Cardiac Arrhythmia Diagnosis and Treatment for the Developing World

Cardiac arrhythmia patients in the developing world can often go many years of experiencing symptoms such as dizziness and fainting, among others, without receiving proper care. Based on epidemiological data around 1.3 million cardiac arrhythmia patients should receive a pacemaker every year. Yet in 2009 only 20 thousand patients had access to this treatment and not much has changed since then. This team at Johns Hopkins is collaborating with Medtronic to identify and address the key bottlenecks for the appropriate diagnosis and treatment of cardiac arrhythmias in targeted Indian demographics. Early on the underserved segment was identified as a critically important population. These individuals have neither the access nor the capabilities to seek care for their arrhythmia ailments. Incorporating this population would not only lead to the downstream increase in pacemaker implantations but would also increase access to lifesaving interventions for millions of patients in dire need.

From ethnographic research in the field the team found the largest clinical opportunity was at the beginning of the care pathway with the Rural Healthcare Practitioners (RHCPs) who serve as the first line of care for roughly 65 percent of the Indian population. To ameliorate this systems-level problem, the team is developing a low-cost tablet device that improves the diagnostic capabilities of RHCPs for a variety of common medical conditions, including cardiac arrhythmias. The tablet leverages established clinical decision support system (CDSS) algorithms, but caters specifically to the disease states seen commonly by RHCPs to help them decide whether to keep a patient for treatment or refer them to a specialized doctor, such as a cardiologist. The system also includes an electrocardiogram (ECG) plug-in that allows RCHPs to perform ECGs within their clinic.

The team has formed a partnership with a local NGO in India, JSV Innovations, to implement field studies. A preliminary ECG monitor and CDSS system was brought to the field and received positive feedback from our partners in India and RHCPs alike. The team will be implementing a more developed prototype to further iterate on this concept and better understand the impact on a workflow and financial standpoint. By developing a system to empower the diagnostic abilities of lower levels of the healthcare system, we believe we can ultimately improve the diagnosis and treatment of cardiac arrhythmias in developing countries.