The Sedona Series Part 2: The UNSERVED Cardiac Patient
The RIGHT DATA for the RIGHT PATIENT
Perhaps one of the most compelling issues in our industry is the challenge of providing the appropriate access to healthcare for our patients. We have talked a lot about health equity and the disparities among the underserved, but what is not discussed as often is the unserved. Many patients fall into the “at-risk for arrhythmias” category, yet they are not given the tools they need to be monitored for these life-threatening events. More importantly, providers are missing an opportunity for early intervention. When providers have access to critical cardiac data, they have a chance to hit the rewind button on a diagnosis… a hospitalization… or even a death.
The RIGHT PATIENT: Connecting the Dots
We heard from several experts at the Mayo Clinic Cardiology Update: The Heart of the Matter 2022 on the patient profiles that are often linked to Atrial Fibrillation (AF). Dr. Amy Pollack presented several case studies on hypertension, while Dr. Rekha Mankad focused on the unique aspects of managing women with heart disease. Both physicians reinforced the need to work backwards and connect the dots from a diagnosis to the potential risk for AF sequelae.
We know that patients with high blood pressure are at risk for AF, and that risk increases substantially with uncontrolled hypertension. In a global four-year study of 15,400 emergency department patients, 66.5% of AF patients had hypertension. Although 93% of these AF patients with hypertension were on at least one antihypertensive medication, fewer than half of the patients had blood pressure levels less than 140/90 (1). Dr. Amy Pollack highlighted a myriad of challenges in trying to gain long-term control over a patient’s blood pressure, taking months to years to find the right combination of medication and lifestyle changes (2). If a patient is at highest risk for AF during times of uncontrolled hypertension, doesn’t it make sense to monitor a daily ECG along with a blood pressure check?
Dr. Rekha Mankad, Director at the Women’s Heart Clinic, presented on the “Unique Aspects to the Assessment and Management of Heart Disease in Women.” She highlighted a case study that showed women aged 30-54 years diagnosed with a myocardial infarction (MI) had longer lengths of inpatient stays, more complications including arrhythmias, and higher mortality rates than men (3). Atrial Fibrillation (AF) presents a two-fold risk of MI (4), so we ask again, doesn’t it make sense to expand cardiac monitoring to this subset of patients as a potential for early diagnosis and intervention?
The RIGHT DATA: Quick Access to Rewind
Patients with hypertension and young women at risk for MI are only a fraction of those with an increased risk of AF. This arrhythmia is prevalent in chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), older adults, and the list goes on.
By properly identifying the at-risk patient population, we have a unique opportunity to prevent the sequalae associated with AF. ECG data, that is sent directly from the patient’s device to a provider, allows for quick access to crucial information that providers have been missing in their decision tree. Healthcare providers can hit the rewind button on costly admissions and emergency department visits, and intervene before dangerous sequelae such as stroke, heart failure, and even death occur. It is time we safeguard these unserved patients and give them a cardiac monitoring solution that focuses on prevention.
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Ombani, Stefano, et al. (2020). Evidence and Recommendations on the Use of Telemedicine for the Management of Arterial Hypertension. American Heart Association. https://doi.org/10.1161/HYPERTENSIONAHA.120.15873
Amy Pollack, MD. Updates in Hypertension Management for Primary and Secondary Prevention of Coronary Artery Disease. Presented at Mayo Clinic Cardiology Update: The Heart of the Matter 2022. August 2022.
Rekha Mankad, MD FACC. Unique Aspects to the Assessment and Management of Heart Disease in Women. Presented at Mayo Clinic Cardiology Update: The Heart of the Matter 2022. August 2022.
Soliman, E., et al. (2014). Atrial Fibrillation and the Risk of Myocardial Infarction. JAMA Internal Medicine. Jamanetwork.com/journals/internalmedicine/fullarticle/1764008