P5530Is the portable device personal analyser a reliable telemonitoring device for prompt diagnosis and timely treatment of patients at high risk after their discharge from intensive care unit?

Abstract

Introduction: In standard Holter ECG diagnostic the information is available after a prolonged period (usually 24 hours) monitoring (passive registration). Howerer, the critical events in high risk patients often appear after their discharge from the intensive care unit (ICU). The portable tele-monitor devices are miniature version of the patient monitors for on-line surveillance and their role for detection of lifethreatening arrhythmias, prompt diagnosis and timely treatment is growing. Purpose: To assess the reliability of the portable device Personal Analyser (PA) in comparison with the Holter ECG to register rhythm pathology and to enable timely anti-arrhythmic treatment in patients taken out of ICU in a general ward. Material and methods: The study included 85 patients (n=85, 54 females and 31 males) with average age 64,8, stratified into two groups: Ischemic heart disease (IHD) - with previous myocardial infarction (MI) 5 (5.8%); without MI 23 (26.7%) Patients at high risk without IHD suffuring from: Chronic congestive heart failure (CHF) - 58 (65.1%) most of whom with III functional class (NYHA) 50 (58.1%) Valvular heart disease - 38 (44.2%) Pericarditis - 13 (15.1%) Diabetes mellitus - 24 (27.9%) Hyperthyroidism - 3 (3.5%), and Hypothyroidism - 5 (5.8%) The statistical analysis was performed by SPSS, version 18.0. Results: A total of 139 rhythm disorders were registered with the PA: ventricular extrasystoles in 44 patients (51.76%); atrial extrasystoles in 37 (43.52%); atrial fibrillation in 31 (36.47%): paroxysmal - 17 (20%), permanent - 14 (16.47%); supraventricular tachycardia in 18 (21.17%), atrial flutter in 4 (4.71%), ventricular tachycardia -5 (5.88%). For every patient a coincidence index (CI) was calculated (ratio of the arrhythmias, registered with PA vs these ones, recorded by Holter ECG:Holter ECG data being considered as 100%). The results showed: • complete coincidence (100% CI) in 75 patients (88.2%) • incomplete coincidence (75- 99% CI) in 9 patients (10.6%) • partial coincidence (50-75% CI)- none • low of coincidence degree (<50% CI) in 1 patient (1.2%) No episodes of PA dysfunction were registered. Conclusion: The results from our single centre study revealed that the portable tele-monitor PA is a highly reliable device for fast detection of various rhythm disorders in patients at high risk moved out the ICU in a step-down unit. The PA data reliability, when compared to Holter ECG, the qualities of the specialized “PatRis” software with a suitable user interface, database management, possibilities for remote control, and the acceptable price make it appropriate for routine use in cardiologuy practice.