Diagnostic processes and the utilisation of ECG have developed considerably over the past few decades.
Before his retirement, cardiologist Mikko Syvänne held several key positions related to the treatment of heart diseases. He served as Chief Physician at the Department of Cardiology of Helsinki University Central Hospital and as Chief Physician of the Finnish Heart Association.
“Although general practitioners were taught the interpretation of basic ECG at least in the 1970s, if not earlier, Holter analytics was initially used mainly by specialists. In long, 24-hour measurements, a specialist would study an ECG report on a computer screen using fast forward and would stop to examine any deviations they detected,” says Syvänne.
In the 1980s, the largest primary healthcare units used to hire clinical physiologists to monitor and interpret the results of stress ECG tests. General practitioners have also wanted to develop their ECG interpretation skills. ECG training sessions are popular at the annual Doctor event in Finland, for example. An ECG ruler is a familiar tool for doctors in measuring ECG time intervals and, these days, also for checking automatic analyses. In addition, it serves as an aid to memory with regard to some common ECG changes.
Holter monitoring – or long-term ECG monitoring as recordings of 24 to 48 hours – is necessary when a patient is suspected to be suffering from heart arrhythmia. To some extent, it can also be used to examine oxygen deprivation in the heart muscle.
Previously, such examinations could only be conducted by referring the patient to a special healthcare consultation. Today, general practitioners and company physicians can often have these examinations carried out at their locations.
A specialist – usually a cardiologist or clinical physiologist – is still needed to analyse the findings. General practitioners can obtain this service from an external provider, or they can make use of the resources available in their local units.
According to Syvänne, remote analysis services are important, cost-effective low-threshold services that provide general practitioners with support. “The threshold for referring a patient to special healthcare may be high if they report that their heart is ‘beating a little faster’. High-quality remote analysis services enable general practitioners to take the treatment process a step further. They can get a statement from a specialist in just a few days.”
ECG analytics will continue to develop further. Large amounts of data, more advanced algorithms and higher computing capacity enable the development of reports that better support general practitioners and specialists in their decision-making.
RemoteA is developing SmartECG, a service that includes an automatic analysis generated by an algorithm and the provision of statements by specialists. After a doctor has uploaded their ECG data, they will get an automatic analysis in just a few minutes. They can also order a specialist’s statement either through the SmartECG service or by making use of in-house processes. In other words, the SmartECG service further accelerates the diagnostic process.
The service will be compatible with 80 per cent of ECG monitoring devices. The medical validation process for SmartECG will begin in spring 2018. The service will be piloted in autumn 2018, after the FDA and CE validation processes have been completed. Then the service will be launched.
The purpose of the SmartECG service is to lower the threshold for examining patients effectively. Patients suffering from palpitations, extrasystoles or similar symptoms will benefit from knowing whether their symptoms are signs of heart disease or harmless. Diagnosing atrial fibrillation is particularly important, even when it is asymptomatic, as it involves a risk of cerebral blood circulation disturbance, which can be significantly reduced through treatment. The risk group for atrial fibrillation includes people suffering from heart diseases, as well as healthy patients aged over 60. “It is beneficial to diagnose atrial fibrillation and start treatment, regardless of whether the patient is experiencing symptoms. Around 100,000–150,000 people in Finland have atrial fibrillation, which is asymptomatic in many cases,” says Syvänne.
RemoteA Group specialises in cardiac data analysis, remote diagnostic services and is a certified medical device manufacturer. Read our story from sleep-apnoea monitoring to developing ECG algorithm. Remote Diagnostics Service Platform is available in Sweden and United Kingdom.
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