Getting to the Heart of the Matter for Chest Pain: 5 Key Considerations for Monitoring Tools

When it comes to cardiovascular care, there seems to be no end in sight to its ballooning costs. By 2035, the American Heart Association (AHA) projects that the cost of treating heart disease—which, by then, would affect some 45 percent of the American population—could exceed $1 trillion.¹

Patients who present with angina comprise a considerable cost burden within those overarching statistics: All told, chest pain prompts about 6 million visits to the emergency department (ED) each year,² and among those patients, 20 to 25 percent will be diagnosed with acute coronary syndrome.³

Consider those numbers, just for a moment. That’s up to 1.5 million patients—the population of Philadelphia⁴—who present with a medically urgent heart complication year after year. What’s more, it’s up to 1.5 million opportunities to do better in both a clinical and cost-saving sense annually.

Increasingly, evidence points to consistent observational protocols as a key factor in managing heart disease and its associated financial burdens.

Namely, research has cited how improved operational efficiency through monitoring technology can not only boost diagnostic accuracy and speed, but do so as cost effectively as routine care.⁵

Putting a dollar amount to it, the Cardiovascular Roundtable from The Advisory Board Company estimates a potential savings of $189,000 for health systems each year, realized through improvements in observational length-of-stays (LOS) for chest pain specifically. That savings represents the difference between LOS numbers within the 80^th percentile (28 hours) and the 20^th percentile (19 hours)—and far exceeds other heart conditions, including that of atrial fibrillation, atherosclerosis, and heart failure put together.⁶

Because chest pain is multidimensional, current guidelines recommend a multi-pronged evaluation approach inclusive of biomarkers, patient history, electrocardiogram (ECG), and imaging to identify the TIMI risk score, and possibly, the need for revascularization.⁷

But when investing in (and using) departmental patient monitoring technology, it’s important to keep many factors in mind so that these tools can help us in our goal to improve outcomes as well as costs sustainably. As leadership explores such technologies, these five considerations should top their list:

1. 12-Lead ECG Analysis Capability

When observational units are equipped with 12-lead analysis technologies, they can potentially realize financial and clinical improvements thanks to a greater degree of efficiency (i.e. no wasted time waiting for the patient’s analysis), as well as the immediate and real-time availability of the technology at the bedside. For pre-hospital ECG, such capabilities can help reduce time-to-balloon by wirelessly providing ED staff with advanced notice and tech-enabled predictive outcomes.⁷

Beyond those benefits, monitoring tools like GE Healthcare’s cardiology solutions enable more departmental collaboration and communication. Patient’s 12-lead ECG’s can be sent to cardiology management systems for serial comparison and storage, as well as to physician’s mobile devices for fast confirmation when, every minute matters.

2. ST Segmentation With Triggered ECG

Adding to the importance of implementing monitoring technologies equipped with 12-lead capabilities, it’s equally important to explore tools that feature 12-lead ST segment monitoring—with the ability to automatically activate a 12-lead ECG analysis based on ST segment changes.

This automation enables a complete view of all areas of the heart, plus real-time documentation of ECG changes. With these important features, providers can instantly be notified so that they can quickly consider implementing interventional approaches that decrease door to balloon time.

3. QT/QTc Measurement Automation

Another important consideration when exploring any monitoring tool for chest pain is the possibility of missing drug-induced long QT syndrome. By selecting technologies that automate QT/QTc measurements, analyzing patterns, and trends for chest pain patients, clinicians can help assess and rule out prolonged QT instances due to medications. As a result they are better equipped to bypass the risks presented by long QT syndrome, such as lethal dysrhythmias (ex. Torsade de pointes).⁸

4. Multi-Lead Arrhythmia Analysis

Multiple ECG leads enable a constant and consistent analysis of the patient’s heart rhythm, which is critical, especially within the context of acute care for lethal dysrhythmias or sudden cardiac death. Monitoring tools that feature four-simultaneous ECG leads for arrhythmia analysis are a clinically effective and valuable option, providing increased accuracy, less false arrhythmia calls, and less unmonitored time due to ECG lead off situations as compared to single lead.

