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Application of handheld Tele-ECG for health care delivery in rural India

Published: 01 January 2014 Publication History

Abstract

Telemonitoring is a medical practice that involves remotely monitoring patients who are not at the same location as the health care provider. The purpose of our study was to use handheld tele-electrocardiogram (ECG) developed by Bhabha Atomic Research Center (BARC) to identify heart conditions in the rural underserved population where the doctor-patient ratio is low and access to health care is difficult. The objective of our study was clinical validation of handheld tele-ECG as a screening tool for evaluation of cardiac diseases in the rural population. ECG was obtained in 450 individuals (mean age 31.49 ± 20.058) residing in the periphery of Chandigarh, India, from April 2011 to March 2013, using the handheld tele-ECG machine. The data were then transmitted to physicians in Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, for their expert opinion. ECG was interpreted as normal in 70% individuals. Left ventricular hypertrophy (9.3%) was the commonest abnormality followed closely by old myocardial infarction (5.3%). Patient satisfaction was reported to be ∼95%. Thus, it can be safely concluded that tele-ECG is a portable, cost-effective, and convenient tool for diagnosis and monitoring of heart diseases and thus improves quality and accessibility, especially in rural areas.

References

[1]
Reducing Risks, Promoting Healthy Life, World Health Organization, Geneva, Switzerland, 2002, http://www.who.int/whr/2002/en/whr02_en.pdf.
[2]
World Health Organization, Global Status Report on Noncommunicable Diseases 2010, WHO, 2011, http://www.who.int/nmh/publications/ncd_report_full_en.pdf.
[3]
R. Gupta, P. Joshi, V. Mohan, K. S. Reddy, and S. Yusuf, "Epidemiology and causation of coronary heart disease and stroke in India," Heart, vol. 94, no. 1, pp. 16-26, 2008.
[4]
R. Gupta, V. P. Gupta, M. Sarna, H. Prakash, S. Rastogi, and K. D. Gupta, "Serial epidemiological surveys in an urban Indian population demonstrate increasing coronary risk factors among the lower socioeconomic strata," Journal of Association of Physicians of India, vol. 51, pp. 470-477, 2003.
[5]
A. Misra, R. M. Pandey, J. Rama Devi, R. Sharma, N. K. Vikram, and N. Khanna, "High prevalence of diabetes, obesity and dyslipidaemia in urban slum population in northern India," International Journal of Obesity, vol. 25, no. 11, pp. 1722-1729, 2001.
[6]
V. Mohan, S. Shanthirani, R. Deepa, G. Premalatha, N. G. Sastry, and R. Saroja, "Intra-urban differences in the prevalence of the metabolic syndrome in southern India--the Chennai Urban Population Study (CUPS No. 4)," Diabetic Medicine, vol. 18, no. 4, pp. 280-287, 2001.
[7]
M. Schuster, M. Pints, and M. Fiege, "Duration of mission time in prehospital emergency medicine: effects of emergency severity and physicians level of education," Emergency Medicine Journal, vol. 27, no. 5, pp. 398-403, 2010.
[8]
S. Scalvini, A. Giordano, and F. Glisenti, "Telemedicine and the relationship between hospital and primary care," Monaldi Archives for Chest Disease, vol. 58, no. 2, pp. 132-134, 2002.
[9]
American Telemedicine Association, What Is Telemedicine?, 2014, http://www.americantelemed.org/about-telemedicine/what-is-telemedicine.
[10]
A. Roth, O. R. Y. Yanay, M. Kehati, N. Malov, and M. Golovner, "Teleconsultation for cardiac patients: a comparison between nurses and physicians: the SHL experience in Israel," Telemedicine Journal and E-Health, vol. 12, no. 5, pp. 528-534, 2006.
[11]
J. Kim, J. Park, K. Kim, Y. Chee, Y. Lim, and K. Park, "Development of a nonintrusive blood pressure estimation system for computer users," Telemedicine Journal and e-Health, vol. 13, no. 1, pp. 57-64, 2007.
[12]
J. Seo, J. Choi, B. Choi, D.-U. Jeong, and K. Park, "The development of a nonintrusive home-based physiologic signal measurement system," Telemedicine Journal and E-Health, vol. 11, no. 4, pp. 487-495, 2005.
