Pre-empting disease with intelligent tools

Medical technology is well placed to assist with the challenge of streamlining healthcare delivery – both in terms of making treatments more effective and improving the ongoing support of patients. In the case of chronic diseases, technology has the potential to assist healthcare professionals with managing diseases in an efficient way. With regard to implantable cardiac rhythm management devices, innovation continues to provide new treatment options for cardiologists and cardiac electrophysiologists and better resources for patients. One technological solution introduced to this field has been remote monitoring – systems that allow healthcare professionals to collect data about the patient without the patient being present. While this may present some cost savings (less work for a healthcare professional and less travel costs for the patient) the real potential in remote monitoring of arrhythmia is the ability to monitor disease progression with a view to taking preemptive and more cost-effective action.

Arrhythmia

Arrhythmia, which can occur in the upper or lower chambers of the heart, is a disorder of the heart’s electrical system, whereby the heart may beat irregularly or have an abnormal rhythm such as tachycardia (beats too quickly) or bradycardia (beats too slowly). These fluctuations in heart rhythm may affect the movement of blood around the body. Around 1.7 million people in the UK are diagnosed with arrhythmia1 and this figure may increase if more of the population become at risk of heart conditions.2 Arrhythmia has the potential to be fatal so it is vital that it is managed properly. This involves monitoring the patient to understand if the disease has changed, and monitoring any implanted cardiac rhythm management device to check that it is functioning properly. Typically, both things would be investigated with routine hospital visits. In an attempt to improve the delivery of this healthcare, initial remote monitoring systems were versions of telemonitoring – whereby the patient reported self-assessments of symptoms over the telephone and then received verbal advice and education. These telemedicine systems evolved in a way that allowed the patient to transfer physiological data by inputting their data through a telephone touch-pad. Certain remote monitoring approaches involve the home installation of simple to use electronic equipment such as weighing scales, blood pressure, and heart rate and rhythm monitors to record vital signs linked to the normal home telephone line. While these forms of remote monitoring certainly provide benefits for the delivery of healthcare, their usefulness is constrained by the fact that the patient has to actively support the process and input the information. If the patient is away from home, loses interest, or becomes confused by the equipment, then the system may break down and the healthcare professional does not receive the information that is required. Some have also questioned the robustness of such technology. An alternative is remote monitoring that is based on information yielded from the implantable cardiac rhythm management device itself. In this model, a physician is able to collect data from the device and establish its functional health in a completely non-invasive way. This works by the implanted device “communicating” with a piece of hardware in the patient’s home – typically the bedroom. While this provides useful information, this type of system tends to leave the healthcare professional lacking information on the progression of the cardiac disease (cardiac arrhythmia or heart failure). In an ideal world, systems that monitor arrhythmia or heart failure patients would allow physicians to monitor the functional health of the implanted device, while at the same time gather information about the disease. This is a technological innovation that is currently under development. These future generation systems can be referred to as “intelligent remote monitoring systems”.