Role of wearable and automatic external defibrillators in improving survival in patients at risk for sudden cardiac death
Byron K. Lee, MD, MAS Electrophysiology and Arrhythmia Service, University of California, San Francisco, Division of Cardiology, 500 Parnassus Avenue, Box 1354, MU 429, San Francisco, CA 94143, USA. . Current Treatment Options in Cardiovascular Medicine
10/2009; 11(5):360-5. DOI: 10.1007/s11936-009-0036-2
Cardiac arrest is a vexing public health problem. Fortunately, implantable cardioverter-defibrillators (ICDs) have been proven to decrease overall mortality in several populations at high risk for cardiac arrest. However, it is still unclear how to treat patients who have an elevated risk of cardiac arrest but are not in one of the identified high-risk groups proven to benefit from an ICD. It also is uncertain how to manage high-risk patients who have an accepted indication for an ICD but are unable or unwilling to have an ICD. In these clinical situations, the wearable defibrillator and automatic external defibrillator are options that should be considered. Both devices have been shown in small series to be highly effective at restoring sinus rhythm in patients with a ventricular tachyarrhythmia. However, there is still a lack of large-scale trials proving that these devices should be employed routinely in specific high-risk patient populations.
Available from: Paolo Bonato
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ABSTRACT: It is now more than 50 years since the time when clinical monitoring of individuals in the home and community settings was first envisioned. Until recently, technologies to enable such vision were lacking. However, wearable sensors and systems developed over the past decade have provided the tools to finally implement and deploy technology with the capabilities required by researchers in the field of patients' home monitoring. As discussed, potential applications of these technologies include the early diagnosis of diseases such as congestive heart failure, the prevention of chronic conditions such as diabetes, improved clinical management of neurodegenerative conditions such as Parkinson's disease, and the ability to promptly respond to emergency situations such as seizures in patients with epilepsy and cardiac arrest in subjects undergoing cardiovascular monitoring. Current research efforts are now focused on the development of more complex systems for home monitoring of individuals with a variety of preclinical and clinical conditions. Recent research on the clinical assessment of wearable technology promises to deliver methodologies that are expected to lead to clinical adoption within the next five to ten years. In particular, combining home robots and wearable technology is likely to be a key step toward achieving the goal of effectively monitoring patients in the home. These efforts to merge home robots and wearable technology are expected to enable a new generation of complex systems with the ability to monitor subjects' status, facilitate the administration of interventions, and provide an invaluable tool to respond to emergency situations.
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ABSTRACT: Sudden cardiac death is a major public health problem, affecting 500,000 patients in the United States annually. An implantable cardioverter-defibrillator (ICD) can terminate malignant ventricular arrhythmias and has been shown to improve survival in high-risk populations. Although sudden cardiac death is a heterogeneous condition, left ventricular ejection fraction of 35 percent or less remains the single best factor to stratify patients for prophylactic ICD implantation, and randomized trials have shown mortality benefit in this population. Therefore, in patients with heart disease, assessment of ejection fraction remains the most important step to identify patients at risk of sudden cardiac death who would benefit from ICD implantation. Physician understanding of each patient's ICD type, indication, etiology of heart disease, and cardiovascular status is essential for optimal care. If the ICD was placed for secondary prevention, the circumstances relating to the index event should be explored. Evaluation of defibrillator shocks merits careful assessment of the patient's cardiovascular status. Consultation with a subspecialist and interrogation of the ICD can determine if shocks were appropriate or inappropriate and can facilitate management.
Available from: Jean-Yves Fourniols
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Extensive efforts have been made in both academia and industry in the research and development of smart wearable systems (SWS) for health monitoring (HM). Primarily influenced by skyrocketing healthcare costs and supported by recent technological advances in micro- and nanotechnologies, miniaturisation of sensors, and smart fabrics, the continuous advances in SWS will progressively change the landscape of healthcare by allowing individual management and continuous monitoring of a patient's health status. Consisting of various components and devices, ranging from sensors and actuators to multimedia devices, these systems support complex healthcare applications and enable low-cost wearable, non-invasive alternatives for continuous 24-h monitoring of health, activity, mobility, and mental status, both indoors and outdoors. Our objective has been to examine the current research in wearable to serve as references for researchers and provide perspectives for future research.
Herein, we review the current research and development of and the challenges facing SWS for HM, focusing on multi-parameter physiological sensor systems and activity and mobility measurement system designs that reliably measure mobility or vital signs and integrate real-time decision support processing for disease prevention, symptom detection, and diagnosis. For this literature review, we have chosen specific selection criteria to include papers in which wearable systems or devices are covered.
We describe the state of the art in SWS and provide a survey of recent implementations of wearable health-care systems. We describe current issues, challenges, and prospects of SWS.
We conclude by identifying the future challenges facing SWS for HM.
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