A 62- year- old diabetic gentleman underwent coronary artery bypass surgery with a weak heart following a large heart attack. He had intermittent irregular heart rhythm with potentially fatal arrhythmia called ventricular tachycardia. He underwent implantation of a Bluetooth enabled automatic cardiac defibrillator (Abbott medical) which can detect these serious arrhythmias and shock the heart internally and convert the rhythm to normal and prevent sudden death. These devices have shown to improve survival among such patients. During the peak of pandemic, he developed palpitations and he transmitted the event with the mobile app and remedial treatment was advised on the phone avoiding the need for a hospital visit.
Evolving technologies like Bluetooth are altering the way healthcare is delivered, and remote patient monitoring (RPM) is leading a transformation in cardiac practise and its use was taken to a new all-time higher during the Covid-19 pandemic. Cardiology was one of the first medical specialties to incorporate RPM into standard practise. In the middle of pandemic, connected health and RPM are more important than ever, because they enable physicians to monitor patients without having to come in contact with them, reducing the risk of virus spread. They also help to keep less severe cases out of the hospital. Within cardiology RPM has several significant applications most notably management of hypertension, heart failure and irregular heart rhythm. RPM can be very useful for a country like ours as it would be possible to monitor and manage patients even from rural areas and offer them treatment with the expertise of a tertiary care consultant.
There are various devices available which can record different vital parameters like blood pressure, weight, pulse or electrocardiogram (ECG) and the data can be stored and transmitted electronically to the healthcare team. Apple has watches equipped with electrocardiogram (ECG) that can detect irregular heart rhythm and atrial fibrillation. The ECG can be shared with the physician and prompt diagnosis is possible. Connected health devices run the gamut from wearable watches to water resistant patch monitors like (SmartCardia) which can monitor patients ECG upto 7 days, store data on cloud, analyse it and transmit live ECGs to the physician for early diagnosis and intervention. Now advanced pacemakers are Bluetooth enabled which measure the parameters and transmit them back to healthcare providers from the comfort of their homes without physically visiting the clinic. The ability to continuously to keep tab on heart rhythm management device is beneficial in several ways. Fewer in person visits are required, saving patient’s time and expense associated with clinic visits. RPM has significant benefits including. Greater than 65% reduction in hospitalisation is due to atrial arrhythmia. Nearly 80% reduction in time taken to detect clinical events. Patients with remote monitoring devices have a probability of survival is more than 2X greater than those without. Significant cost saving has been associated with RPM by way of fewer follow up visits, fewer hospital admissions and shorter stay if admission is required. Smartphone enabled remote monitoring is a game changer and helps personalise the approach to cardiac care by enabling patients to be in complete control of their heart health and be involved in their treatment ensuring a better quality of life.
Dr Manoj R. Mashru, Interventional Cardiologist, Director of Cardiology Department of Sir H. N. Reliance Foundation Hospital and Research Centre
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