Better cardiac monitoring boosts patient outcomes

A new strategy for hastening treatment for heart attack victims is being tested in a mountainous California county where drive times to hospitals often are long, and the lead researcher says it could become a way for EDs to be their community’s leader in cardiac care.

Since August 2003, all ambulances in Santa Cruz County have been equipped with sophisticated cardiac monitors that can send vital data directly by cell phone to the ED of the receiving hospital.

This is a significant step up from the typical data received by ED physicians and staff when the ambulance is en route, says Barbara Drew, RN, PhD, the study’s principal investigator and a professor of physiological nursing in the University of California, San Francisco School of Nursing.

"Continuous ischemia monitoring has never been done before, so this is a first," she says. "In most places, no information comes in from the field about the electrocardiogram [ECG], and if the triage nurse doesn’t pick up on the fact that this is a possible acute coronary syndrome, the patient may wait a long time when he or she needs treatment immediately."

If a hospital wants to become a major cardiovascular center, "tele-electrocardiography" would be an improvement to consider, she says.

Low-cost improvement

The software is not yet commercially available, but Drew expects it will be soon if the study results continue to be positive. The technology could be of most use to EDs in areas with long transport times.

"This is a relatively low-cost improvement that could result in all the cardiac patients coming to your center, so I would expect that EDs wouldn’t mind funneling more of these patients on to the cardiology department," Drew says. "Cardiovascular patients are a lucrative group of patients to have, and every hospital wants them."

Clinicians already are reporting good results with the system, she points out.

While specifics about the product still are to be determined, Drew says the service would be relatively inexpensive because it requires only a software upgrade to existing cardiac monitoring equipment.

12-lead monitor used

The new "tele-electrocardiography"system consists of an easily attachable 12-lead cardiac monitor that takes readings every 30 seconds and can detect ischemia, Drew says. The system includes a cell phone that transmits the information directly to the ED.

The standard heart monitoring procedure used by medics responding to calls from people experiencing heart attack symptoms involves attaching a cardiac monitor with a single recording lead to the patient’s chest.

The monitor provides only a basic ECG that measures the patient’s heart rate and rhythm. It can’t detect ischemia, and Drew says that is a critical difference.

A small number of ambulances in the United States are equipped with 12-lead cardiac monitors.

Although these can detect ischemia, Drew notes that they require attachment of 10 electrodes to the patient’s chest, and they make only a single 10-second recording, which may miss rapidly changing abnormalities common in heart attacks.

The tele-electrocardiography system Drew is using in her study consists of a 12-lead cardiac monitor that requires only a five-electrode attachment to the patient’s chest, software that analyzes the ECG every 30 seconds for signs of ischemia and heart damage, and a cell phone.


For more information on tele-electrocardiography, contact:

  • Barbara J. Drew, RN, PhD, FAAN, Professor of Nursing and Clinical Professor of Medicine, University of California, San Francisco, Two Koret Way, San Francisco, CA 94143-0610. Phone: (415) 476-4302.