Wearable remote monitoring in cardiac cases

March 11, 2020
By Doug Beinborn

Medical advancement in remote monitoring is progressing at a rapid rate thanks to wearable and implantable devices. The consumer market is driving this progress, and the possibilities for the medical-grade market are just being realized.

According to GlobalData forecasts, the wearable tech market was worth approximately $23 billion in 2018 and is predicted to grow to $54 billion by 2023. More than 25% of the current $23 billion market is for medical grade devices — an amount that is projected to more than double by 2025.

Integrating these devices into patient care is expected to drive down costs and improve quality outcomes. Here’s how medical-grade cardiac wearables are already being used in healthcare today:

As a means to monitor patients with suspected arrhythmias (heart rhythm disorders). For patients who are discharged without a clear diagnosis via traditional means such as electrocardiograms (ECGs), inpatient monitoring, Holter monitors or event monitors, wearable devices allow for continuous 15- to 30-day monitoring that captures rhythm abnormalities and guides physicians to appropriate therapy. This improves patient outcomes and potentially helps avoid life-threatening heart arrhythmias.

For the treatment of atrial fibrillation. In 2010 an estimated 5.1 million people were living with A-fib and that number is expected to surpass 12 million by 2030. Through wearable devices doctors are able to diagnose this disorder and assess effectiveness of various treatment strategies with anti-arrhythmic drug therapy, ablation intervention and rate control.

To monitor potassium levels in dialysis patients. Dialysis patients experience abnormal levels of blood potassium (hypo or hyperkalemia), which can lead to life-threatening arrhythmias. Through signal processing by a wearable single-lead ECG, changing morphology can be used to calculate potassium levels and eliminate the need for blood draw and testing.

To diagnose stroke. Traditional testing fails to determine a definitive root cause in about 25% of ischemic stroke patients. Though atrial fibrillation is commonly suspected, ischemic stroke can also be caused from a patent foramen ovale (hole in the heart), thrombophilias (increased risk of blood clotting), or large-artery atherosclerosis. Prolonged monitoring can help diagnose the potential for, and reduce the risk of, recurrent stroke. Wearables make sense for monitoring 30 days or less while injectable technology can be the preferred choice for longer assessments.

Wearable technologies are expanding in capabilities, operating platforms and physiological output. No longer limited to smartwatches, new wearables include smart clothing, where electronics can be incorporated into shirts, pants, shoes, blankets, wristbands, and hats to obtain physiological data. Jewelry including rings, necklaces, and bracelets are in development application for medical and personal use. The potential for these devices to transform patient care is revolutionary, but implementation and integration into healthcare will take time.

Challenges facing remote healthcare monitoring
There are many obstacles to navigate and pitfalls to avoid in the adoption of medical-grade wearable devices where various therapies will be initiated based on their medical findings:
• Patient acceptance: Are patients ready to have their physiological data shared electronically? Some may feel that this is intrusive or won’t want to wear the device all the time.
• Data security: Health care providers/hospitals will need reassurance that physiologic and personal data is secure. Health care IT security will need to evaluate chosen platforms and minimize risk.
• Data accuracy and processing: Providers are dependent on accurate data to make changes to their patient’s plan of care. They must be able to process the physiological data and treat patients based on those findings in a timely, accurate manner.
• Device, platform and disposable item costs: The device itself is only the beginning. Monitoring will require software and those costs can include initiation of service and/or yearly fees. Disposables can include electrodes or skin prep items.
• Systems integration: Health care providers want to be able to access a single source for information and, ideally, remote data is contained within the same system.
• Reimbursement: Medical reimbursement may not yet exist through Medicare or private insurers, depending on the device or physiological specific output providers want to assess. If reimbursement exists, it is often shared between the hospital and device company.

Doug Beinborn
Remote care through wearable devices has the potential to provide many applications in cardiology and beyond in both acute and chronic medical conditions. As our healthcare system moves from pay-per-service to episode-of-care models of reimbursement, this technology has promising applications. Through remote physiological data-gathering, providers will have the ability to intervene earlier in patient care, which will reduce hospital admissions, length of stay, clinic visits, and, hopefully, overall healthcare costs.

About the author: Doug Beinborn is a senior director in physician preference and contract services with Vizient and works closely with industry and hospital members in the cardiovascular, orthopedic and neuro intervention space.