Clinical Techniques

How to optimally use SensiCardiac, perform cardiac auscultation and classify heart murmurs.

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There seems to be a slight problem in the digital healthcare industry. Ok well not a slight problem, a few massive gaps. In a recent Forbes article Todd Hixon discusses why healthcare practitioners are frustrated with digital health companies. And I am inclined to agree.

Healthcare practitioners have been encouraged, either by companies, their peers or the healthcare community to accept new technologies into their practices. Instead of assisting them in making valuable diagnostic decisions, simplifying their lives and making it, well, easier to deliver healthcare, it has been plagued with issues. Most of these technologies have usability issues, and do not deliver useable results to the practitioners. These systems are hard-to-use, are sometimes divided into multiple systems (i.e. no integration on multiple platforms), and they are not allowing practitioners to enable their patients to engage in their care. So digital healthcare is not being seen in a very pretty light.

I think this has its origin in a few places. Firstly the adoption of technology is at a very slow pace. In most other industries, like consumer electronics, aviation, automotive and automation, retail etc. there seems to be a much higher uptake on new technologies. These technologies have been positioned to reduce production times, increase sales, simplify their work etc. In healthcare, however, it is moving at a snail’s pace.

A review article published by England, Stewart and Walker discussed the problem of information technology adoption in healthcare. They found that organizational factors within healthcare as well as the delivery of products and services by vendors are to blame. Healthcare organizations seem to be very complex and tend to have fragmented internal structures. This can delay the adoption of new technologies, as well as hinder the implementation of a one-time digital solution. Health information technology is also relatively immature, can be complicated to implement, and are usually unable to show measurable benefits to healthcare practitioners or larger organizations.

The organizational aspects cannot be directly solved by the digital health industry (or can it?), but we do have the chance to provide simple-to-use technologies that are great for the user. It must show a direct benefit (saving time, reducing costs, improving patient participation in their care etc.) to the healthcare industry. Otherwise the adoption will continue to be painfully slow.

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One football program. Five years. Six deaths. Two life-altering injuries. Earlier this year I visited Tarleton University in Stephenville, Texas, "The Cowboy Capital of the world". I was devastated to hear about the tragedies that hammered this small community over the last few years. The immediate question that jumps to one's mind is, Why does this happen? Is this totally random, or could it be prevented? 

Why are tragedies happening on the sports field?

In the US, 10 to 15 million athletes participate in organized sport. Fewer than 300 die annually due to a cardiovascular cause, but with head injuries are the main cause for sports deaths. In the bigger picture, this is not a lot of fatal incidents, but are highly visible events with significant liability considerations.

Pre-participation examinations (PPE) are a rite of passage for young athletes. Will it minimize the number of tragedies? The fact is, PPEs are a challenge for most healthcare providers. And it is usually a last minute job.

A study published in the Clinical Journal of Sports Medicine examined PPE in clinical practice among AAP members and family practitioners in the State of Washington. Many participants reported barriers to the effective performance of PPE:

  • 37% were unsure on how to perform PPE.
  • 50% were unsure about the relative importance of a PPE.
  • 58% reported a lack of standardized approach.
  • 63% felt they did not have enough time with patients.

Guidance for performing effective PPEs is readily available and provided by the AAP and ACSM. The ACC also provides a specific statement on Cardiovascular Screening for competitive athletes

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Users often ask us what they could do to get the best results from SensiCardiac. Here are a few tips from our experience:

  • If you can’t hear the heart sound, SensiCardiac can’t either.

Most users violate this rule! Make sure the S1/S2 heart sounds are clearly audible before you start recording.  This is sometimes challenging at the aortic position. Ask the patient to do three to five squats to make the heart work a little bit harder. This may help to hear the heart more clearly.

  • Get the heart as close as possible to the chest wall.

If the patient is in the supine position there’s always the possibility of creating a cavity between the heart and the chest wall. Sounds from within the body, especially the lungs, can resonate within these cavities, creating unwanted noise.

  • Avoid breathing sounds, at all cost.

Ask the patient to hold his/her breath for the duration of the recording.

  • Body tissue is a heart sound killer.

If the patient does have excessive body tissue around the chest/breast and the heart sounds are not audible, don’t use SensiCardiac, or limit the recordings to the positions where the heart sounds are audible.

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