[13]
N. Balogh, G. Kerkovits, L. Horvath et al., "Cardiac digital image loops and multimedia reports over the internet using DICOM," Studies in Health Technology and Informatics, vol. 90, pp. 148-151, 2002.
[14]
K. Berdusis, "The state of the art: tele-echocardiography and telecardiology," Telemedicine Today, vol. 7, no. 3, pp. 25-36, 1999.
[15]
B. Crowe and D. Hailey, "Cardiac picture archiving and communication systems and telecardiology--technologies awaiting adoption," Journal of Telemedicine and Telecare, vol. 8, supplement 2, pp. 9-11, 2002.
[16]
R. Fogliardi, E. Frumento, D. Rincón, M. Á. Viñas, and M. Fregonara, "Telecardiology: results and perspectives of an operative experience," Journal of Telemedicine and Telecare, vol. 6, supplement 1, pp. S162-S162, 2000.
[17]
D. Shanit, A. Cheng, and R. A. Greenbaum, "Telecardiology: supporting the decision-making process in general practice," Journal of Telemedicine and Telecare, vol. 2, no. 1, pp. 7-13, 1996.
[18]
B. Schwaab, A. Katalinic, J. Riedel, and A. Sheikhzadeh, "Prehospital diagnosis of myocardial ischaemia by telecardiology: safety and efficacy of a 12-lead electrocardiogram, recorded and transmitted by the patient," Journal of Telemedicine and Telecare, vol. 11, no. 1, pp. 41-44, 2005.
[19]
J. A. Blaya, H. S. F. Fraser, and B. Holt, "E-health technologies show promise in developing countries," Health Affairs, vol. 29, no. 2, pp. 244-251, 2010.
[20]
M. B. Alkmim, A. L. Ribeiro, G. G. Carvalho, M. Pena, R. M. Figueira, and M. B. Carvalho, "Success factors and difficulties for implementation of a telehealth system for remote villages: minas Telecardio Project case in Brazil," Journal of eHealth Technology and Application, vol. 5, pp. 197-202, 2007.
[21]
A. Deshpande, S. Khoja, A. McKibbon, and A. R. Jadad, Real-Time (Synchronous) Telehealth in Primary Care: Systematic Review of Systematic Reviews, Technology Report no. 1002008, Canadian Agency for Drugs and Technologies in Health, Ottawa, Canada, 2008.
[22]
G. Molinari, A. Valbusa, M. Terrizzano et al., "Nine years' experience of telecardiology in primary care," Journal of Telemedicine and Telecare, vol. 10, no. 5, pp. 249-253, 2004.
[23]
E. H. Locati and M. F. Piepoli, "Telecardiology: perspectives and limitations," Italian Heart Journal, vol. 5, no. 3, pp. 192-198, 2004.
[24]
M. J. McCue, C. L. Hampton, W. Malloy, K. J. Fisk, L. Dixon, and A. Neece, "Financial analysis of telecardiology used in a correctional setting," Telemedicine Journal and e-Health, vol. 6, no. 4, pp. 385-391, 2000.
[25]
H. S. Rissam, S. Kishore, S. Srivastava, M. L. Bhatia, and N. Trehan, "Evaluation of cardiac symptoms by trans-telephonic electro-cardiographic monitoring (TTEM): preliminary experience," Indian Heart Journal, vol. 50, no. 1, pp. 55-58, 1998.
[26]
C. Sable, "Telecardiology: potential impact on acute care," Critical Care Medicine, vol. 29, no. 8, pp. N159-N165, 2001.
[27]
G. Molinari, G. Reboa, M. Frascio et al., "The role of telecardiology in supporting the decision-making process of general practitioners during the management of patients with suspected cardiac events," Journal of Telemedicine and Telecare, vol. 8, no. 2, pp. 97-101, 2002.
[28]
H. H. Ting, H. M. Krumholz, E. H. Bradley et al., "Implementation and integration of prehospital ECGs into systems of care for acute coronary syndrome: a scientific statement from the American Heart Association Interdisciplinary Council on quality of care and outcomes research, Emergency Cardiovascular Care Committee, Council on cardiovascular nursing, and Council on clinical cardiology," Circulation, vol. 118, no. 10, pp. 1066-1079, 2008.
[29]
R. Žaliunas, R. Benetis, G. Vanagas, R. Šlapikas, and A. Vainoras, "Implementation of international transtelephonic ECG platform for patients with ischemic heart disease," Medicina, vol. 45, no. 2, pp. 104-110, 2009.
[30]
G. Vanagas, R. Žaliunas, R. Benetis, and R. Šlapikas, "Factors affecting relevance of tele-ecg systems application to high risk for future ischemic heart disease events patients group," Telemedicine and e-Health, vol. 14, no. 4, pp. 345-349, 2008.
