ActiveECG Review

In clinical research, in education, in homecare and for all the healthcare professionals who appreciates the functionality of a Palm OS handheld device, ActiveECG is a boon to mobile monitoring at the point of care.

Homecare Application of ActiveECG:

Jeneane A. Brian, BSN, MBA, CEO, VNAHHS trialed ActiveECG in discharged post-op Coronary Artery Bypass Graft (CABG) patients in their own home. Ms Brian reports that the length of stay (LOS) in hospital for these open-heart patients has been reduced in recent years. These patients receive routine cardiac monitoring for a shorter period of time as a result of earlier discharge.

Routine cardiac monitoring in the hospital usually means continuous 3 lead cardiac monitoring for abnormal rhythms. If a significant cardiac rhythm is detected a 12 lead ECG is usually performed to facilitate diagnosis and a treatment plan.

When the visiting nurses assess the post-op CABG patients in the home they can perform a 3 lead ECG using ActiveECG. ActiveECG monitors the heart's rhythm in real time, allowing the nurse to evaluate the rhythm on the spot, record a rhythm strip and store it on the handheld to be loaded onto the PC/laptop for interpretation.

If the nurse detects an abnormality these findings can be reported to a cardiologist from the patient's home.

Ms Brian says that their lead cardiologist is thrilled that the visiting nurses are able to take a rhythm strip daily until the first post-op office visit, which is typically one week after discharge. The cardiologist believes the daily cardiac monitoring provides important information and early detection of rhythm problems which can be treated with medication, potentially avoiding invasive procedures or re-hospitalization for the patient.

Ms Brian reports that many clinicians would like to receive 12 lead reports instead of 3 lead ECG reports. Although a 12 lead ActiveECG machine would be a welcome addition to the 3 lead ActiveECG for more in-depth interpretation of abnormal cardiac rhythms I suspect that the 3 lead device is the appropriate monitoring and diagnostic tool for the majority of CABG patients who are seen by the visiting nurse.

Clinical Trial Application of ActiveECG:

The portability of ActiveECG makes it a good choice for use in clinical trials. I have used a much larger portable 12 lead ECG machine in a clinical trial. One of the drawbacks to this machine was the fact that I couldn't see the patient's waveform. The machine stored the waveform and sent it via modem to a central location. I would dial the phone and provide my site details to the person on the other end of the phone and then transmit the waveform. At the end of the transmission the person at the other end of the phone would report the quality of the waveform to me. It would either be acceptable or I would have to do it again. This was both time consuming and cumbersome. Perhaps not being able to see the waveform was the price of getting a 12 lead ECG into a box the size of a regular tissue box.

Another drawback was that the ECG report would be faxed back to the site after interpretation by a cardiologist, for the study investigator to review. The quality of the fax was often poor and made assessment of the cardiologist's findings difficult. Meanwhile we would wait for the hard copy to arrive by mail. The machine was capable of storing only one ECG at a time. I would have to purge the previous waveform before I could take another. Being able to store waveforms in real time would have allowed the study investigator to review the waveform within hours after it was obtained rather than having to wait several days for the hard copy to arrive by mail.

The ActiveECG is about 1/10th the size of the tissue box and uses the handheld device to display the waveform. The storage and displaying capabilities are limited only by the available memory on the handheld device. Portability and functionality are very important considerations in clinical trials. Smaller and lighter pieces of equipment are easier to lug around and much appreciated by the research nurse who is always on the move.

Not all study-related ECGs need to be 12 lead; the need would be study-dependent. ActiveECG is well-suited to the study that requires 3 lead ECGs. It is perfect for clinical trials employing handheld devices for electronic data capture and transmission. The combination of handheld & ActiveECG clearly demonstrates the enormous potential of mobile computing in a clinical trial.

The ability to get a waveform without the patient having to remove their clothing or being exposed is very appealing to the patient and well received in the outpatient setting. I introduced the ActiveECG to participants in a study in which I am currently involved. The ECG is unrelated to this study but it gave me the opportunity to get feedback from the participants. The women in this study were very appreciative of the fact that they did not have to remove their top and that I was not fumbling around their chest trying to place the leads under their clothing! The size of the device is definitely a plus; it seems to be less intimidating than the more familiar ECG machines. The ActiveECG is both patient and user friendly.

A 12 lead ActiveECG would be welcome and useful in some circumstances, however the 3 lead ActiveECG will provide more than adequate monitoring and interpretation of cardiac rhythms in the majority of cases. Patients with abnormal rhythms can always be referred for a 12 lead and follow-up by a cardiologist based on the findings of the 3 lead ECG obtained in the field.

ActiveECG will assist the clinician to determine the need for a 12 lead ECG. This device has huge potential for homecare, outpatient clinics, family practice offices, and clinical trials by providing the patient and the clinician with relevant information instantly and in the palm of their hand. It is most useful in these settings as a portable and practical monitoring and diagnostic tool.

ActiveECG and the Educator.

As an educator I can see the utility of ActiveECG in a rhythm interpretation course. When I learned rhythm interpretation (too many years ago to mention) the instructor had overheads of photocopies of actual 3 lead rhythm strips taken from ICU and CCU patients. These were frequently of poor quality and made interpretation frustrating for the novice.

Now imagine you are in a modern classroom with a laptop, a multi-media projector, a document camera, your Palm OS handheld and your ActiveECG. On your laptop you have several aberrant rhythm strips and you obtain some rhythm strips from volunteers in the class for comparison.

Using the ActiveECG you can project the volunteer's rhythm in realtime onto the screen. Then you can upload it to the laptop. Using the ActiveECG software you can re-size and calibrate all of the rhythm strips that are projected onto the screen as you demonstrate interval measurement and interpretation of aberrant and normal rhythm strips. The ActiveECG software will project a distinct rhythm strip onto a clear graph that will make interval measurement and analysis a snap and enhance the education and learning process for the novice!

Homecare Application of ActiveECG:

Clinical Trial Application of ActiveECG:

ActiveECG and the Educator.

Summary