Use of traditional Holter monitor leads can be an issue for patient compliance and comfort. The newer generation ambulatory cardiac monitors use a small, adhesive patch that sticks directly on the patient's chest and allows them to shower and go about daily activities without a belt mounted monitor or leads getting in the way. This is especially important for longer term monitoring of seven days or longer.
Advances in the technology of wearable cardiac monitors are improving both the experience of the patient and the effectiveness of clinicians to gather data and analyze ECG-based cardiac activity. While previous methods of cardiac monitoring resulted in low patient compliance and delayed access to patient data, new cardiac monitoring technology is less cumbersome to patients, and provides clinicians with immediate access to and analysis of patient ECG data.
The Challenges of Previous Technology
For many years, Holter monitors have been the standard option for cardiac monitoring. Many patients have found the bulky monitor disruptive to their routines, however, and the adhesive electrodes to be cumbersome and irritating, said Robert Hauser, M.D., FACC, FHRS, senior consulting cardiologist at the Minneapolis Heart Institute, former president of the Heart Rhythm Society and chair of Cardiac Insight’s Scientific Advisory Board.
“Patients didn’t like walking around with a box on their hip,” Hauser said. “They also couldn’t take a shower and couldn’t do all the things you liked to do for a normal two- to three-day period.”
Holter monitors typically track 24 to 48 hours of cardiac activity, and patients are asked to keep a diary of their symptoms. This process is often problematic in gathering accurate and helpful information for clinicians.
“You had to write down the exact time that you were experiencing symptoms, and often times patients did not use the diary, so you had no idea when they were symptomatic,” Hauser said.
Moving Beyond Holter Monitors
The next generation of wearable monitors could be worn for seven to 14 days. After the monitoring period, clinicians mailed the device to the manufacturer or a third-party service company to analyze and prepare a report of the patient’s ECG rhythm activity. This lengthy process prevented clinicians from accessing and analyzing information in a timely fashion and also meant the service company captured the majority of the billable procedural value.
“Sometimes there would be no report, and then you’d have to get on the telephone and talk to the service,” Hauser said. “It was all very inefficient and often not comparable with any level of patient satisfaction.”
Improving the Patient and Clinician Experience
The latest monitors available today provide a patient-friendly, comprehensive and complete arrhythmia and analysis system for in-office or clinic-based healthcare.
The newest devices are small, lightweight, water-resistant, disposable, and can be worn for up to seven days. This extended time period allows for efficient diagnosis of a variety of irregular heart rhythms, including the most common form — atrial fibrillation (AF).
Less invasive, newer, wearable monitors that offer this type of long-term data beyond 48 hours include the Cardiac Insight Cardea Solo, iRhythm Zio, Biotricity Bioflux, Medicalgorithmics PocketECG, ScottCare novi Patch Holter and the BardyDx CAM Ambulatory ECG Monitor Patch, to name just a few.
When Hauser had his wife wear a Cardea Solo device for a week to monitor her arrhythmia, he had a front-row seat to her patient experience.
“I found it was really easy to put on,” Hauser said. “She wore it for seven days, and she forgot she had it on.”
When the seven-day period was over, accessing data from the device was also much easier, Hauser said. Clinicians simply remove the electronic module from the patch and plug it in to their computer. The software then produces an automated draft ECG analysis summary report. Hauser received a summary draft findings report of his wife’s cardiac activity within three minutes.
Cardiac Insight’s software uses a robust set of ECG algorithms and interactive full-disclosure trace review tools so that every heartbeat can be reviewed if necessary. This allows frontline clinicians to perform all three components of the patient diagnostic process — application, data analysis, and professional review and interpretation — without delay and without the need to outsource sensitive protected health information (PHI).
“When I compare that with my experience with other wearable monitors, it was vastly different,” Hauser said. “I didn’t need a technician to put on the (wearable sensor.) I didn’t need to mail anything in. All I did was take it off, plug it into the computer, and we were done. For a busy clinician, it’s a whole level of improvement, from a 3-star to a 5-star.”
And, because this technology eliminates the need for multiple clinical hand-offs, it offers greater operational efficiency and potential savings for patients and insurers.
Being able to quickly retrieve data on a patient’s cardiac activity is critical for managing heart rhythm disorders, according to Albert Waldo, M.D., FACC, FHRS, The Walter H. Pritchard Professor of Cardiology, professor of medicine and professor of biomedical engineering at Case Western Reserve University School of Medicine and associate chief of cardiovascular medicine for academic affairs at University Hospitals Cleveland Medical Center.
With the Cardea Solo system, “we can print out all the data immediately instead of going through a third party that calls it into us and sends it,” Waldo said. “I find that’s a very refreshing thing.”
This is part of a series of articles on the newer generation of ambulatory cardiac monitors, including:
1. Smithsonian National Museum of American History. At the Heart of the Invention: The development of the Holter Monitor. Published online Nov. 16, 2011
2. Harold L. Kennedy. The evolution of ambulatory ECG monitoring.Prog Cardiovasc Dis. 2013 Sep-Oct;56(2):127-32. doi: 10.1016/j.pcad.2013.08.005. Epub 2013 Sep 11. https://www.sciencedirect.com/science/article/pii/S0033062013001503?via%3Dihub
3. Health Quality Ontario. Long-Term Continuous Ambulatory ECG Monitors and External Cardiac Loop Recorders for Cardiac Arrhythmia: A Health Technology Assessment. Ont Health Technol Assess Ser. 2017; 17(1): 1–56. Published online 2017 Jan 31. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300052/