[31]
D. Alte, H. Völzke, D. M. Robinson et al., "Tele-electrocardiography in the epidemiological "Study of Health in Pomerania" (SHIP)," Journal of Telemedicine and Telecare, vol. 12, no. 2, pp. 103-107, 2006.
[32]
V. N. Dhruva, S. I. Abdelhadi, A. Anis et al., "ST-segment analysis using wireless technology in acute myocardial infarction (STAT-MI) trial," Journal of the American College of Cardiology, vol. 50, no. 6, pp. 509-513, 2007.
[33]
C. J. Terkelsen, B. L. Nørgaard, J. F. Lassen et al., "Telemedicine used for remote prehospital diagnosing in patients suspected of acute myocardial infarction," Journal of Internal Medicine, vol. 252, no. 5, pp. 412-420, 2002.
[34]
G. L. Adams, P. T. Campbell, J. M. Adams et al., "Effectiveness of prehospital wireless transmission of electrocardiograms to a cardiologist via hand-held device for patients with acute myocardial infarction (from the Timely Intervention in Myocardial Emergency, NorthEast Experience [TIME-NE])," American Journal of Cardiology, vol. 98, no. 9, pp. 1160-1164, 2006.
[35]
S. Scalvini and F. Glisenti, "Centenary of tele-electrocardiography and telephonocardiography--where are we today?" Journal of Telemedicine and Telecare, vol. 11, no. 7, pp. 325-330, 2005.
[36]
M. Sejersten, M. Sillesen, P. R. Hansen et al., "Effect on treatment delay of prehospital teletransmission of 12-lead electrocardiogram to a cardiologist for immediate triage and direct referral of patients with ST-segment elevation acute myocardial infarction to primary percutaneous coronary intervention," American Journal of Cardiology, vol. 101, no. 7, pp. 941-946, 2008.
[37]
J. H. van Bemmel, J. A. Kors, and G. Van Herpen, "Methodology of the modular ECG analysis system MEANS," Methods of Information in Medicine, vol. 29, no. 4, pp. 346-353, 1990.
[38]
J. L. Willems, P. Arnaud, J. H. Van Bemmel et al., "A reference data base for multilead electrocardiographic computer measurement programs," Journal of the American College of Cardiology, vol. 10, no. 6, pp. 1313-1321, 1987.
[39]
K.-P. Bethge and B.-D. Gonska, "Long-term electrocardiography: valence and reliability of different systems," Zeitschrift fur Kardiologie, vol. 74, no. 10, pp. 567-579, 1985.
[40]
M. Mars, "Telemedicine and advances in urban and rural healthcare delivery in Africa," Progress in Cardiovascular Diseases, vol. 56, no. 3, pp. 326-335, 2013.
[41]
M. B. Alkmim, R. M. Figueira, M. S. Marcolino et al., "Improving patient access to specialized health care: the Telehealth network of minas Gerais, Brazil," Bulletin of the World Health Organization, vol. 90, no. 5, pp. 373-378, 2012.

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  • (2015)A real-time health monitoring system for remote cardiac patients using smartphone and wearable sensorsInternational Journal of Telemedicine and Applications10.1155/2015/3734742015(8-8)Online publication date: 1-Jan-2015
  1. Application of handheld Tele-ECG for health care delivery in rural India

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      cover image International Journal of Telemedicine and Applications
      International Journal of Telemedicine and Applications  Volume 2014, Issue
      January 2014
      157 pages
      ISSN:1687-6415
      EISSN:1687-6423
      Issue’s Table of Contents

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      Hindawi Limited

      London, United Kingdom

      Publication History

      Accepted: 09 September 2014
      Revised: 06 September 2014
      Received: 28 April 2014
      Published: 01 January 2014

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      • (2015)A real-time health monitoring system for remote cardiac patients using smartphone and wearable sensorsInternational Journal of Telemedicine and Applications10.1155/2015/3734742015(8-8)Online publication date: 1-Jan-2015

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