Heartbeats: The Value of Remote Cardiac Monitoring

Note: There are a number of methods used to monitor heart rhythms outside of the hospital for diagnostic purposes, also known as remote cardiac monitoring. While those are valuable tools, this article focuses solely on the methods used in an inpatient or hospital setting.

Cardiovascular disease has been the leading cause of death in the world for the last 100 years, creating a significant burden on patients and the healthcare system. In 2021, there were over 4.6 million cardiovascular-related hospitalizations in the United States alone. In the hospital, cardiac monitoring is a valuable tool in the care of these patients, but there are a limited number of units and beds that are available. In order to maximize the use of this resource, remote cardiac monitoring has become a viable option to monitor patients regardless of where they are admitted in the hospital.

What is cardiac monitoring?

Example of electrode placement and telemetry monitors, retrieved from https://my.clevelandclinic.org/health/diagnostics/cardiac-telemetry-monitoring

Also known is cardiac telemetry, cardiac monitoring is a tool that monitors a patient’s heart rhythm in real time. This type of monitoring is reserved for cardiovascular/telemetry and intensive care units. Electrode stickers are placed on specific locations on the patient’s torso which are attached to wires, and these wires are connected to a monitor next to the patient’s bed which displays the heart’s electrical activity, more or less continuously. Alternatively, smaller box monitors, a little larger than a modern smartphone, which can fit in the patient’s pocket are available to allow for better mobility.

Regardless of the method, the data from the patient’s individual monitor is wirelessly transmitted to a larger monitor that is typically housed at the unit’s nursing station, which allows for a team-based approach to rhythm monitoring. There are a number of reasons why cardiac monitoring may be indicated, but patients who are admitted to these units have been determined by providers to require very close monitoring of their heart rhythm to assess for changes and to direct their treatment.

For example, if a patient is diagnosed with acute congestive heart failure, they will likely need to be admitted to a telemetry unit so their rhythm can be continuously monitored for any dangerous arrhythmias that can result from the issue. The specialized nursing staff on the unit can respond quickly and appropriately compared to different types of patient care units.

What is remote cardiac monitoring?

Example of remote cardiac monitors, retrieved from https://www.uchealth.org/today/remote-patient-monitoring-of-covid-19-brings-peace-of-mind/

Remote cardiac monitoring is logistically very similar to cardiac monitoring; the patient is typically connected to the smaller box monitor only, and the larger monitors are monitored by trained technicians. These monitors can still be on a specific unit, but they can also be in a centralized location off the unit or even in a separate building miles away. Depending on the location of the monitors, the technicians will alert the patient’s nurse if there are changes in the patient’s heart rhythm or rate via phone call, direct messaging, or simply face-to-face.

These centralized remote cardiac monitoring units may include a nurse trained in telemetry who serves as a resource to finalize cardiac strips sent by the technicians, and to review the chart for medications and lab results which helps guide the care team’s decision-making. Patients on remote telemetry are typically admitted for a non-cardiac issue, but may also need monitoring for a certain amount of time.

For example, atrial fibrillation is associated with a higher risk of ischemic stroke due to risk for blood clots. For a patient with this type of stroke, it is generally recommended to monitor their heart rhythm for atrial fibrillation for at least 24 hours in order to treat the underlying cause. In this case, they can be placed on remote cardiac monitoring and admitted to a neurology unit to receive care, and the monitoring may only be necessary for 1-3 days depending on the patient’s progression and the preference of the provider.

Conclusion

Remote cardiac monitoring can be found in some hospitals in the United States, but is still a relatively new resource and currently, there are a lack of studies and data for the best practices. There are certainly drawbacks of remote cardiac monitoring which largely fall under user/human error and technical difficulties, so it would be useful to explore these gaps to develop evidence-based protocols and improve efficiency before it becomes commonplace. As long as hospitalizations requiring cardiac monitoring maintain their numbers or continue to steadily increase, proper implementation and wider availability of remote cardiac monitoring can become a great option of easing the burden on our healthcare system.

References:

American Heart Association - More than half of U.S. adults don't know heart disease is leading cause of death, despite 100-year reign, https://newsroom.heart.org/news/more-than-half-of-u-s-adults-dont-know-heart-disease-is-leading-cause-of-death-despite-100-year-reign

The American Journal of Cardiology - National Costs for Cardiovascular-Related Hospitalizations and Inpatient Procedures in the United States, 2016-2021, https://www.ajconline.org/article/S0002-9149(24)00729-X/fulltext

The Cleveland Clinic - Cardiac Telemetry Monitoring, https://my.clevelandclinic.org/health/diagnostics/cardiac-telemetry-monitoring

Archives of Internal Medicine (accessed from https://www.ncbi.nlm.nih.gov/) - Use and Outcomes of Telemetry Monitoring on a Medicine Service, https://pmc.ncbi.nlm.nih.gov/articles/PMC3851315/

Journal of the Society for Simulation in Healthcare (accessed from https://www.ncbi.nlm.nih.gov/) - Effect of remote cardiac monitoring system design on response time to critical arrhythmias, https://pmc.ncbi.nlm.nih.gov/articles/PMC8904642/

European Stroke Journal (accessed from https://www.ncbi.nlm.nih.gov/) - Prolonged cardiac monitoring from stroke prevention: A systematic review and meta-analysis of randomized-controlled clinical trials, https://pmc.ncbi.nlm.nih.gov/articles/PMC10069201/

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