Background: the challenge faced

BHT comprises of 3 hospital sites (Wycombe, Stoke Mandeville and Amersham) serving a population of 500,000. As part of BHT’s arrhythmia service, the trust fitted an average of 410 Lifecard CF Holter monitors per month in 2019, with approximately 80 – 130 requests received weekly.

On 12th March 2020, BHT entered a state of critical incident planning due to the COVID-19 pandemic, with a decision made to defer or cancel all elective outpatient activity. Patients who were booked for monitors had their referrals triaged and were classified as follows:

• Urgent – appointment to be kept

• Soon – appointment to be made within 3 months

• Non-Urgent – Appointment to be deferred by 6 months

• Cancel - Referral to be returned to requestor

To maintain the arrythmia service whilst minimising infection risk, a method of ambulatory ECG monitoring for urgent patients with minimal or no hospital attendance was required.

The solution

CardioSTAT® single-use ambulatory ECG recorders were the preferred choice due to the fact that they are cost effective with pay-per-duration pricing. They also offer flexible service models with standard service and ship-to-patient for home application.

In April, the majority of patients were scheduled to be fitted with ambulatory ECG monitors in the clinic setting. However, due to patient reluctance to attend appointments and reduced capacity to accommodate for social distancing measures, the department switched to sending CardioSTAT out to patients for home application purposes, thereby enabling them to rapidly scale up their service.

Outcomes

The use of CardioSTAT Home Application monitors enabled BHT to maintain an arrhythmia service in the midst of the first wave of the pandemic with similar levels of patient access versus the same period the previous year (100.6% vs. 93.9% respectively).

Of the patients prescribed CardioSTAT by BHT, several different types of cardiac arrythmias were detected including and not limited to 3rd degree AV block, 2nd degree AV block (type II), sinus pause (over 3.05 s), paroxysmal atrial fibrillation and atrial fibrillation/atrial flutter throughout.

The ship-to-patient CardioSTAT Home Application model enabled patients in the BHT catchment area to continue to gain access to high-quality ambulatory ECG monitoring. It also minimised infection risk for both patients and HCPs alike by reducing unnecessary hospital visits.