Advanced cardiac rhythm monitoring for the bottom of the pyramid
By: Waferchips Technosolution
Tags: Startup, Healthcare, Cardiac, Ecg, Heart

With India being dubbed as the ‘heart disease capital’ of the world, how well is the Indian healthcare system equipped to provide adequate cardiac rhythm monitoring for the rural population?

In May 2018, the World Health Organization (WHO) published in its website that ischemic heart disease and stroke are the world’s biggest killers, accounting for a combined 15.2 million deaths in 2016.

Cardiac diseases and stroke have emerged as the primary cause of deaths in India too, affecting the rural and urban populations alike. Cardiac rhythm monitoring using Electrocardiogram (ECG) is the most common technique used to diagnose cardiac diseases and detect the incidence of a stroke.

However, the people at the bottom of the pyramid do not have access to adequate medical facilities for cardiac rhythm monitoring, resulting in under-diagnoses. In Economics, the term ‘bottom of the pyramid’ refers to the poorest two-thirds of the human economic pyramid.

These rural and urban poor people are more susceptible to cardiac diseases because they tend to ignore the medical condition. This is mainly due to inadequate access to health care, high cost of treatment, social stigma and, illiteracy. The fear of missing wages and reduced productivity also discourage people from seeking treatment.

In 1932, the U.S. president Franklin D. Roosevelt said in his radio address,

“These unhappy times call for the building of plans that rest upon the forgotten, the unorganized but the indispensable units of economic power . . . that build from the bottom up and not from the top down, that put their faith once more in the forgotten man at the bottom of the economic pyramid.”

Likewise, we need to focus on the forgotten man at the bottom of the economic pyramid and tackle the unavailability of timely healthcare that he is facing. This will, in turn, improve the health of the country’s rural and urban poor population.

Providing adequate cardiac healthcare to the staggering number of underprivileged heart patients in India is one of the major areas that require immediate focus.

Cardiac rhythm monitoring helps to capture and display the heart’s performance and allows the doctor to determine if your heart is working properly or if you might have a heart condition. Holter monitors are the most commonly used portable ECG device in India.

Cardiac rhythm monitoring can help detect Arrhythmia (irregular heartbeats), find the cause of dizziness, fatigue, palpitations and, syncope (fainting), monitor chest pain, check if the pacemaker is working fine, detect Atrial Fibrillation (a rapid heartbeat that can lead to stroke), detect Ventricular Tachycardia, etc.

What are the disadvantages of Holter monitors?

In India, the purchasing cost of a Holter monitor varies from Rs. 50,000 to Rs 3,50,000. Due to the steep cost, hospitals usually procure only up to a maximum of two Holter monitors.

The few available Holter monitors in hospitals do not meet the huge demand for cardiac rhythm monitoring. Thus, there is a long waiting list of patients for Holter monitoring. The waiting time can extend up to 4 months. This waiting time delays timely diagnosis and treatment of cardiac ailments thus worsening the health of numerous patients.

Also, in India, due to the high cost of a Holter machine, many hospitals do not allow patients to carry the device home for continuous monitoring. They insist that the patient be present at the hospital throughout the monitoring period.

Therefore, even though Holter monitors are ambulatory ECG devices and can be normally used for monitoring cardiac rhythms for 24–48 hours, they do not serve the purpose as most patients are asked to remain in the hospital.

This adversely affects the people at the bottom of the pyramid as they rely on daily wages for running their household and cannot afford to miss work. Losing multiple days of work for cardiac monitoring might plunge them into absolute poverty.

Moreover, the Holter monitors are bulky and have multiple leads which are inconvenient for the wearer and restricts movement. In the rare circumstance that the patient is allowed to carry the monitor home, doing work with the Holter monitor attached, is difficult.

Holter monitoring test can cost anywhere between Rs. 1,500 to Rs. 5,000 for 24 hours monitoring in India. This is very expensive for a person who is struggling to make ends meet.

Holter monitors cannot come in contact with water or else the device will get damaged. Thus, patients cannot take a bath or swim during cardiac monitoring disrupting their daily routines.

All these factors force the economically weak people in India, to ignore their medical condition and delay treatment, thus contributing to the ever-growing number of cardiac patients in India.

How can clinicians reach out to people at the bottom of the pyramid?

The answer lies in Advanced remote cardiac rhythm monitoring technologies.

Advanced cardiac rhythm monitoring technologies provide cost-effective, easy-to-use, compact and long-term remote ECG monitoring which can be made accessible to people at the bottom of the pyramid, without disrupting their lives.

Advanced cardiac rhythm monitoring provides networked communication. This helps exchange digitized ECG data from implanted or wearable cardiac monitors devices.

It also reduces the need for frequent clinic visits and allows earlier detection of heart ailments. The schema for remote monitoring is shown in the figure below.

Using remote monitoring, the recorded data can be transmitted to health care personnel by phone or over the internet.

Wearable Adhesive patch ECG monitors use low-power and are inexpensive and affordable. They are wireless single-lead monitors designed for the convenience of users. Hospitals can procure several wearable adhesive patch ECG monitors thus reducing the waiting time of cardiac patients.

The adhesive patch is thin and very flexible and can be attached comfortably on the person’s chest allowing the wearer to perform his/her daily activities with ease. It can record the ECG continuously for a period of 3–30 days as recommended by the clinician.

An android application is used to display the ECG graphically on the mobile phone. These ECG results can be uploaded to the Cloud on the Internet. Clinicians can directly access the ECG from the internet and provide a timely diagnosis to patients, with the readily available data.

The adhesive patch ECG monitors are usually waterproof and do not get damaged if they come in contact with water. Hence patients can carry out all activities without any hindrance.

What can be done?

The use of advanced remote cardiac monitoring techniques could significantly shorten the time to detect and treat cardiac ailments and reduce clinic visits. It could also help cut costs to the healthcare system. Patients and their families have experienced positive results with long-term remote cardiac monitoring.

It is high time that clinicians and health care units embrace digital technologies like the advanced remote cardiac rhythm monitoring to transform the healthcare system into a more personalized, convenient and effective process.

The Biocalculus is one such advanced remote cardiac monitoring device that is developed in India and is an inexpensive, single-lead, wireless, adhesive patch type ECG screening device that can monitor ECG up to 40 days. Such futuristic technology will be a boon to the cardiac health of millions of Indians.