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Wei W, Lu LX, Hao Y, Kang S, Liu Y, Yu J, Chen W, Fan CH. Application of remote electrocardiogram monitoring systems in chest pain centers for patients with high-risk chest pain. Technol Health Care 2024; 32:411-421. [PMID: 37694323 DOI: 10.3233/thc-230582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
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.
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Affiliation(s)
- Wei Wei
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lin-Xiang Lu
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ying Hao
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Sheng Kang
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yonghua Liu
- Department of Cardiology, Baoshan People's Hospital, Yunnan, Kunming, China
| | - Jing Yu
- Department of Nephrology, Baoshan People's Hospital, Yunnan, Kunming, China
| | - Wenli Chen
- Department of Nephrology, Baoshan People's Hospital, Yunnan, Kunming, China
| | - Cheng-Hui Fan
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
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Diby FK, Adoubi AK, Esse-Diby MCA, Gnaba AL, Zadi SZ, Ouattara AEP, N'Guessan KE, Boidy K, Azagoh-Kouadio R, Nanan I, Doumbia M, Kpon R, Ayegnon KG, Meneas CG, Diomande M, Sall F, Koffi MN, Coulibaly A, Ehui EA, Yao KM, Yapo JM, Ehua SF, Yangni-Angate HK, Simon P, Moulin T. A Medico-Socio-Economic Analysis of TeleEKG in Ivory Coast. Telemed J E Health 2020; 27:286-295. [PMID: 32907516 DOI: 10.1089/tmj.2020.0075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Florent Kouakou Diby
- Department of Cardiovascular and Thoracic Diseases of Bouaké Teaching University Hospital, Côte d'Ivoire
| | - Anicet Kassi Adoubi
- Department of Cardiovascular and Thoracic Diseases of Bouaké Teaching University Hospital, Côte d'Ivoire
| | | | - Ambroise Loa Gnaba
- Department of Cardiovascular and Thoracic Diseases of Bouaké Teaching University Hospital, Côte d'Ivoire
| | - Serge Zadi Zadi
- Department of Ethnosociology Alassane Ouattara University of Bouaké, Bouaké, Côte d'Ivoire
| | | | | | - Kouakou Boidy
- Hematology Department of Yopougon University Hospital, Yopougon, Côte d'Ivoire
| | | | - Innocent Nanan
- Francophone Africa Telemedicine Network and the Ivorian Society of Biosciences and Medical Informatics Abidjan, Côte d'Ivoire
| | - Mamadou Doumbia
- Francophone Africa Telemedicine Network and the Ivorian Society of Biosciences and Medical Informatics Abidjan, Côte d'Ivoire
| | - Roger Kpon
- Francophone Africa Telemedicine Network and the Ivorian Society of Biosciences and Medical Informatics Abidjan, Côte d'Ivoire.,Department of Swiss Center for Scientific Research, Abidjan, Côte d'Ivoire
| | - Kouakou Grégoire Ayegnon
- Department of Cardiovascular and Thoracic Diseases of Bouaké Teaching University Hospital, Côte d'Ivoire
| | - Christophe Gueu Meneas
- Department of Cardiovascular and Thoracic Diseases of Bouaké Teaching University Hospital, Côte d'Ivoire
| | - Manga Diomande
- Department of Cardiovascular and Thoracic Diseases of Bouaké Teaching University Hospital, Côte d'Ivoire
| | - Fatouma Sall
- Department of Cardiovascular and Thoracic Diseases of Bouaké Teaching University Hospital, Côte d'Ivoire
| | - Marie-Nina Koffi
- Department of Cardiovascular and Thoracic Diseases of Bouaké Teaching University Hospital, Côte d'Ivoire
| | - Abdoulaye Coulibaly
- Department of Cardiovascular and Thoracic Diseases of Bouaké Teaching University Hospital, Côte d'Ivoire
| | | | | | | | - Somian Francis Ehua
- Francophone Africa Telemedicine Network and the Ivorian Society of Biosciences and Medical Informatics Abidjan, Côte d'Ivoire
| | - Hervé Koffi Yangni-Angate
- Department of Cardiovascular and Thoracic Diseases of Bouaké Teaching University Hospital, Côte d'Ivoire
| | - Pierre Simon
- Administrative Department of French Telemedicine Society (SFTelemed), Paris, France
| | - Thierry Moulin
- Administrative Department of French Telemedicine Society (SFTelemed), Paris, France.,Neurology Department of University Hospital of Besançon, Besançon, France
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Verburg A, Selder JL, Schalij MJ, Schuuring MJ, Treskes RW. eHealth to improve patient outcome in rehabilitating myocardial infarction patients. Expert Rev Cardiovasc Ther 2019; 17:185-192. [PMID: 30732481 DOI: 10.1080/14779072.2019.1580570] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Ashley Verburg
- a Department of Cardiology , Leiden University Medical Center , Leiden , The Netherlands
| | - Jasper L Selder
- b Department of Cardiology , Amsterdam UMC, location VU , Amsterdam , The Netherlands
| | - Martin J Schalij
- a Department of Cardiology , Leiden University Medical Center , Leiden , The Netherlands
| | - Mark J Schuuring
- c Department of Cardiology , Amsterdam UMC , Amsterdam , The Netherlands
| | - Roderick W Treskes
- a Department of Cardiology , Leiden University Medical Center , Leiden , The Netherlands
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Singh M, Agarwal A, Sinha V, Manoj Kumar R, Jaiswal N, Jindal I, Pant P, Kumar M. Application of Handheld Tele-ECG for Health Care Delivery in Rural India. Int J Telemed Appl 2014; 2014:981806. [PMID: 25368654 PMCID: PMC4195398 DOI: 10.1155/2014/981806] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 09/06/2014] [Accepted: 09/09/2014] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Meenu Singh
- Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Amit Agarwal
- ICMR Centre for Evidence Based Child Health, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Vineet Sinha
- Department of Electronic Division, Bhabha Atomic Research Center, Mumbai 400085, India
| | - Rohit Manoj Kumar
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Nishant Jaiswal
- ICMR Centre for Evidence Based Child Health, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Ishita Jindal
- ICMR Centre for Evidence Based Child Health, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Pankaj Pant
- ICMR Centre for Evidence Based Child Health, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Munish Kumar
- ICMR Centre for Evidence Based Child Health, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
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Al-Zaiti SS, Shusterman V, Carey MG. Novel technical solutions for wireless ECG transmission & analysis in the age of the internet cloud. J Electrocardiol 2013; 46:540-5. [DOI: 10.1016/j.jelectrocard.2013.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Indexed: 10/26/2022]
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Winkler S, Axmann C, Schannor B, Kim S, Leuthold T, Scherf M, Downes R, Nettlau H, Koehler F. Diagnostic accuracy of a new detection algorithm for atrial fibrillation in cardiac telemonitoring with portable electrocardiogram devices. J Electrocardiol 2011; 44:460-4. [DOI: 10.1016/j.jelectrocard.2011.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Indexed: 10/18/2022]
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Lin CT, Chang KC, Lin CL, Chiang CC, Lu SW, Chang SS, Lin BS, Liang HY, Chen RJ, Lee YT, Ko LW. An intelligent telecardiology system using a wearable and wireless ECG to detect atrial fibrillation. ACTA ACUST UNITED AC 2010; 14:726-33. [PMID: 20371411 DOI: 10.1109/titb.2010.2047401] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Chin-Teng Lin
- Brain Research Center and the Department of Electrical Engineering, National Chiao-Tung University, Hsinchu 30010, Taiwan.
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