Professor Faizel Osman, consultant cardiologist and electrophysiologist at University Hospital Coventry and Warwickshire NHS Trust, and member of Creavo Medical Technologies medical advisory board tells us about new technology that could save both lives and money
The persistent pressure the NHS operates under is well documented, and as a cardiologist I witness the effects of this every day. With resources limited, we need to look increasingly carefully at who we refer for in-hospital treatment and who we don’t, who needs specialist treatment and who doesn’t. The NHS simply can’t afford to spend valuable resources on treatments for people who don’t need them.
Innovative technology has always played a large role in helping us to improve efficiency and patient care. In my specific field of cardiology, technology is fundamental – you just have to look at the heart monitor or defibrillator to imagine where we’d be without it. However, as healthcare professionals we need to continually explore new technologies that could have the potential to solve major challenges. Clinicians have been extensively studying the potential for a portable form of magnetocardiography (MCG) – measurement of magnetic fields produced by the heart’s electrical activity – to alleviate one of the critical pressures cardiologists face today: chest pain triage.
Before discussing the technology’s potential, let’s first look in more detail at a key problem it could potentially address. In the UK, just over five per cent of emergency department visits and up to 40 per cent of emergency admissions are due to patients experiencing chest pain. However, it’s a highly complex medical area; there are many underlying problems that can cause chest pain. It could be a symptom of an ischaemic condition – but it could also be a result of other issues such as severe stress and anxiety, or even indigestion. If the problem is ischaemia-related, we need to know quickly.
In reality, a very small number of patients – about a third – who present to emergency departments with chest pain are ultimately diagnosed with acute coronary syndrome (ACS). However, we currently are still required to place the remaining majority through the complete chest pain pathway before we can safely rule them out. This places a large strain on clinicians’ time, as they stratify the risks of a serious heart problem by analysing multiple factors including an electrocardiogram (ECG) test, blood testing, and the patient’s medical history. This process isn’t perfect as it looks at different factors in isolation, not as a single picture, and can’t always provide a conclusive result.
Researchers have been conducting studies using a portable MCG scanner developed by Creavo Medical Technologies, whose medical advisory board I am a member of. The device detects extremely small magnetic fields in a patient’s heart, which produces a map indicating the difference between normal and abnormal cardiac behaviour. The technology existed previously in SQUID devices, but these are large and expensive. However, to have MCG available at a patient’s bedside could be a game changer. Using Creavo’s MCG device, the heart’s electromagnetic fluctuations can be measured and used to produce a trace, numerical data and a 2D visual magnetic field map of the heart to aid triage. Cells in the heart that lack oxygen or are dying distort the data points and parameters picked up by the scanner, so this can be seen in the resulting trace and map.
Crucially, we can perform the scan in under five minutes, which means that we can not only potentially rule out ischaemia accurately, but also very quickly – meaning those that need urgent treatment get it rapidly, and those that don’t can either be channelled to an appropriate pathway or sent home.
Outside of the emergency medicine setting, we are working on a piece of research which will assess the potential for MCG to classify people at risk of sudden cardiac death. From a patient-outcome perspective, an effective screening tool for a life-threatening condition could save lives. We must also view things from a resource point of view – can the technology give us an answer to whether a patient requires an implantable defibrillator (ICD) or not?
Defibrillators are expensive and can be associated with problems long-term. Not all those who have an ICD implanted will benefit from them. Also, current ICD implant criteria do not necessarily identify all those that would benefit. By exploring the MCG technology with patients at risk of sudden death, we may arrive at solutions which cut unnecessary implants as well as identifying those who would benefit that would not currently get an implant. While we continue to carry out research with portable MCG in the emergency department, this is our initial step into how the technology could add value and can be utilised in the hospital cardiology setting.
In my years as a cardiologist I have witnessed and explored many new technologies, but portable MCG could be a significant one. We’ve never been able to measure the heart’s magnetic field at a patient’s bedside before, and certainly haven’t been able to obtain specific answers from the tools we’ve had at our disposal to date. The technology could improve cardiac patient outcomes and could also create huge efficiencies within the broader healthcare system and free up resource that is required urgently elsewhere. Similar challenges exist with chest pain triage in Europe, in North and South America, and elsewhere, and I believe that this new technology could have a global impact.
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