Factors Affecting Relevance of Tele-ECG Systems Application to High Risk for Future Ischemic Heart Disease Events Patients Group

Application of remote electrocardiogram monitoring systems in chest pain centers for patients with high-risk chest pain

BACKGROUND

Chinese chest pain centers (CPCs) have been expanding and maturing for the past decade, but patient wait times for pre-hospital care remain long.

OBJECTIVE

To demonstrate that the remote electrocardiogram (ECG) monitoring system can ensure more efficient treatment for patients with ST-elevation myocardial infarction (STEMI) in CPCs, we compared patients with high-risk chest pain who used remote ECG monitoring systems to those who used conventional ECGs in retrospective cohort study.

METHODS

Based on the inclusion and exclusion criteria, 290 patients who visited our CPC between June 2019 and March 2022 with acute chest pain and a diagnosis of STEMI as well as patients who had undergone an emergency primary percutaneous coronary intervention were selected. Among them, 73 patients with STEMI had employed remote real-time dynamic 12-lead ECG monitoring devices, while 217 patients with STEMI (i.e., the controls) had used conventional ECG monitoring. The effectiveness of treatment procedures for the two groups was investigated. As statistical measures, the symptom onset-to-wire times, first medical contact (FMC)-to-wire times, door-to-wire times, major adverse cardiac events in hospital, and the troponin T levels were analyzed.

RESULTS

Compared with the control group, the patients with remote real-time dynamic 12-lead ECG monitoring devices showed shorter times for both symptom onset-to-wire (234.8 ± 95.8 min vs. 317.6 ± 129.6 min, P= 0.0321) and from symptom onset-to-FMC (170.5 ± 86.3 min vs. 245.3 ± 115.6 min, P= 0.0287); this group also had a lower 30-day mortality rate (2.73% vs. 4.14%, P= 0.003). The differences between the two groups were statistically significant (P< 0.05).

CONCLUSION

With remote real-time dynamic 12-lead ECG monitoring equipment, myocardial ischemia can be treated more quickly, leading to fewer possible cardiac events and a better prognosis.

A Medico-Socio-Economic Analysis of TeleEKG in Ivory Coast

Background: TeleEKG is gradually being integrated into the care offered to the most isolated Ivorian populations, however, no medico-socio-economic analysis of its impact has yet been conducted. Introduction: The aim of this study was to assess the medico-socio-economic impact of a teleEKG network in the provision of cardiology care in Ivory Coast. Methods: A retrospective study of the data transmitted by the 10 centers involved in the pilot phase of the teleEKG project from January 2015 to December 2017. Results: The average ratio between the cost to the patient of performing an electrocardiogram (EKG) according to the traditional practice and using a teleEKG was 3.8 ± 1.64. The distance avoided by the 6,045 patients was 1,074,090 km (average 177.7 km/patient). The 6,045 teleEKGs carried out over the period of the study produced a total revenue of 36,270,000 XOF (55,290 EUR) or an average revenue per site of 3,627,000 XOF (5,529 EUR). Dyspnea on exertion (22%), and hypertension (21%) were the main indications for performing the EKG, and left ventricular hypertrophy was the most common electrical anomaly detected (19.8%). Acute coronary syndrome with persistent ST segment elevation was diagnosed in 0.7% of cases (40 cases) and atrial fibrillation in 1.12% of cases (68 cases). Discussion: These results confirm the key role telemedicine can play in the treatment of heart conditions in rural populations and the economic sustainability of such telemedicine networks. Conclusions: teleEKG offers economic accessibility to cardiology care for isolated populations in Ivory Coast.

eHealth to improve patient outcome in rehabilitating myocardial infarction patients

INTRODUCTION

Cardiac rehabilitation is aimed at risk factor modification and improving quality of life. eHealth has a couple of potential benefits to improve this aim. The primary purpose of this review is to summarize available literature for eHealth strategies that have been investigated in randomized controlled trials in post-myocardial infarction (MI) patients. The second purpose of this review is to investigate the clinical effectiveness in post-MI patients. Areas covered: The literature was searched using PubMed. Randomized controlled trials (RCTs) describing interventions in patients that had experienced an ST-elevation myocardial infarction or non-ST acute coronary syndrome were eligible for inclusion. Fifteen full-texts were included and their results are described in this review. These RCTs described interventions that used remote coaching or remote monitoring in post-MI patients. Most interventions resulted in an improved cardiovascular risk profile. Remote coaching had a positive effect on activity and dietary intake. Expert opinion: eHealth might be clinically beneficial in post-MI patients, particularly for risk estimation. Moreover, eHealth as a tool for remote coaching on activity is a good addition to traditional cardiac rehabilitation programs. Further research needs to corroborate these findings.

Application of Handheld Tele-ECG for Health Care Delivery in Rural India

Telemonitoring is a medical practice that involves remotely monitoring patients who are not at the same location as the health care provider. The purpose of our study was to use handheld tele-electrocardiogram (ECG) developed by Bhabha Atomic Research Center (BARC) to identify heart conditions in the rural underserved population where the doctor-patient ratio is low and access to health care is difficult. The objective of our study was clinical validation of handheld tele-ECG as a screening tool for evaluation of cardiac diseases in the rural population. ECG was obtained in 450 individuals (mean age 31.49 ± 20.058) residing in the periphery of Chandigarh, India, from April 2011 to March 2013, using the handheld tele-ECG machine. The data were then transmitted to physicians in Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, for their expert opinion. ECG was interpreted as normal in 70% individuals. Left ventricular hypertrophy (9.3%) was the commonest abnormality followed closely by old myocardial infarction (5.3%). Patient satisfaction was reported to be ~95%. Thus, it can be safely concluded that tele-ECG is a portable, cost-effective, and convenient tool for diagnosis and monitoring of heart diseases and thus improves quality and accessibility, especially in rural areas.

An intelligent telecardiology system using a wearable and wireless ECG to detect atrial fibrillation

This study presents a novel wireless, ambulatory, real-time, and autoalarm intelligent telecardiology system to improve healthcare for cardiovascular disease, which is one of the most prevalent and costly health problems in the world. This system consists of a lightweight and power-saving wireless ECG device equipped with a built-in automatic warning expert system. This device is connected to a mobile and ubiquitous real-time display platform. The acquired ECG signals are instantaneously transmitted to mobile devices, such as netbooks or mobile phones through Bluetooth, and then, processed by the expert system. An alert signal is sent to the remote database server, which can be accessed by an Internet browser, once an abnormal ECG is detected. The current version of the expert system can identify five types of abnormal cardiac rhythms in real-time, including sinus tachycardia, sinus bradycardia, wide QRS complex, atrial fibrillation (AF), and cardiac asystole, which is very important for both the subjects who are being monitored and the healthcare personnel tracking cardiac-rhythm disorders. The proposed system also activates an emergency medical alarm system when problems occur. Clinical testing reveals that the proposed system is approximately 94% accurate, with high sensitivity, specificity, and positive prediction rates for ten normal subjects and 20 AF patients. We believe that in the future a business-card-like ECG device, accompanied with a mobile phone, can make universal cardiac protection service possible.