Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

A Sea Change in Treating Heart Attacks

nytimes.com

Post reply on HN
Print view View original

31–40 of 61 posts

Re: A Sea Change in Treating Heart Attacks

#31

Post by JshWright »

mindcrime wrote: post #27
Animats wrote: post #23

But who calls an ambulance? Now that's an opportunity for a wearable device.

After I had my heart-attack last year[1], I was asked to participate in a clinical trial of a device called a "Life Vest". I did so briefly, although I ditched it pretty quickly because it was too uncomfortable to sleep in. But this thing was basically a wearable EKG/defibrillator. It monitored your heart rhythm and, if you went into a bad rhythm, would actually give you a shock from the defibrillator. Handy if you w…

Other than being slightly less invasive, this seems significantly inferior to an AICD [1]

[1]: https://en.wikipedia.org/wiki/Implantable_cardioverter-defib...

Re: A Sea Change in Treating Heart Attacks

#32

Post by JshWright »

mindcrime wrote: post #30
JshWright wrote: post #24

They included ambulance drivers’ transmitting electrocardiogram readings to emergency rooms, E.R. doctors’ deciding whether a person was likely having a heart attack, and hospital operators’ summoning treatment teams with a single call. These hospitals also continually measured performance. I know it's a really minor thing, but the term 'ambulance driver' is a little irksome... It's like calling a doctor a 'prescript…

To be fair to the author, not every ambulance crew is paramedic level. And the term "ambulance attendant" was, at one time, in widespread use - to the point that the first level of EMS certification was actually called "Ambulance Attendant", if memory serves correctly. I know it's annoying when non-domain-specialists misuse terminology, even slightly, but I could see giving them a pass on this one.

Yeah, hence my being 'irked' not 'really offended'.

I suspect most folks here consider themselves more than just "typists".

Re: A Sea Change in Treating Heart Attacks

#33

Post by noir_lord »

Few weeks ago I woke up with massive chest pain, struggling to breathe and pouring with sweat, rang ambulance and went to open door by time I'd limped to unlock it one of the fast response cars not ambulance was at my home total time was Turned out to be an awful gallstone attack blnot heart attack but damn was I impressed with speed of response for early hours of Sunday morning - traditionally their busiest time.

Still ended up in hospital as they recommended that since I was projectile vomiting I should get checked out.

Re: A Sea Change in Treating Heart Attacks

#34

Post by mindcrime »

JshWright wrote: post #31
mindcrime wrote: post #27

Earlier quoted context omitted.

After I had my heart-attack last year[1], I was asked to participate in a clinical trial of a device called a "Life Vest". I did so briefly, although I ditched it pretty quickly because it was too uncomfortable to sleep in. But this thing was basically a wearable EKG/defibrillator. It monitored your heart rhythm and, if you went into a bad rhythm, would actually give you a shock from the defibrillator. Handy if you w…

Other than being slightly less invasive, this seems significantly inferior to an AICD [1] [1]: https://en.wikipedia.org/wiki/Implantable_cardioverter-defib...

Yeah, I'm not entirely sure about all the rationales behind the device. I just agreed to do the clinical trial, then wore the thing about a day and ditched it. :-)

My doctors initially suggested that I might need a implantable defibrillator if my EF didn't recover sufficiently, but it turns out that by about 3 weeks after, my EF was back close to normal, so no defibrillator required. Now I'm hoping I can talk my cardiologist into taking me off of Metoprolol at some point, since I do some competitive endurance athletics and that stuff supposedly hurts your performance. And from what I've been reading, some newer research suggests that there's no real benefit to continuing to take it more than a year after an MI.

Re: A Sea Change in Treating Heart Attacks

#35

Post by JshWright »

Animats wrote: post #23

But who calls an ambulance? Now that's an opportunity for a wearable device.

It would have to be a pretty awkward device if you wanted to automatically detect a STEMI. An EKG capable of diagnosing a STEMI requires at least 9 electrodes (most use 10+), placed in very specific locations around the body.

Re: A Sea Change in Treating Heart Attacks

#36

Post by mrestko »

JshWright wrote: post #31
mindcrime wrote: post #27

Earlier quoted context omitted.

After I had my heart-attack last year[1], I was asked to participate in a clinical trial of a device called a "Life Vest". I did so briefly, although I ditched it pretty quickly because it was too uncomfortable to sleep in. But this thing was basically a wearable EKG/defibrillator. It monitored your heart rhythm and, if you went into a bad rhythm, would actually give you a shock from the defibrillator. Handy if you w…

Other than being slightly less invasive, this seems significantly inferior to an AICD [1] [1]: https://en.wikipedia.org/wiki/Implantable_cardioverter-defib...

They are usually used as bridge devices until a patient can be scheduled for an AICD placement. Not all patients that need a permanent defibrillator are immediately fit for surgery and having a device like the Life Vest allows for them to be safely discharged from the hospital until it's time for surgery.

Re: A Sea Change in Treating Heart Attacks

#37

Post by GoodOldNe »

stephengillie wrote: post #10
tgokh wrote: post #8

Earlier quoted context omitted.

