About Outpatient ECG

Holter recording and Event Recorder monitoring are two commonly used diagnostic tools for long- term outpatient ECG monitoring, while hospitalized patients are routinely monitored by hospital Telemetry equipment. Each of these modalities has different characteristics that influence their use. For example, Holters are inconvenient for recording over about 48 hours and the diagnostic data is delayed by up to several days while Event Recorders can capture only symptomatic events . Telemetry provides ECG monitoring with rapid response capability, is routinely used as a potentially lifesaving measure for essentially 100% of the nation's heart attack victims who are monitored during their hospital stay , but is not available on an outpatient basis.

Cardiac Surveillance

As the nature of health care delivery in the United States changes, one consistent theme is that hospitals may soon be limited to very sick individuals and more will be done on an out patient basis and at alternative lower cost sites. Recently, a new monitoring modality has been developed and become routinely available, combining many of the advantages of previous technology. It provides real time ECG arrhythmia monitoring (“Cardiac Surveillance”) for any potential expanded patient sites; taking it all the way to the patient's home. The system is known as the HEARTLink II, a fully automatic, real-time cardiac arrhythmia detection and alarm system that has specifically been designed to operate in a home environment. It is not intended for individuals who are at high risk of developing lethal arrhythmias such as primary ventricular fibrillation or sustained ventricular tachycardia, but rather those who might benefit from timely identification of less malignant arrhythmias. HEARTLink basically operates as telemetry for the home providing cardiac surveillance with automatic rapid notification of rhythm abnormalities. Illustrating its compatibly with in-hospital telemetry, an essentially identical system, HEARTtrac, has been cleared by the FDA for use in hospital step down units.

Monitoring Modes

Operationally, the system monitors and labels electrocardiogram (ECG) patterns, automatically detects any rhythm abnormality based on 16 different proprietary diagnostic algorithms, and automatically transmits them via a standard telephone to a central monitoring station. It operates without patient intervention and has four operational modes: real-time automatic event mode, real-time display mode, patient activated mode for symptomatic events, and patient help request. The device is most commonly left in automatic mode. Any automatically transmitted rhythm strip is seen within 15 seconds by trained operators at a central location that is manned 24 hours/day. As occurrences of arrhythmias are detected, transmitted and displayed at the central station, they are viewed by medical professionals and handled per protocol, stored and later merged with trend data developed at the patient site. This allows a “Holter Scan” equivalent report to be prepared for any past 24 hour period that the patient is on the system providing a parallel to conventional Holter equipment. Should a patient feel a symptom, a push button is provided which immediately sends a strip establishing compatibility with traditional event recorders. The same push button is used to activate a “Help Request” for use in a possible non-cardiac emergency. Additionally, during the real-time display mode, medical technicians can log on from a remote terminal and display and view ECG patterns in real time as they occur.

Monitoring Service

HEARTLink II is available to physicians as a service called “Telemetry @ Home”, initially targeted for patients who can benefit from its ability to: 1. provide timely diagnosis and notification of arrhythmias, 2. detect asymtomatic arrhythmias, 3. be conveniently worn for a period longer that a conventional Holter, or 4. operate without patient intervention. A patient transmitter (Patient Module) digitally transmits cardiac information to a ruggedized, computer box (Tele-Link) that monitors, analyzes, stores and quickly transmits predetermined cardiac events to a Surveillance Lab (Independent Diagnostic Testing Facility: IDTF). This analysis is real time and the analysis/transmission time to the Surveillance Lab is typically less than 12 seconds. Detection parameters can be changed per physician instructions from the Surveillance Lab. The patient’s telephone line works as a normal telephone line when the Tele-Link processor is not transmitting data. If the patient is on the phone when a transmission is initiated, the voice call is disconnected by the Tele-Link allowing the data call to proceed. Extensive error detection provisions are made for most situations that may arise outside of the surveillance itself (e.g. low battery, leads off, patient out of range, phone line down, etc.) and a four (4) hour battery backup is included in the Tele-Link Processor itself.

Patient Transmitter				Tele-Link

Patient Enrollment

During patient enrollment the physician determines arrhythmia detection parameters and notification criteria for the patient. Detection criteria are programmed into the Tele-Link during the patient setup process to accommodate for the fact that each patient situation is unique. Once Cardiac Telecom receives this information, verification is immediately faxed back to the physician with dates of the patient surveillance. The physician has the opportunity to modify any of the default diagnostic criteria prior to the patient coming on service (and again, has the ability to change these during the service as well). As enrollment proceeds, the Lab contacts the patient, explains the process of the surveillance to them; and, for the entire surveillance period, speaks with each patient at least twice a day as part of normal protocol.

To ensure patient compliance, the system is extremely easy to use as all the patient needs to do is wear the transmitting device and change the battery when needed. Most are even capable of connecting the equipment up in their home, and for those who cannot; arrangements can be made to have it done for them. Although the system performs significant cardiac surveillance and analysis on a continuous basis, this is done transparently.

Usually, each evening, the Lab will call each patient’s Tele-Link and download additional information about the patient’s cardiac activity. Daily diagnostic reports are sent to each patient’s physician for review. Although clinicians normally associate telemetry with “immediate on-site” care, this is not the case with HEARTLink II. Very high risk patients should be avoided; however, the Lab is staffed with highly trained EMT-Paramedics and/or RNs 24/7.

Based on the acuity of the patient local EMS facilities may be notified upon patient hookup that a patient is on the system for cardiac surveillance and an explanation of HEARTLink II™ is given at that time. Regardless of patient acuity the Lab obtains information about each patient’s local EMS facility prior to patient hookup.

How do I provide Telemetry@Home to my patients?

If you are a physician, or part of a nursing home, hospital or other medical facility and would like to evaluate the use of Telemetry@Home for your patients please call us at (201) 670-9999. See our T@H service overview for more information on how you and your patients can benefit from the service.