Mobile Telemonitoring for Arrhythmias in Outpatients in the Republic of Georgia: A Brief Report of a Pilot Study

Abstract

As the very first trial of mobile telemedicine in the Republic of Georgia, in June-December 2010 we investigated 35 outpatients with different types of arrhythmia (male/female ratio=16/19; 12-80 years old), among them 5 patients with concomitant epilepsy. The control group comprised 7 clinically healthy sportsmen (soccer players, all men; 15-17 years old), during a 30-min velo ergometer stress test. A three-lead electrocardiogram (ECG) loop recorder (Vitaphone BT 3300; Vitasystems GmbH, Mannheim, Germany) was used in automatic mode, using special LRMA software (MDT, Lázně Bohdaneč, Czech Republic) and a Nokia (Espoo, Finland) model 6730 Symbian phone. Automatically recorded arrhythmia events were transmitted from the loop recorder by Bluetooth(®) (Bluetooth SIG, Inc., Kirkland, WA) to a phone and then by 3G (through our partner mobile operator, MagtiCom Ltd. [Tbilsi, Georgia]) to the Vitasystems server in Germany and were available to Georgian physicians via e-mail/Internet. Arrhythmias were recorded/monitored during 7-68 h of observation. The number of automatically recorded ECG events varied between 3 and 170 per observation, or 0.4-10.7 hourly. Cases of sinus brady- and tachyarrhythmia, sinus node weakness syndrome, atrial fibrillation, supraventricular tachycardia, supraventricular premature complexes, and ventricular premature complexes were correctly recognized by automatic recognition software and recorded. In 3 patients and 1 sportsman previously unspecified (despite multiple investigations), arrhythmias were recorded: paroxysmal tachycardia (n=1), sinus node weakness syndrome (n=1), and ventricular premature complexes (n=2). In 3 cases (all women) light insomnia and nervousness were reported. In 2 patients with neurosis (both elderly men, 1 with epilepsy) we had to stop investigation prematurely because of anxiety/agitation. Mobile telecardiology represents feasible methodology to monitor arrhythmias in outpatients in Georgia, promoting earlier discharge of non-life-threatening cases, improving patients' comfort of life, and increasing their mobility with enhanced safety. Mobile telehealth might also represent significant cost-saving for insurance companies (this is an ongoing study). Finally, in remote areas mobile telemonitoring of patients will improve quality of care by timely provision of a second opinion in cases when local expertise is not sufficient.

Long-term event-Holter monitoring in low-populated areas as a valuable diagnostic tool in the detection of arrhythmia

“…A large group of registered arrhythmias were premature atrial and ventricular contractions (PACs and PVCs), founded in 6% and 11% patients, respectively, what corresponds with other studies (4,22).…”

mHealth for cardiac patients telemonitoring and integrated care

“…m-telemonitoring is certainly more comfortable, as concomitant life-threatening conditions can be controlled at homes [2]. As cardiovascular diseases represent one of the leading morbidity and, especially, mortality cause throughout the world [4], telemonitoring of cardiac patients is one of the important parts of e-Health and mHealth [5,6]. WHO's notion of integrated healthcare carries the promise of cost containment through shortening of hospital stay and reduction of inappropriate hospitalizations and admissions to long-term care, at the same time creating conditions for seamless and timely referral of a patient from primary healthcare (PHC) system to secondary or tertiary level hospital whenever needed [1].…”

“…For out-of-hospital monitoring of cardiovascular patients loop recorders and event recorders are available. The use of event recorders with a direct transmission of ECG's can reduce the time of admission to hospital for risk groups, particularly -for arrhythmia patients, facilitate the diagnosis on an ambulant basis and reduce costs [5,6,9].…”

Telemedicine: a technological revolution

“…This study serves to demonstrate the viability and efficiency of telemedicine for monitoring and making an early diagnosis of arrhythmias among outpatients. 3 Among the many studies on the efficacy of using tele-education within medicine, Pereira et al recently published a successful experience achieved in Brazil. These authors examined the teleconferencing program of Hospital das Clínicas, Universidade Estadual de Campinas, for communication with other institutions (both in Brazil and abroad) between September 2009 and August 2010.…”