Thursday, July 16, 2009

Monitoring patients remotely

CRT-D with wireless capabilities
Jagmeet Singh, MD, PhD

This summer clinicians at the Massachusetts General Hospital Heart Center took monitoring their patients to a new level. Patients with heart failure can now read vital information about their condition in real time, right on their phones. At the same time, Mass General clinicians are able to read these measurements and contact patients immediately if they see changes.

On June 16, 2009 Stephanie Moore, MD, and Jagmeet Singh, MD, PhD, led a team that implanted a pressure monitoring lead into a patient's heart, the first of this type of procedure done in New England. Currently under investigation, this left atrial pressure monitoring lead measures the pressures directly in the heart. These real-time readings are directly recorded via a small handheld device held over the chest.

Measuring left atrial pressure is the most accurate way to detect very early changes in the heart function and build up of fluid. This information is transmitted wirelessly to a secure website, which patients read via a smart phone, and clinicians read on computer monitors at the hospital.

Patients with advanced heart failure often experience irregular heart rhythms, weight changes and fluid buildup within their hearts. Measuring fluid levels is critical as it influences the amount of medication physicians prescribe to prevent heart failure. "By acting quickly and adjusting medication, we should be able to keep more patients out of the hospital and improve their quality of life," says Mary Orencole, NP, coordinator for the Cardiac Resynchronization Therapy Program.

Called the Homeostasis Trial, the procedure is a joint research venture between the Heart Center's Heart Failure and Cardiac Transplant Program and Cardiac Resynchronization Therapy Program. Leading this innovative work was Dr. Moore, the trial’s principal investigator, and Dr. Singh, an interventional electrophysiologist who was specially trained to insert the device.

Taking a proactive approach

It’s not the first time Mass General has used wireless technology to monitor patients. In 2005 the Cardiac Resynchronization Therapy Program was established to treat patients using wireless technology combined with devices (called CRT-D) that synchronize the beating of the heart. It is the only program of its kind in the United States and draws upon the collective expertise of specialists in echocardiography, electrophysiology and heart failure.

"Alerts are viewed on a secure web-based server, and any patient who has had a cardiac event comes up on the first page we see," says Orencole. Several hundred patients currently use CRT-D with wireless capabilities at Mass General.

This standard of care saves lives by alerting patients and physicians, often before symptoms are present. Providers view patients' EKGs, body weight or blood pressure fluctuations and receive alerts in real time if changes occur. Patients can also voluntarily alert their providers if they feel like they are experiencing a cardiac event - all with the ease of a button.

Now through the Homeostasis Trial, patients can monitor their own fluid levels via a smart phone. "This is the latest trend in caring for heart failure, and it's a wonderful thing to see the impact this technology has on patient care and outcome," remarks Singh.

A busy mother goes about with her day

Maria Freda, a busy real estate agent and mother of four, suffers from a potentially debilitating heart condition, viral cardiomyopathy. Yet her device allows her to live a normal, active life where she can work and care for her teenagers - without worrying about unexpected hospital visits.

In August of 2007 Kevin Heist, MD, PhD, implanted a CRT-D in Freda's chest. Since then it has saved her life at least once. In October she overcame an unexpected arrhythmia, an abnormal heart rhythm that disrupts blow flow. Immediately the device jolted Freda's heart back to a normal beat and alerted Mass General clinicians to her condition.

"You feel like you have a network watching you, and you do. I can go about with my day," says Freda. "It’s my own air bag."

Learn more about the Cardiac Resynchronization Therapy Program at the Massachusetts General Hospital Heart Center.

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