Project of the Month January 2004

Cardiac Patients can be Monitored in their Home

The patient avoids hospitalization, and the health sector saves costly bed-days owing to the ”Remote Monitoring of Cardiac Patients” project

By Naia bang / Texthuset Aalborg
When a patient with a heart disorder is admitted to hospital, he or she is connected to a telemetric device monitoring his or her heart rate. Patients are being monitored around the clock for two to five days, and based på these measurements the patient is given medication and prescription and subsequently discharged from the hospital. In our homes, however, we are much more active than during hospitalization. And the medication is either not working, or only so to a limited effect. The result is that the patient gets worse – and will be admitted to the hospital again.
This is the background of the ”Remote Monitoring of Cardiac Patients” project, run under the umbrella of the Digital North Denmark. In short the project is about equipping the patient with a small mobile telemetric device. Using wireless connectivity to a mobile phone it transmits cardiac information to the Cardiological Department of the Hospital of Aalborg. Here the staff can monitor several patients simultaneously – eventhough the patients are back in their own homes. The hospital staff will quickly detect if a patient gets worse, and they will either call the patient on the phone and recommend a different medication – or make sure the patient is readmitted to hospital.

Yousef Jasemian, Project Lead with a test version of the cordless telemetric-device. According to plans the people behind the ”Remote Monitoring of Cardiac Patients” project will be able to present a version that is fully operative - and ready for market within a year.
Photos: Ajs Nielsen

Old Equipment Too Slow
Most Danes know a friend or a relative suffering from a cardiovascular disorder. According to the Danish Heart Foundation, around 450,000 Danes are suffering from a cardiovascular disorder. More than one out of ten Danes admitted to hospital are suffering from cardiac disorders – and they occupy more than 17 percent of the bed capacity. More than half of the hospitalized cardiac patient are readmitted.
- Before setting up this project, we had two options for monitoring a cardiac patient: Either they could be monitored at the hospital, or they could be discharged and left in their homes with a kind of tape recorder called a Holter monitor recording the heart rate. The following day the patient would deliver the tape to the doctor at the hospital. He would then forward the tape to a specialist, who would analyse the tape for a diagnosis. It would be returned to the department, and from here the patient would be mailed, explains Yousef  Jasemian, who is a technical engineer and the project leader – as well as the initiator of the ”Remote Monitoring of Cardiac Patients" project. And he elaborates:
- This system was really slow -- and costly. The procedure could easily take a week until the patient was informed.
Actually, the Holter-monitor system is still being used according to Yousef Jasemian. For the doctors have no alternative. - Not yet...

New Technology for the Equipment
When Yousef Jasemian started up his PhD studies at the Institute of Sensomotoric Interaction of Aalborg University, this was exactly what he had in mind: A better solution for cardiac patients. And as he was working with Ericsson, the wireless mobile communication solution was the obvious choice. - I spoke to Egon Toft, consultant doctor of the Hospital of Aalborg and asked if the hospital would join in – and encourage patients to participate in tests. And his response was quite positive, recalls Yousef Jasemian.
So a consortium was founded, consisting of the hospital, the university, Ericsson, Sonofon and Danica Biomedical – the latter manufacturing the telemetric devices to be used. And the ”Remote Monitoring of Cardiac Patients” project became reality.
- The intention was to use the existing telemetric equipment – and upgrade it to a more contemporary technology. We would eliminate all cables between the equipment and the patient – enabling the patient to stay in a daily environment, explains Yousef Jasemian.

Better Medication – Less Hospitalization
- However, the goal was not only of a technical nature. It is vitally important that the cardiac medication works as intended, and therefore its effects should be monitored in a realistic environment, ie. the patient's home. This also gives the pharmaceutical industry a far better opportunity to know the full effects of the medicine – and in turn make a much more precise description of the medication for the doctors prescribing it, states Yousef Jasemian.
The project had yet another goal, namely that of reducing waiting lists for cardiac examinations. At the launch of the ”Remote Monitoring of Cardiac Patients”, waiting times for the so-called Holter monitor amounted to around two months, and approximately 850 patients used the device annually.
Once the cordless telemetric device is in production, the Holter monitor is likely to be phased out. Adding to this the people behind the ”Remote Monitoring of Cardiac Patients” rely on the cordless telemetric device helping to reduce the number of readmissions – and hence the number of bed-days for cardiac patients. And in terms of money there is a huge saving potential in the health sector: Prices for a patient bed-day start from DKK plus…  

Inger Møller Thomsen of Aalborg was the first patient to test the cordless telemetric-device, and in particular she appreciated the peace of mind it gave her knowing that somebody was ”looking after” the condition of her heart even though she was in her home.
Photos: Ajs Nielsen

The Monitoring Equipment gives you Piece of Mind
The ”Remote Monitoring of Cardiac Patints” project was launched around Christmas 2001 – but in the beginning the technology was tricky.
- We wanted to use Bluetooth wireless connectivity technology, which is working really well on short distances. However, the first generation of Bluetooth mobile phones was not sufficiently reliable for our purpose. Later it has improved greatly, adds Yousef Jasemian.
In 2002 it was time for testing a prototype of the cordless mobile telemetric device. The hospital staff asked the Inger Møller Thomsen, 81, if she would care to be a testee. Over the recent years Inger Møller Thomsen has suffered from cardiac disorders, and especially at night her heart was rather unsteady. So she had been readmitted several times. Inger Møller Thomsen agreed to be in on the test. She was equipped with a test version of the cordless telemetric device.
- It feels safe to know that somebody is keeping an eye on your heart even though you're away from the hospital. You can move about freely in your home and do your usual stuff – and even go in the garden or take a walk. You can't just sit in a chair reading books from the library all day, explains Inger Møller Thomsen, and adds:
- This device would prove really helpful to a lot of people. And you don't have to pay attention to all the technical stuff, – it looks after itself. So there is no reason to be uneasy with such good help at hand!

Ready for Clinical Test
Since Inger Møller Thomsen was a testee, the people behind the project have been working to further develop the system, and today a prototype of the device is ready. The actual telemetric device is small enough to fit in a large pocket. From the telemetric device small probes are wired to be placed on the patient's chest. The telemetric device will transmit measurements wirelessly to a GPRS-mobile phone, which will forward measurements to the Cardiological Department of the Hospital of Aalborg.
Officially the ”Remote Monitoring of Cardiac Patients” project was concluded by the end of 2003, but the people behind it are continuing the development. Beginning in late January the Hospital of Aalborg starts up a large-scale clinical test of the device. Around 150 cardiac patients will be involved in the testing. Completing the test and analysing the results will take almost a year. At that time the people behind the ”Remote Monitoring of Cardiac Patients” hope the device will be ready for production in the spring of 2005.

Read more about the ”Remote Monitoring of Cardiac Patients” project on www.thedigitalnorthdenmark.dk

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