The application of telecommunication to the clinical evaluation of patients nowadays enables continuous, personalised care of a patient with heart disease, regardless of geographical distance.
The Unit of Telemedicine is dedicated to the continuous remote surveillance of patients with cardiovascular diseases. Electrocardiograms, blood pressure measurements, pulse oximetry, blood glucose levels and coagulation indices are some of the information that can be easily shared, through an ordinary telephone connection, with a team of medical specialists, so as to obtain immediate, "on-line" clinical cardiologic counselling.
The Centro Cardiologico Monzino has been one of the pioneers of this service and can boast the implementation of several cardiologic remote care protocols.
The Telecardiology Centre at Monzino, established in 2000 in support of the implementation of a post-cardiac surgery home rehabilitation project, has, over time, become increasingly specialised in remote management of clinical problems. The Centre, manned by specific medical and nursing staff, is active 24 hours a day, 365 days a year, guaranteeing a continuous teleconsultation service.
Through specialised evaluations conducted at home and programmed, repeated telephone contacts, the patients’ clinical condition is monitored in order to pick up changes in their state of health early and to intervene promptly with the appropriate therapeutic changes. In addition, the patients, appropriately trained, can easily record and transmit their electrocardiograms by telephone through a small portable device which they are given. This activity is carried out by a dedicated call-center with H24 medical and nursing staff.
Activities of the Unit
- The Cardiovascular Telemedicine Center provides a home-based rehabilitation for patients who underwent a cardiac surgery procedure, given a more rapid recovery in their own familiar environment. The dedicated medical and nursing staff continuously assures the best support to assist the patient in his or her re-introduction into everyday normal life routine. Programmed evaluations are performed at patient’s home and, in addition (by mean of a continuous phone follow-up) clinical conditions are constantly monitored, for example by the use of a portable electrocardiographic device able to transmit by phone their electrocardiogram (EKG) to the center, to ensure prompt therapeutic intervention if necessary. All these activities contribute to patient’s psychological well-being. The progressive evolution of Cardiovascular Telemedicine Center staff (which now guarantees continuous service 24/7, all year long) has led to progressive specialization in handling and solving clinical problems at distance.
- Our Center provides home surveillance and monitoring in patients with cardiac arrhythmias too, with a week-long Holter device, and with a continuous EKG monitor to guarantee an immediate alert when an adverse condition is diagnosed. This reduces inappropriate or unnecessary visits to the Emergency Department, thus reducing patients’ anxiety.
- To complete monitoring for the arrhythmic patients, the Telemedicine Center provides electrocardiogram portable devices that let patients perform his/her own EKG all the year long, when necessary.
In the future, in cooperation with the Oral Anticoagulation Therapy Center of CCM, patients will be encouraged to monitor their anticoagulation status even with an INR dosage in pharmacy.
Post-operative domiciliary rehabilitation
Projects include a programme of both motor and respiratory rehabilitation carried out completely in the patient's home, supported by specialised medical and nursing staff. This programme is targeted at all partients who have undergone cardiac surgery in our Institute and who live in the municipality of Milan and the hinterland.
The project, supported by the Region of Lombardy, has been promoted by the Institute since 2000, first nationally and then internationally. It is completely safe, ensures careful control of the clinical and functional evolution of the patient in the early post-intervention phases and aids early and protected reintroduction in the family environment and society.
The only requirement to be able to use this service is the presence of a person who can provide continuous informal assistance (for example, shopping and preparing meals) for the three weeks of the “domiciliary hospitalisation”.
The patient is contacted daily by telephone by the staff of the Cardiology Centre and his or her clinical condition (including an electrocardiographic trace transmitted by telephone) is re-evaluated daily by the cardiologist of the Telemedicine Service.
Specialised cardiac surgery visits, dietary and/or psychological consultations, physiotherapy sessions assisted by a specialist and exercise and physical training with the aid of an exercise bike equipped with a remote monitoring system are also planned.
Half way through the rehabilitation programme some instrumental control tests (blood sampling, echocardiography, chest X-ray, stress test ...) are scheduled in the Day Hospital at the Centre, and the patient undergoes specialised nursing, cardio-surgical and cardiologic global re-evaluation.
As far as regards the management of any urgent situations/emergencies, the patient is protected by two convergent systems: the cardiology and cardiac surgery teams of the Telecardiology Centre and a continuously available, domiciliary medical and nursing service. The service is provided both through the National Health Service and privately.
Remote monitoring of the decompensated patient
This is a six-month programme of monitoring the cardiac function parameters of patients with cardiocirculatory failure. Through weekly, scheduled telephone contacts, a nurse ascertains the patient's clinical condition, paying particular attention to any changes in symptoms, body weight and diuresis; transmission of an electrocardiographic trace via telephone is also foreseen during these contacts. Furthermore, clinical evaluations are performed by nursing staff in the patient’s home. Any changes in the patient’s health status are promptly communicated by the nurse to the referring cardiologist, who can then modify the therapy or recommend expedited access to the Accident and Emergency Department. This remote monitoring programme has led to an improvement in the quality of life of decompensated patients and a reduction in the number and duration of new hospital admissions due to acute decompensation. This programme of the Region of Lombardy is carried out within the context of the National Health System.
Telemetric Holter electrocardiography
This is an electrocardiographic monitoring project via telephone that lasts from one to three weeks, during which the patient (upon payment of a weekly fee) can memorise his or her ECG trace, recorded on the occasion of symptoms (palpitations, fleeting chest pain ...), and send it to our station via telephone in real time,. This monitoring system particularly useful in cases of infrequent, symptomatic and short-lasting arrhythmias, which are difficult to document with the common diagnostic tools (e.g., ambulatory ECG, 24-hour Holter dynamic ECG).
Domiciliary monitoring of patients waiting for heart surgery
This project is applied to patients who are waiting for a planned myocardial revascularization intervention. The patients, appropriately selected, send a 12-lead electrocardiographic trace daily to the Telecardiology Centre which monitors them. In this way, patients are managed directly and quick action can be taken in the case of possible recurrent angina and/or episodes of silent ischaemia. This programme is free of charge for the patients.
Continuous electrocardiographic monitoring of patients at high cardiovascular risk
The aim of the project is to offer a continuous electrocardiographic monitoring service to patients with known cardiac disease, judged at our Centre to be at too high a risk to undergo cardiac surgery. The monitoring lasts for at least six months and a (12-lead) electrocardiogram is requested weekly and in the case of any clinical event. This programme is free for the patients.
Cardiologic teleconsultation with other clinical facilities
Thanks to its continuously available cardiology service, the Monzino Cardiology Centre offers affiliated clinical facilities the possibility of sending, round the clock, electrocardiographic traces of patients in urgent and(or emergency circumstances by telephone and obtaining the ECG report in real time and a subsequent telephonic cardiology consultation.
Continuous electrocardiographic monitoring
Patients have the possibility (on payment of a monthly, quarterly, semi-annual or annual fee) of a simple, portable device that can record their electrocardiographic traces in all circumstances if required. The patients can then easily transmit the recording to our Centre and obtain a cardiologic evaluation in real time.