ANALI PAZU Let. 13 . 2, pp. 1 16, november 2023 https://doi.org/10.18690/analipazu.13.2.1-16.2023 2023 IMPLEMENTACIJA PRENOSNEGA EKG TELESNEGA MERILNIKA SAVVY ZA PRESEJANJE ZDRAVSTVENI RAVNI: INTERVENCIJSKA Sprejeto 11. 7. 2021 Recenzirano 13. 10. 2023 Izdano 7. 11. 2023 S V Univerza v Mariboru, Medicinska fakulteta, Maribor, Slovenija, stasa.vodicka@gmail.com DOPISNI AVTOR stasa.vodicka@gmail.com Znanstvena veda: Medicina motnje ritma, palpitacije, primarna zdravstvena raven, prenosni EKG telesni merilnik Savvy; napotitve osebni prenosni merilnik EKG Savvy, ki deluje v kombinaciji s pametnim telefonom in ga lahko uporabljamo pri bolnikih, ki uporabnost telekardiologije na primarni zdravstveni ravni z uporabo prenosnega EKG telesnega merilnika Savvy. Ljubljana in Zdravstvenem domu Murska Sobota. Bolniki so bili razdeljeni v testno skupino, kjer so dobili prenosni EKG telesni merilnik, in kontrolno, kjer ga niso. ritma in ukrepov za zdravljenje bolnikov, bodisi z opazovanjem bodisi z dajanjem novega zdravila. V testni skupini pa je bilo h kardiologu napotenih bistveno manj kot v kontrolni skupini (p <0,001). ANALI PAZU Vol. 13, No. 2, pp. 1 16, November 2023 https://doi.org/10.18690/analipazu.13.2.1-16.2023 IMPLEMENTATION OF SAVVY PORTABLE ECG BODY MONITOR FOR HEART RHYTHM DISORDER SCREENING IN PRIMARY CARE: AN INTERVENTION RANDOMIZED CONTROLLED STUDY S V Accepted 11. 7. 2021 Revised 13. 10. 2023 Published 7. 11. 2023 University of Maribor, Faculty of Medicine, Maribor, Slovenia, stasa.vodicka@gmail.com CORRESPONDING AUTHOR stasa.vodicka@gmail.com developed a personal portable EKG meter Savvy, which works in combination with a smartphone and can be used in patients who complain of heart rhythm disorders. The aim of the study was to analyze the utility of telecardiology at the primary health care level using the Savvy portable ECG body monitor. Methods: We included 400 patients with a suspected heart rhythm disorder who visited their family doctor in the Ljubljana Health Center and the Murska Sobota Health Center from October 2016 to January 2018. The patients were divided into a test group, where they received a portable ECG body meter, and a control group, where they did not. Results: The study showed that there was no statistically significant difference between the test and control groups regarding detected rhythm disturbances and measures to treat patients, either by observation or by administering a new drug. In the test group, there were significantly fewer referrals to a cardiologist than in the control group (p <0.001). Science: Medicine Keywords: disturbances of the heart rhythm, palpitations, primary medical level, portable EKG physical meter Savvy; referrals : Implementacija prenosnega EKG telesnega merilnika Savvy za presejanje motenj 3. 1 Uvod (Levy, Yasa, Wong, Hill, Piwonska in drugi) (World Health Organisation, Health Topics, 2023) (Hu in drugi, 2017). bolnikove anamneze in fizikalnem pregledu, snemanje elektrokardiograma (EKG) s standardnim 12-odvodnim EKG- motnje ritma, ki je lahko prehodna, zato se v diagnostiki uporabljajo bolj neprekinjene metode, kot je holter, ki je lahko 24 ali 48 urni (Gou in drugi 2019) Za (na sekundarno ali terciarno raven), kar lahko ustvari poplavo nepotrebnih napotitev da je javni zdravstveni sistem zelo dober (Organisation for Economic Co-operation and Development, World Health Organisation, 2020) zdravili na primarni zdravstveni ravni brez nepotrebne napotitve bolnikov na druge zdravstvene ravni, -19, kjer se izvajajo . (In-Vivo Microsystems, 2020). 