Marta Niezgoda, Manager of the Remote Medical Care Center, answers questions about Remote Cardiac Care.
1. What is Remote Cardiac Care?
Remote Cardiac Care is a form of service by which patients can monitor their health 24/7 for any period of time. Apart from automatic detection of irregular heart rate, patients can also perform tests on demand. At any time, they can also press the panic button, or ask for urgent contact with the Remote Medical Care Center, using Comarch PMA (Personal Medical Assistant). PMA is a certified ECG recording device with a telemedical function and inbuilt algorithms to detect basic cardiac irregularities.
2. What kind of tests can be performed within Remote Cardiac Care?
The service offers several types of tests, including cardiac telemonitoring (heart rate monitoring with detection of irregularities at any time intervals), remote ECG on demand (resting ECG with 12 leads) any time, in any place), Event Holter (involving registration of short ECG fragments, for example when adverse symptoms present), and ECG Holter with monitoring (for continuous heart beat registration using seven or 12 leads with cardiac monitoring).
3. What are the leads and what are they for?
The leads map electrical activity of the heart muscle. They can be compared to virtual cameras observing the heart from various places. The diagram informs us about the course of the electrical signal causing heart contraction.
4. What do tests performed within the Remote Cardiac Care look like?
The tests are performed with a portable ECG signal recording device. Before starting the test, medical personnel perform a cardiac interview with the patient, and perform a reference ECG test. During monitoring, using inbuilt detection algorithms, the device automatically detects irregularities in the patient’s heart rate. Sections of the recorded ECG signal are transmitted to the e-Care Remote Cardiac Care Center, and then analyzed in detail by specialists.
5. Who can benefit from the tests?
Everyone who needs them. The service is most frequently used by patients with cardiac problems, suffering from arrhythmia or hypertension, with dyspnoea and vertigo, or with cases of cardiac diseases in the family. The test can also be used as support for cardiac rehabilitation after heart attacks, or to provide diagnostics after cardioverter implant or ablation procedures. Remote Cardiac Care is also a useful tool for very active athletes.
6. What happens when irregularities are detected by medical staff analyzing the records?
If a potentially dangerous heart rate is detected, personnel at the Center contact the patient to perform a medical interview, in accordance with predefined procedures, to determine the best way to proceed. In the event of a risk to a patient's life or health, Center personnel notify the emergency services providing the latest information on the patient’s health. After the test, the data is downloaded from the device and analyzed using specialist software by a cardiologist, and the results of this analysis are given to the patient.
7. Do I need to prepare for the test?
You needn’t prepare for the test in any special way. It is recommended to avoid using creams or body balms for 24 hours before the test. The skin must be prepared appropriately for the placement of electrodes, by shaving the adhesion sites and epithelial abrasion (removal of dead cells) to improve the quality of the signal. The test in itself does not greatly limit the patient’s regular activities. It is aimed at recording a typical day for them.
8. Will I get training before using the device?
Yes. Everyone willing to use the Remote Cardiac Care service is trained by medical staff. The training includes simple activities, such as turning the device on and off, and using the inbuilt activity log where the patient is to record their day. The log also allows events such as going to bed, getting up, , undertaking physical effort, drug administration, and any sensation of distorted heart rate to be marked. Owing to this function, the patient can inform paramedics or doctors analyzing the test about activities undertaken during the day. This facilitates the patient monitoring process, with alarms about irregularities being activated automatically. The device itself also contains a training option, which includes electrode connection. The option is available immediately after turning the device on. If an electrode is accidentally disconnected, the patient is alerted immediately.
9. How long does the test take?
The duration depends on the type of test we decide to perform. In the case of cardiac telemonitoring, the patient or doctor in charge decides how long and when the test is to take place. Depending on those preferences, the test can be performed throughout the day or during specific activities undertaken by the patient, as well as at selected time intervals. ECG Holter with monitoring can last from 24h to up to one week. Apart from the ECG signal, the device transfers information about anomalies detected during the test to the Remote Cardiac Care Center. Remote ECG on demand can be performed at any time and in any place. The test can be carried out in two ways, either in accordance with a doctor's recommendations (for example, at a fixed time), or while a patient is experiencing cardiac symptoms. The result of the test is transmitted immediately to the Remote Cardiac Care Center. The ECG record is analyzed by the doctor, and the result of this interpretation is sent by text message to the device or to the patient’s phone number.
10. In what conditions should be test be performed?
Depending on the type of the test we decide to perform, you can perform it during physical activity, rest, rehabilitation, or routine activities. Patients should remember not to wear any jewellery on their neck during the test. You must also avoid wearing bags or backpacks that could exert pressure on the electrodes. Remember not to bathe with electrodes on, and do not get them wet.
11. What should I do if the device turns off during the test?
During a test, PMA cannot turn off if a charged battery has been connected. The patient cannot terminate the test. The device will continue working until the test has been terminated by the qualified personnel at the Remote Cardiac Care Center. If there are any problems or technical questions, the patient can always call the Center to explain the problem.
12. What happens if the test is performed incorrectly, for example, if one of the electrodes is attached in the wrong place?
The first placement of the PMA is done by a nurse who instructs the patient how to connect the device correctly. Moreover, the patient is provided with information material, and receives confirmation from the device about whether all the electrodes have been placed correctly. Therefore, the possibility of incorrect electrode placement is minimal. While seeing the artefacts , Remote Cardiac Care Center staff can also call the patient and instruct them how to attach the electrodes correctly.
13. Will I be informed if irregularities are detected (for example, during the test)?
Yes. All results obtained during a test are sent to the e-Care Remote Cardiac Care Center. They are also analyzed by paramedics and doctors. Each measurement sent is analyzed in detail. If, when interpreting the data sent to the Remote Cardiac Care Center, paramedics notice results that may point to a risk to the patient’s life or health, they follow the applicable procedures.
14. If I faint while using Comarch PMA, will the paramedics be able to help me?
Yes, if fainting is caused by heart rate irregularities, or if the patient managed to press the contact button to contact the Remote Medical Care Center. In order to intervene, according to the applicable procedures, paramedics must see changes to the ECG records or contact the patient by phone. Comarch PMA has an inbuilt GPS, owing to which it is possible to pinpoint the patient using geolocation, so an ambulance can be called if needed.
15. What irregularities are usually detected?
The most frequently detected irregularities are too fast or slow a heart rate. Another frequent irregularity detected by PMA involves atrial fibrillation. Every patient receives a device individually configured to his condition, pursuant to information gathered during the cardiac interview and reference ECG record.
16. What are the major problems of patients using the Remote Cardiac Care services?
Most problems are related to the patient becoming acquainted to the continuous presence of the device. Usually, after several hours, patients become used to it and do not sense any discomfort while engaging in their daily activities.
17. What are the benefits to patients using Remote Cardiac Care?
Patients using the Remote Cardiac Care services gain a sense of safety for themselves and their families under the care of Center's staff. Continuous heart rate monitoring and practically unlimited test duration make it much more likely that cardiac irregularities can be detected, than in the case of tests lasting 24h or 48h.
The test is also comfortable. The device is small and ergonomically shaped. It is discreet and does not limit daily activities. Test results can be provided to medical staff in the form of extended reports that are also a tool for cardiac diagnostics. The type of test is individually tailored to the patient’s condition and lifestyle.
18. How does the Remote Cardiac Care with e-Care Remote Medical Center differ from other such solutions?
Remote Cardiac Care is the most universal solution.I t involves choosing one of many operating modes and setting the monitoring parameters to tailor the test to the individual patient’s needs.