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  • Writer's pictureLohman Tech

Connecting the Dots Between Intermittent & Continuous Cardiac Monitoring.

Updated: Apr 8

Healthcare providers can now keep a closer watch over patients at-risk for cardiac events and subsequent deterioration before (and after) the intervention of continuous monitoring.



The benefits of Remote Patient Monitoring (RPM) in managing chronic disease, including a myriad of heart conditions, are:

  • Better patient engagement and compliance

  • Fewer emergency department visits

  • Hospital readmission avoidance

  • Reduced length of stay


Remote Cardiac Monitoring (RCM) is a blanket term that can apply to the utilization of several methods and modalities to help the healthcare provider keep a closer watch over patients at-risk for cardiac events and subsequent deterioration. When monitoring patients inside the four walls of a hospital, careful thought goes into the precise care plan for each patient type for exactly HOW they will be monitored.

 

The question many providers in the outpatient setting are struggling with is:


 

Whether to Choose Intermittent or Continuous Cardiac Monitoring Will Depend on the Individual Patient.

 

Understanding Monitoring Criteria

 

Every at-risk patient is unique in their needs and there are a variety of ambulatory ECG monitors to choose from. Some patients need continuous monitoring with a permanent insertable cardiac monitor for tracking to identify an abnormal heart rhythm or irregular heartbeat (or heart rate), while others need a few short days with a wearable device.

 

  • A symptom event monitor typically collects ECG data for 2-4 hours, while a Holter monitor is a continuous monitoring device used for 24-48 hours. Wearable sensors and 24/7 patch recorders (like the Zio patch) can be used for several weeks of surveillance. These are all often prescribed AFTER a patient has initiated a visit to a physician’s office, urgent care, or hospital seeking answers to a set of symptoms caused by a cardiac arrhythmia.

 

  • An Implantable Loop Recorder (ILR), also known as a cardiac event recorder or implantable cardiac device, is warranted AFTER patients have experienced symptoms and is typically used “for the evaluation of recurrent palpitations, syncope of unknown etiology or when other ambulatory monitoring devices of shorter duration are unrevealing”. (1)

 

Earlier Intervention

 

The other group of patients, often understated in the remote monitoring worlds (RPM & RCM) are those who don’t qualify for continuous ECG monitoring, but who would benefit greatly from an intermittent, daily capture of their ECG rhythm. Here is a quick reminder of risk-factors associated with atrial fibrillation (Afib) and their prevalence in the US:

 

  • 58M+ are Adult Patients Over the Age of 65

  • 37M+ are Diabetic

  • 800k+ Per Year Suffer from Myocardial Infarction

  • 12M+ Living with COPD

  • 40% are Obese

  • 28M+ are Smokers

  • 50% of Adults have High Blood Pressure

  • 5M+ Suffer from CHF

 

A daily, intermittent remote cardiac monitoring device is often what is missing from the very robust arsenal of at-home patient equipment. All too often, the types of monitoring devices are not being matched with the types of patients and their conditions. While continuous wearable devices can be used to diagnose cardiac arrhythmias, there is often not a need to gather the large amount of data generated from continuous monitoring. With large data and detailed information, comes the challenge of separating the actionable data from noise (2).


 

What if we armed our providers with a remote cardiac monitoring device that provides guardrails for the at-risk population?

 

These guardrails are a specific course of treatment that would serve the patients on BOTH SIDES of the continuous monitoring continuum. What if these two scenarios became the norm in patient care?

 

1. Providers prescribe an intermittent cardiac monitoring device to patients who fall in the “at-risk” categories as mentioned earlier and capture an arrhythmia that would allow them to then prescribe a wearable device, or even an intervention, long before patients became symptomatic.

 

2. After a patient completes a prescribed course of continuous monitoring-they are given an intermittent device to serve as a safeguard and to deescalate surveillance.


intermittent vs continuous for cardiac event monitoring

 

A Call to Action for Providers

 

Providers should incorporate an intermittent cardiac device into their diagnostic toolkit. This will allow the ability to transition between intermittent and continuous monitoring as appropriate, tailored to the patient's unique circumstances. This action empowers providers to leverage the added reimbursement opportunities that a cardiac device adds to the RPM suite of services.

 

By broadening the scope of cardiac monitoring beyond wearables, providers can enhance patient care outcomes and refine best practice.

 

 

 

 

For more information about the Hom ECG+ solution, click here.


References:


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