“Your Weekly Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive.
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For years I have struggled with the fact that when you’re sick and hospitalized, medical personnel check on your status multiple times each day, but when you’re sick and treated as an outpatient, medical personnel check on you during your visit, and then you’re on your own until the next visit. That can be days, weeks, or even months later. Wouldn’t it be great if, even as an outpatient at home in your living room or out shopping, medical personnel could check on your health status multiple times each day?
Wearable and implantable medical technology to accomplish that end is the direction of future health care — and some of it is already here. For example, implantable devices such as ECG recorders, pacemakers, and defibrillators can transmit the status of the heartbeat to medical personnel and forewarn of potential problems. For heart failure patients, implanted devices can monitor heart failure status and similarly register worsening of changes.
Future technology may enable stents used to prop open narrowed coronary arteries to monitor blood flow and warn of reduced flow and impending occlusion, thereby averting a heart attack.
Wearable devices to monitor physical activity have been available for some time. Recent developments include devices to monitor heart rhythm, particularly atrial fibrillation (AF). AF is the most common sustained heart irregularity, affecting one in three individuals in older age groups. AF increases the risk of stroke, heart failure and death, all of which can be reduced with appropriate therapy.
A recent study of a self-applied continuous ECG monitoring patch used at home during routine activities demonstrated that individuals at high risk for developing AF who wore the patch had higher rates of AF diagnosis, greater initiation of anticoagulants, and increased health care resource utilization at one year compared with nonmonitored controls.
Digital watches can provide an ECG recording that can be used to diagnose the presence of AF. ECG sensors in smartphones can record a single or multiple ECG lead capable of accurate heart rhythm detection.
Wearable technology can interface with patches, clothing, shoes, badges, bracelets, watches, tattoos, and jewelry to detect and transmit a host of signals in addition to ECGs, such as respiration, oxygenation, motion, pressure, touch, vibration, temperature, video, voice, and external environment. A wearable defibrillator vest can detect and treat lethal heart rhythms.
Remote ECG monitoring or a 911 call could spot a cardiac arrest victim and trigger a drone to transport an external defibrillator to the patient’s side in minutes for prompt resuscitation.
The ability to wirelessly obtain and transmit data coupled with video streaming allows for implementation of remote medical education and consultation, essentially creating a virtual care clinic. Utilization of data from a digitalized patient could facilitate diagnosis, treatment plans, physician-patient interaction, and accelerate medical research, education and training. One could envision a global healthcare system in which experts and solutions bypass restrictive medical infrastructure.
Of course, any advances in remote monitoring will need to be accompanied by measures to protect patients against problems such as network downtime or malicious hacking. Despite these cautions, the future of wearable and implantable medical technology is truly exciting. Hopefully, outpatients of the future will receive almost the same surveillance as inpatients.
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