4 ANALI PAZU. (Tamayol in drugi, 2016) dragocene informacije o zdravstvenem stanju osebe (de Graaf in drugi, 2019) Ti (Chen in drugi, 2017). V Sloveniji so na In titutu Jo efa tefana v sodelovanju z zdravniki razvili osebni prenosni merilnik EKG, ki deluje v kombinaciji s pametnim telefonom (Rashovksa, . Osebni digitalni mobilni EKG merilnik je v lasti podjetja Savvy za Android (Savvy, 2020) EKG merilnik je sestavljen iz dveh elektrod, ki sta Meritev se prek Bluetooth povezave prenese na pametni telefon, kjer se naprava najprej seznani in nato upravlja prek mobilne aplikacije MobECG. na bolniku, ki se premika in opravlja dnevne aktivnosti. Program VisECG nam je meritev samo eno kanalna, lahko ocenimo pogostost in vrsto motnje ritma, ne pa tudi ishemije. akutnega miokardnega infarkta do potrebnega zdravljenja (Scalvini in drugi, 2002) laboratorijem akutnim miokardnim infarktom (Chan in drugi, 2012), pri presejanju bolnikov za paroksizmalno atrijsko fibrilacijo (Halcox in drugi, 2017) in pri odkrivanju aritmij v bolniki s palpitacijami in sinkopo (Klein-Wiele in drugi, 2016), (Sutton in drugi, 2018), (Benditt in drugi, 2018). bolnikov (Leijdekkers, Gay in Barin, 2009), (Weenk in drugi, 2020) : Implementacija prenosnega EKG telesnega merilnika Savvy za presejanje motenj 5. (Brunetti in drugi, 2014). Po drugi strani pa primanjkuje dobro naprave v primarnih zdravstvenih ustanovah (v ambulanta - zadovoljstvo pacientov in dr 2 Preiskovanci in metode 2.1 Izvedba raziskave motnje ritma, ki so od oktobra 2016 do zdravnika v Zdravstvenem domu Ljubljana in Zdravstvenem domu Murska Sobota. bili povabljeni bolniki brez predhodno -te v 12-kanalnem EKG zapisu po prvem obisku niso imeli. lnik zdravljen v skladu s smernicami je obstajal podatek o sumu na motnjo ritma, ob pregledu je bil EKG posnetek v merilnik in kontrolno skupino brez merilnika, drug za drugim glede na njihove prvega pacienta, ki je obiskal zdravnika, drugega v kontrolno skupino, nato tretjega je prejel EKG merilnik, ki mu ga je namestil zdravstveni delavec in ga je nosil 3 dni, hkrati pa je dobil tudi informacije o namestitvi in ravnanju z merilnikom. Merilnik je 6 ANALI PAZU. bolj redno, merilnika pa ni potrebno odstranjevati med prhanjem ali spanjem; pametni telefon pa je moral ostati v isti sobi kot oni. V primeru, da se je elektroda -dnevno meritvijo je vsak se je vrnil k zdravstvenemu delavcu, ki je odstranil merilnik in s telefona prenesel Nato je vsak bolnik imel kontrolo pri izbranem zdravniku po 5 10 dneh. Zdravnik ru hude motnje ritma bolnika takoj poklical na 10 dneh vrnil k zdravniku. ali enega za bolnika ob prvem obisku po 5 10 dneh in drugega po 3 mesecih. ukrepe, sprejete po prvem in drugem obisku. Tako zdravnike kot bolnike v testni skupini smo pro bolnikov (200 v testni in 200 v kontrolni skupini) zadostna za pridobitev ustreznih 4,9% napake). -299 / 2017-7, KME 47/06/17). Vsak bolnik je prejel in podpisal pisno soglasje, s katerim je potrdil ClinicalTrials.gov (ID: NCT04463524). : Implementacija prenosnega EKG telesnega merilnika Savvy za presejanje motenj 7. 2.2 (Statistical package for social science, SPSS Inc., Chicago, IL, ZDA). porazdelitve so prikazani mediana, interkvartilni razmik (med 25. in 75. precenilo) ter minimum in maksimum; za opisne spremenljivke pa frekvence in odstotke. V univariantni analizi so bili uporabljeni naslednji testi: - t- spremenljivke; - Mann-Whitney U- - Pearsonov hi-kvadrat test za opisne spremenljivke oziroma Fisherjev eksaktni test 3 Rezultati in razprava 3.1 Kot je prikazano v diagramu pretok zdravnikov, vendar so bili popolni 8 ANALI PAZU. Vir: lasten 3.2 Opisni podatki tabeli 2. : Implementacija prenosnega EKG telesnega merilnika Savvy za presejanje motenj 9. Tabela 1 Opisne spremenljivke n (%) Spol 14 (47) 16 (53) Specialnost specializant 1 (3) 21 (70) Brez specializacije 8 (26) spremenljivke Starost (leta) Delovna doba (leta) Vir: lasten Tabela 2 Testna skupina Kontrolna skupina razlika Opisne spremenljivke n (%) n (%) Spol 57 (28.5) 44 (22) NS a 143 (71.5) 156 (78) NS a Izborazba Osnovna ali 110 (55) 