The technology exists -- see http://www.physio-control.com/ProductDetails.aspx?id=2147484... and http://www.zoll.com/medical-products/data-management/rescuen... from PhysioControl and Zoll, two of the biggest EMS EKG monitor manufacturers, but its certainly not easy to use. In my system, we used to have to upload the EKG to the computer and then "e-fax" it from he computer to the Emergency Department -- practically,…

> In my system, we used to have to upload the EKG to the computer and then "e-fax" it from he computer to the Emergency Department -- practically, this took 3-4 minutes to do, and when you're in an urban area and nearly always Those steps could be automated. And since this would usually be life-threatened situations, they should be automated. I wonder how much HIPAA rules complicate the technology; they certainly don…

Those steps could be automated. And since this would usually be life-threatened situations, they should be automated. I wonder how much HIPPA rules complicate the technology; they certainly don't make the space attractive or fun to work in. This sounds like a great disruption for a startup to make, if they can deal with HIPPA effectively.

There are several companies (including a couple YC alums like Aptible) working in the helping-developers-deal-with-HIPPA space already. Creating a compliant application for transmitting ECGs wouldn't really be a new thing-- when attending an emergency medicine conference two years ago I met a physician/programmer who had done just this for both stroke and heart attack, designed and marketed as a wraparound subscription-based solution. The trick is doing it well, and if you could integrate the information with the receiving hospital's workflows (e.g. EPIC integration or something) you could sell it easier. Pictures of ECGs are also a fairly inelegant solution compared to sending it to the ECG printers that a receiving hospital has, or sending the actual waveform data, but for rural/underfunded EMS agencies it would be nice.

(FWIW, I work in a Bay Area emergency department that is a STEMI receiving center but does not receive field-transmitted ECGs prior to arrival. There's room to work on this stuff. If anyone wants to do research relating to it or build a system and then let me do research with it, get in touch.)

Re: A Sea Change in Treating Heart Attacks

#38

Post by eplanit »

mindcrime wrote: post #29

Yeah, this jibes with my experience. I was rushed to UNC Hospital in Chapel Hill last Nov. with a STEMI, and I was amazed at how fast things progressed. Granted, time seems to compress in highly stressful situations, and I wasn't exactly timing with a stopwatch, but subjectively, I feel like I was in the ER maybe 15-20 minutes top, before they had me on my way to the cath lab. And the catheterization procedure took s…

I'm grateful to be in the same club. My Myocardial Infarction was in 2005: blockages in coronary arteries of 100%, 98%, 95%, and 80%. From the time I arrived at the E/R to the time the acted on me in the Catheterization lab was < 15 minutes. One hour and three stents later I was in recovery. My cardiologist explained that people with my symptoms, had they come to the E/R 3 years earlier, usually would die. I try to never forget to be grateful to all those who acted so quickly.

Re: A Sea Change in Treating Heart Attacks

#39

Post by BjoernKW »

stephengillie wrote: post #5
Cass wrote: post #2

A month ago, a friend who'd worked as a doctor in South Africa for decades was interning with me to learn about the procedures in our German ER. I remember the first time a patient with a heart attack came in while she was there, and the speed of the proceedings just blew. her. mind. What happens, if things go well, is this: The EMTs transmit a picture of the electrocardiogram to us[1]. We confirm that it's a STEMI (…

> By taking a picture of it on their phone and transmitting it via Whatsapp, which is just about the ugliest, hackiest and probably borderline-legal way of transmitting patient data imaginable, but it gets the job done. Congrats on the massive process improvement on using readily-available technology. I'm no lawyer but I'm pretty certain that this violates HIPAA, which means it's a new market just screaming for PII-m…

Yes, it is. HIPAA doesn't apply to Germany though, unfortunately. Despite its reputation for privacy Germany's healthcare regulations are severely lacking in that respect.

Implementing a more stable - and legal - system for exchanging medical data is next to impossible because there's a bunch of stakeholders who actively undermine what's in the interest of the patients for their own good.

So, for the time being, transmitting patient data via WhatsApp and the likes unfortunately - and quite bizarrely - probably is the only option to act in the patient's interest. Besides, the regulators won't notice anyway because for them the Internet still is some passing fad.

Re: A Sea Change in Treating Heart Attacks

#40

Post by maxerickson »

JshWright wrote: post #28
maxerickson wrote: post #19

Earlier quoted context omitted.

It isn't clear to me that the destination is always strictly determined; in the article, the ER doctor or consulting cardiologist would sometimes divert the ambulance. So the simplest implementation has the copy being easily available at the 'reasonably local' hospitals, rather than having someone push a button to send it to the diversion destination. edit: I see in your other comment that you are talking about scrol…

It adds, _maybe_ three seconds to the process of transmitting an EKG. The interface is pretty well designed. It makes more sense for me to be the person making that decision as I am the person with the most complete clinical picture at the time that decision is made. If I'm sending an EKG, I'm also going to be picking up the phone shortly to talk things over with the doc at that ER. There would never be a situation w…

My question could be rephrased as: Why is it a decision?.

When you pick up the phone and are talking to someone, the system could be showing them the EKG you did, with no intervention on either end.

I realize there is much opportunity there for bad implementation, I'm more interested in understanding the characteristics of a great implementation. Maybe there are reasons to leave it to the discretion of the EMT, but it being easy for the EMT to handle isn't one that I find very satisfying (I find it arbitrary to the implementation).

Post reply on HN