Detect and manage crises in outpatient setting

A phone line, electricity — you’re in business

Some new in-home telemetry devices are coming on the market that could save your cardiac unit money while allowing patients to go where they want to go most — home.

HeartLink II was approved by the Food and Drug Administration (FDA) late this past December for home use for low-risk patients — those who are not at risk of sustained ventricular tachycardia or ventricular fibrillation.

Manufactured by Cardiac Telecom in Turtle Creek, PA, HeartLink II needs only a standard telephone line and an electrical outlet to provide immediate, accurate, and real-time cardiac monitoring from any location.

"When an event occurs — tachycardia of 140, for example — it grabs the phone line," says Lee Ehrlichman, president of Cardiac Telecom. "If someone is on the phone, it disconnects and transmits alarm data to the central station. It takes six to 10 seconds from the time the event is detected to its appearance on the screen monitored by paramedics. When the data come up, they state the patient’s name, ID number, and what’s going on."

Even though hospitals are under financial constraints for capital equipment — and this device will be costly — still, HeartLink II could save significant dollars by eliminating days in the hospital. If a patient goes into atrial fibrillation after a bypass, standard medical practice is to keep him or her there for three to five days.

Most doctors agree it would be more cost- effective if those patients could be sent home for three days; then, if they need cardioversion, they could come back.

HeartLink II has CPT code approval. The first patient was sent home with the device late December following the FDA trial, and Ehrlichman says he was assured the patient’s treatment would be reimbursed by Medicare.

Kathleen Lyons, RN, coordinator of the thoracic surgery department at St. Francis Medical Center in Pittsburgh, says the center, which performs over 1,000 open-heart cases a year, was part of the FDA’s trial to test the efficacy of HeartLink II. In comparisons made at several major teaching hospitals, the system detected cardiac events missed by other commercially available monitors.

"A third of our patients develop atrial Arrhythmias in the post-op period," Lyons says. "The sooner the arrhythmias are treated, the sooner the patient converts to a sinus rhythm. An additional comfort level is having a device that allows us to monitor the patient beyond the acute in-hospital phase — at home. This device satisfies that."

Lyons says insurance companies, on one hand, pressure you not to keep patients in an acute care setting unless they are getting acute care, "but their definition of acute’ gets more aggressive every day," she explains.

"Say you have a patient in a sinus rhythm who has attained all his clinical goals — he’s walking 600 feet; he’s ventilating on room air; he’s gotten his education; he has complete social support at home; and he’s well into his outpatient cardiac rehab. But, on the other hand, he’s just 24 hours into his sinus rhythm. That’s a place for home telemetry."

When a patient is discharged, his or her cardiologist or thoracic surgeon orders the device for about three days and indicates a physician to be responsible for responding to alarms. A clear protocol for monitoring response is prescribed. Prior to hookup, a Telecom team educates the patient at home.

The caregiver plugs a module into an electrical outlet, inserts the phone cord into the patient’s home phone jack, and attaches three gel leads to the patient.

Unless an emergency is in progress, the system sits idle and doesn’t affect the phone line, similar to a home security service.

In the event of any unusual cardiac event, or the push of a panic button by the patient, the device captures and reports relevant data leading up to and following the event and automatically transmits an alarm over the telephone line. In addition, it can produce an expanded array of one- and 24-hour trend graphs. (See photos, p. 32.)

Patterns monitored, arrhythmias detected

Heart Link II monitors and diagnoses EKG patterns, and data analysis routines built into the system automatically detect any of 16 arrhythmias including asymptomatic atrial fibrillation. Signals are transmitted to a remote location where paramedics monitor around the clock.

There are various levels of response. If the patient develops a change from sinus rhythm, the paramedic calls the physician and he responds accordingly, such as sending out a home care nurse. Should the patient have a crisis, the paramedic dispatches a team to bring the patient to the hospital.

Every eight hours, the paramedic at the central station calls the patient to answer questions. The patient can bathe, if the electrodes are removed first and the patient calls before interrupting the service. At the end of the prescribed period, the paramedic visits the patient to remove the device.

"The patient doesn’t have to do anything," says Ehrlichman. "One 78-year-old woman had a heart block at 3 a.m. while she was sleeping, and the hospital was informed seconds later."

The device weighs less than 11 oz., and the range of transmission — 200 feet to 500 feet — allows the patient to move freely and perform normal home activities.

"Patients view this as a security blanket," says Lyons. "Otherwise, they go from a high level of monitoring and intervention when in the hospital to nothing at home."