129 (65) NS a Univerza, podiplomski 90 (45) 71 (35) NS a Delovno razmerje zaposlen 94 (47) 92 (46) NS a Nezaposlen ali upokojen 106 (53) 108 (54) NS a Razvade kajenje 41 (20.5) 92 (46) p < 0.001 a alkohola 130 (65) 120 (60) NS a bolezni Art. hipertenzija 47 (27) 73 (36) NS a Sladkorna bolezen 28 (14) 26 (13) NS a SD Starost (leta) NS b Indeks telesne mase (kg/m 2 ) NS c Hg) NS c a 2 test; b t-test za neodvisne vzorce; c Mann Whitney U- Vir: lasten 10 ANALI PAZU. skupinama ni bistvene mm Hg) in 54 zaradi sladkorne bolezni, 133 je kadilcev in 250 prekomernih pivcev 3.3 Po opravljeni meritvi z EKG merilnikom in prvem kontrolnem pregledu pri napotitev k kardiologu. V testni skupini je bilo bistveno manj napotitev h kardiologu v primerjavi s kontrolno skupino (11,5% v primerjavi z 32,0%). Tabela 3: Ukrepi ob prvem kontrolnem obisku za bolnike v testni in kontrolni skupini Motnja ritma prisotna Zdravljenje - opazovanje n (%) Zdravljenje predpis zdravila n (%) Napotitev h kardiologu n (%) Testna skupina vsi 52 (26) 110 (55) 55 (27.5) 23 (11.5) 36 (18) 78 (39) 37 (18.5) 16 (8) 16 (8) 32 (16) 18 (9) 7 (3.5) Kontrolna skupina vsi 64 (32) 124 (62) 8 (4) 64 (32) 40 (20) 108 (54) 0 (0) 44 (22) 24 (12) 16 (8) 8 (4) 20 (10) razlika vsi NS a NS a p < 0.001 a p < 0.001 a NS a NS b p < 0.001 b p = 0.009 b NS a NS b 2 test; b Vir: lasten : Implementacija prenosnega EKG telesnega merilnika Savvy za presejanje motenj 11. 3.4 s to metodo uporabe EKG dravljenje bolnikov, z veseljem pa bi dnevno uporabljali v svoji praksi. Skoraj vsi bolniki so ocenili, da je EKG merilnik enostaven veseljem nosili. 4 Razprava h kardiologu (p <0,001). V testni skupini so zdravniki napotili 11,5% bolnikov, v smo morali dokazati, da je ta nova metoda uporabe EKG merilnika tako dobra kot -kanalni EKG, napotitev k kardiologu). Po opravljeni meritvi in prvem k prisotnimi motnjami ritma; tako smo dokazali, da je to dobra in zanesljiva presejalna nega ritma na primarni zdravstveni ravni. Zaradi tega se nam je zdelo zelo pomembno, ali so bolniki in njihovi zdravniki s to metodo zadovoljni. 98% bolnikov povedalo, da je bila uporaba EKG merilnika enostavna, ni jih motil in so ga (World Health Organisation, Health Topics, 2023). - (Chan in drugi, 2012). Ugotovili so, fibrilacijo in 6,5 (Chan in drugi, 2012): med testno in kontrolno 12 ANALI PAZU. paciente na sekundarno raven na pregled h kardiologu. so v 88,7% primerov spremenili bolnikovo farmakoterapijo, 26,8% pacientov pa je s svojimi pacienti enako tako v testni kot v kontrolni skupini; spremenili so terapijo ali nadaljevali s spremljanjem pri 62% 74% bolnikov, 2% 10% pa jih je bilo napotenih k drugim specialistom. kljub normalnemu EKG posnetku, bolnike, za katere je obstajal sum, da gre za pravo zaradi anksiozne motnje (Snider in drugi, 2020), (Steinhubl, Waalen in Edwards, 2018). menili, da gre za anksiozno motnjo in ne za dejansko motnjo ritma. skupini so si sicer telesne spremembe podobne, prav tako tudi hormonske spremembe in smo predvidevali, da ne morej raziskave. Med spo ((Klein-Wiele in drugi, 2016). - (American Medical Association. 2020), (De Smedt, Kotseva in De Bacquer, 2012). Ali je z uporabo (Mistry, 2012), (Whitten, Mair, in Haycox, 2002) : Implementacija prenosnega EKG telesnega merilnika Savvy za presejanje motenj 13. (Roehring, Miller in Lake, 2009), (Chernew, Hirth in Cutler, 2009), je sedanja pandemija COVID-19 ob kolapsih zdravstvenih sistemov (Bodenheimer in Fermandez, 2005) (Brunetti, Dellegrottaglie in Lopriore, 2014) kontrolno skupino saj so imeli to kardiologu. Zadovoljstvo uporabnikov in izvajalcev zdravstvenih storitev ima zelo pomembno so pokazale zmerno stopnjo zadovoljstva tako zdravnikov kot bolnikov, ki uporabljajo teleme (Brunetti, Dellegrottaglie in Lopriore, 2014). 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