Hospital Monitors Vital Signs on Telephone Lines
Celia Mendola gently reprimanded Willie, an impetuous Shih-Tzu puppy fond of nuzzling and nibbling visitors, then relaxed on the sofa in her Saugus home. Pointing to the three electrodes taped to her chest and the small transmitter attached to a belt around her waist, Mendola, a 72-year-old heart attack survivor, had nothing but praise for the state-of-the-art technology she wore. “It’s a lifesaver,” beamed the great-grandmother.
Mendola’s lifesaver is a portable cardiac monitor system called “CELIA,” which she jokingly says is named after her. Actually, the acronym stands for “continuous electrocardiogram in ambulatory patients,” a system designed to help Mendola’s physician quickly detect abnormal cardiac activity that may follow her recent heart attack.
As Mendola relaxed, the small transmitter, which looks like a walkie-talkie, broadcast her heart signals to a briefcase-sized communication unit that plugs into her telephone. The signals are then transmitted at high speed over telephone lines to a 24-hour monitoring station at Holy Cross Hospital in nearby Mission Hills. There, the signals are printed out as an electrocardiogram (ECG), a graph showing the electrical activity of the heart.
The high-speed transmission leaves the telephone lines free for normal use 90% of the time. If Mendola’s heart rate falls too low or rises too high, the system automatically dials the monitoring station. By watching the monitors and the ECG printout, hospital personnel who consult frequently with her doctor can advise Mendola to reduce activity when necessary and to increase or decrease medication.
Doctor Called Quickly
“We don’t take chances,” explained nurse Kathy Rendon, the project coordinator of the CELIA system. “If we see patients getting worse, we don’t wait. We call the doctor immediately.”
Holy Cross is the only hospital in the country with a CELIA system, but Dr. Allen E. Karz, a Holy Cross Hospital physician and director of development for CELIA, says that that won’t be the case much longer. The system will be placed in a Northern California hospital in January. After the system gains the approval of the federal Food and Drug Administration, which could happen within a year, Karz predicts that the system will become commonplace.
In the past three years, 80 patients have been monitored with CELIA. In the future, the system may allow heart attack patients to return to work sooner, confident that danger signs will be quickly detected.
New System Has More Capabilities
Although the CELIA system is new, the concept of home cardiac monitoring is not. For about 15 years, heart patients have been able to monitor themselves at home by wearing a portable recorder, usually for 24 hours, then returning it to the doctor’s office or hospital. The recording is converted there to an electrocardiogram.
The 24-hour recorders have been constantly improved over the years. The weight of the equipment has decreased; the capabilities of the equipment have increased. Some of the home cardiac monitors, for example, can now obtain ECG and blood pressure readings simultaneously. “CELIA gets the information back faster and is usually run on the patient for a longer time” than the 24-hour monitor, according to Karz.
Interest in home monitoring has mushroomed in recent years due both to technological advances and to today’s health care climate. Many of the larger Valley hospitals now offer some type of home cardiac monitoring program. And some Valley health care providers even offer delivery and pickup of the cardiac monitors. CliniShare, a Chatsworth health care provider that services doctors’ offices and hospitals, began to deliver cardiac home monitors to heart patients just a month ago, and has already had six patients request the service, according to Jack Schlosser, CliniShare’s executive vice president.
Home cardiac monitoring can benefit everyone involved, according to the experts. Patients can often be discharged from the hospital more quickly and are sometimes less anxious if they know their cardiac activity is being watched at home. “I didn’t have to stay in the hospital for weeks,” said Mendola. “I was home in nine days. CELIA gave me peace of mind, knowing if anything went wrong, right away the hospital would call me.”
Mendola’s reaction to home cardiac monitoring is typical of most patients, Karz finds. “They feel more comfortable, knowing they’re being watched.”
Physicians who prescribe home cardiac monitoring for their patients often breathe easier, too, because they can follow their progress more closely.
The home cardiac monitors are also a boon for hospital administrators, who are under increasing pressure to contain costs and discharge patients as quickly as is safely possible.
Home cardiac monitors have a number of applications, according to Karz. One of the most common is to keep a close eye on patients after a heart attack. But monitors can also help physicians decide if medications prescribed after a heart attack are working or if a change in the medication regimen is effective. The monitors can also pinpoint episodic problems, Karz said. “Patients may experience lightheadedness or chest discomfort that might happen only once a week or so, and it’s difficult to document what happens.”
When heart attack patients begin exercising as part of their prescribed cardiac rehabilitation program, the home cardiac monitors can detect overexertion. With the CELIA system, for example, the overexerting patient can be instructed to check in with hospital personnel before continuing.
Patients undergoing cardiac monitoring at home do put up with minor inconveniences. With the CELIA system, for example, patients must stay within a 300-foot range of the communication unit so the heart’s signals can be picked up and transmitted. Home monitored patients sometimes tire of wearing the transmitter or recorder. “Most patients are glad something like this is available, but most patients are also glad when it’s time to take it off,” observed nurse Ronda Peters, the cardiology department manager at Sherman Oaks Community Hospital, who is investigating a new monitor that can be worn for a week or longer.
Patients on the CELIA monitor disconnect themselves before entering a bath or shower--alerting the hospital that they have done so)--but patients on the 24-hour monitors are asked to postpone bathing.
The costs of home cardiac monitoring vary, but are generally below the cost of a day’s hospitalization and can be partially or fully reimbursed by insurance or Medicare. The CELIA system averages about $140 per day, according to Karz, and is usually worn for two to six weeks. The 24-hour monitors cost about $220 per day, according to CliniShare’s Schlosser.
Most experts observe that cardiac home monitoring is here to stay and that today’s health care market has room for many types of monitors. “The movement to non-institutional care is clear,” said Schlosser.
