the appropriate device and clinical decisions resulting from the surrogate assessed.

2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry

Ambulatory ECG (AECG) is very commonly employed in a variety of clinical contexts to detect cardiac arrhythmias and/or arrhythmia patterns which are not readily obtained from the standard ECG. Accurate and timely characterization of arrhythmias is crucial to direct therapies that can have an important impact on diagnosis, prognosis or patient symptom status. The rhythm information derived from the large variety of AECG recording systems can often lead to appropriate and patient-specific medical and interventional management. The details in this document provide background and framework from which to apply AECG techniques in clinical practice, as well as clinical research.

SEEQ™ MCT wearable sensor performance correlated to skin irritation and temperature

The Medtronic SEEQ(™) Mobile Cardiac Telemetry System provides continuous monitoring of symptomatic and asymptomatic cardiac arrhythmias. Deployed across disparate geographies, the device and the patients wearing it are subject to a wide range of weather conditions, specifically differing temperatures. We hypothesized that extremes of temperature would result in degradation of SEEQ system performance due to patient discomfort, perspiration, and other factors. Towards that end, we investigated data from over 5000 devices worldwide, including those linked to patient complaints for discomfort. We found that the data does not show a degradation of wearable performance as defined by artifact or event rate with temperature. However, there was a correlation between patient complaints of discomfort and degraded performance as well as a weak correlation with reduced system longevity at temperatures above 80° F.

Comparison of arrhythmia prevalence in NUVANT Mobile Cardiac Telemetry System patients in the US and India

The Corventis NUVANT™ Mobile Cardiac Telemetry System provides continuous monitoring of symptomatic and asymptomatic cardiac abnormalities to help physicians diagnose and treat non-lethal cardiac arrhythmias. Analysis of a sample of 2231 US and 1053 Indian NUVANT patients has revealed interesting statistics on the prevalence of various cardiac arrhythmias in the patient populations of the two nations. The population is non-randomized and consists of US patients where often a traditional Holter Monitor study was negative and self-pay Indian patients. Mean age was 61.3 for the US and 57.8 for India with 57% of US patients and 32% of India patients being female. Presentation of specific arrhythmia types was similar across populations with the exception of atrial fibrillation and flutter being more prevalent in the older US population as well as increased prevalence of symptomatic atrial and ventricular ectopic rhythms in all patients and SVT for female patients in India. Utilization as defined by the number of patient triggers was 50% higher for Indian patients.

A study of activity and body posture with the PiiX mobile body-adherent device

Remote monitoring of in-home activity and body posture provides useful physiological parameters for understanding patient status and for making clinical judgment in patients living with heart failure. The Corventis PiiX is a mobile chest-adherent device that provides continuously recorded accelerometer data from patients in an in-home setting. In particular, a 3-axis accelerometer enables quantification of full body activity and body posture changes. In this paper, the prevalence of sedentary activity with subject age, the population-wide distribution of upright body posture and resting body posture, and a diagnostic for reduced activity levels and resting body posture is presented with retrospective analysis on a large nonrandomized dataset.

Study of arrhythmia prevalence in NUVANT Mobile Cardiac Telemetry system patients

The Corventis NUVANT™ Mobile Cardiac Telemetry system is an innovative solution in the field of continuous monitoring of symptomatic and asymptomatic cardiac abnormalities to help physicians diagnose and treat non-lethal cardiac arrhythmias. As an FDA cleared product on the market for more than 2 years, the collected body of patient data represents a unique and powerful source of clinical information. Analysis of a sample of 951 NUVANT patients has revealed interesting statistics on the prevalence of various cardiac arrhythmias in the patient population. The population is non-randomized and largely consists of US patients where a traditional Holter Monitor study was negative. The analysis here is focused on classifying the detected arrhythmias using potential therapy solutions as a classifier. Across the total population, 2.2% of patients presented arrhythmias indicating assessment for clinically significant tachycardia, 19% indications of potential bradycardia, 20% had indications of atrial fibrillation, 1% indicating arrhythmias requiring other conditional treatment, and 58% presenting arrhythmias likely not requiring treatment.

Patient selection for ambulatory cardiac monitoring in the Indian healthcare environment

Cardiovascular disease (CVD) in India comprises the bulk of non-communicable diseases, resulting in 2 million deaths per year. The incidence of CVD in India is estimated to be up to four times higher than in other countries. Though the quantification of the prevalence of rhythm disorders in India is not available, it can be inferred to be proportionately high. Identification and treatment of arrhythmia is limited by several socioeconomic factors including low health insurance penetration, limited reimbursement and high out-of-pocket expenditures. Thus, there exists a need in India to (1) select an appropriate tool that is both high yielding and cost effective and (2) employ a suitable patient selection method. This paper focuses on these two aspects for cardiac arrhythmia diagnosis using ambulatory monitoring technology, while keeping in mind the dynamics of the Indian healthcare setting.