5. Cardiology Management System

All of these cutting-edge technologies, and the data they generate, is greatly enhanced when combined with a cardiology management system, like GE Healthcare’s MUSE. One of the biggest operational challenges is comparing the patient’s prior ECG and assessing for change. This is a critical step that can be completely automated with the MUSE cardiology management system, which enables serial comparison between real-time ECG readings and the measurements recorded from previous evaluations. With a bi-directional network connection, the data is easily viewable at the patient bedside or a workstation within the department. This feature help clinicians assess changes rapidly based on patient history and deploy associated interventions as they take place. The platform does this automatically and accurately thanks to common algorithms that are consistent across GE Healthcare’s product line.

And of course, remote communication factors into this as well. As soon as changes are detected, teams can transmit the 12-lead ECG data, observations, and test results to the attending physician’s mobile device which, again, saves time when every minute is critical.

The Heart of the Matter

With acute coronary syndrome, every minute wasted is heart muscle that the patient will never get back: Delays in intervention have been linked with increased risk of mortality and morbidity.⁷ An undercurrent of this is that it exposes ED physicians to risk for malpractice: Researchers note that 1 in 5 malpractice suits against emergency physicians relate back to chest pain.⁵ So of course, time is of the essence for both patient care and risk mitigation. Not to be overlooked, cost is another big factor, one that’s expected to break into 10-digit territory for heart disease treatment by 2035.

Each of these factors is the heart of the matter with chest pain, an exceedingly costly—and exceedingly dangerous—clinical symptom. That’s why implementing improvements in observational units has the potential to become a major driver of improved clinical outcomes, reduced costs, and greater operational efficiency.

If you recognize in your own health system these same pain points—as many organizations across the country do⁵—consider monitoring solutions to help temper those costs and improve diagnostic accuracy and speed so that patients can get the lifesaving treatment they need the moment they need it.

References

1. Cardiovascular Disease Costs Will Exceed $1 Trillion by 2035, Warns the American Heart Association, American Heart Association, https://healthmetrics.heart.org/cardiovascular-disease-costs-will-exceed-1-trillion-by-2035-warns-the-american-heart-association/. Accessed June 25, 2019.
2. Evaluation of the Adult With Chest Pain in the Emergency Department, UpToDate, https://www.uptodate.com/contents/evaluation-of-the-adult-with-chest-pain-in-the-emergency-department. Accessed June 25, 2019.
3. The Interdisciplinary Management of Acute Chest Pain, Deutsches Ärzteblatt International, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4660855/. Accessed June 25, 2019.
4. Philadelphia, Pennsylvania, United States Census Bureau, https://www.census.gov/quickfacts/philadelphiacitypennsylvania. Accessed June 25, 2019.
5. Clinical Outcomes and Cost Effectiveness of Accelerated Diagnostic Protocol in a Chest Pain Center Compared With Routine Care of Patients With Chest Pain, PLoS One, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4306554/. Accessed June 25, 2019.
6. Finding Cost Savings With Improved Patient Observation, Advisory Board, https://www.advisory.com/research/cardiovascular-roundtable/resources/2016/posters/finding-cost-savings-with-improved-patient-observation. Accessed June 25, 2019.
7. Acute Coronary Syndrome, GE Healthcare, https://www.gehealthcare.com/specialties/cardiology-solutions/acute-coronary-syndrome. Accessed June 25, 2019.
8. Sandau, KE, FunkM, AuerbachA, et al. Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement from the American Heart Association. Circulation. 2017;136(19):e273–e344. DOI: 10.1161/CIR.0000000000000527. Accessed May 10, 2019.
9. A Four-Lead Real Time Arrhythmia Analysis Algorithm. Computing in Cardiology. http://www.cinc.org/archives/2017/pdf/214-182.pdf. Accessed June 25, 2019.