Dr. Wadhwa: That’s very interesting. I agree that a longer duration of monitoring provides additive diagnostic yield. The 30 days of continuous monitoring on a non-invasive Philips MCOT unit as an alternative to using an ILR may represent a more cost-effective diagnostic strategy.
There has been a revolution around ILRs and direct-to-consumer remote cardiac monitors. What can the industry do to help care providers manage the data around these devices?
Dr. Lakkireddy: ILRs completely changed the way we treat arrhythmias. Continuous ILR monitoring gives physicians a much better picture of the patient’s lifestyle, which allows for real-time intervention in emergencies, more informed treatment decisions, and more precise care for the patient. One disadvantage of both ILRs and wearable consumer monitors is the data deluge that continuous monitoring creates. As many existing processing units are not positioned to aggregate extensive amounts of incoming data, providers must sift through this patient data manually.
To lessen the data burden presented by ILRs and direct-to-consumer monitors, new devices should focus on actionable insights. Care providers want to know about events that are important and require intervention, without being continuously alerted of incoming data from patients who are not experiencing any adverse symptoms. When it comes to monitoring, I always say, ‘The more you look the more you find, the more you find, the more you record, the more you record the more answers you have.’ If doctors don’t incorporate monitoring, there is less data to look at, but they may also be missing the answers needed to make a difference for the patient.
For cardiology departments and private practices, setting up new monitoring devices, it is common for devices to be used with their “out of the box” settings. However, to get the best results, I’ve found that it can be helpful to review available resources, focusing on the specific conditions they are treating, and indications for how these devices are being used together. This packaged view allows care providers to set and optimize guardrails for what clinically significant data should lead to notifications. In my practice, we have a “red, yellow, green” notification system to help us determine if a patient requires immediate intervention, whether they should be monitored more closely for a set amount of time, or if they do not require additional attention at that time. Having effective communication to understand the needs of the clinical care team who is treating patients every day is crucial to running an effective monitoring program.