The advent of GPSIs and practice-based commissioning, and the evolution of general practice as a whole has brought a new meaning to medicine in the community.
To deliver quality care, a high level of knowledge and skills are required, as well as access to investigative tools.
Without diagnostic equipment, however, community doctors may be forced to refer to secondary care prematurely causing frustration to GPs, inconvenience to patients and rising debts in the NHS.
A large proportion of cardiological referrals relate to palpitations. The majority of these patients do not have sinister pathology.
A number of guidelines exist to help community physicians manage patients who present with palpitations, including those produced by the British Heart Foundation.
Concerning symptoms, such as loss of consciousness, structural abnormalities and an abnormal 12-lead ECG clearly require referral to secondary care, whereas asymptomatic palpitations can be managed in the community.
Arrhythmias that present infrequently can be difficult to capture on standard ECG or even on event recorders. Yet the Omron HeartScan HCG-801 overcomes this hurdle by allowing the patient to record their own cardiac rhythm when they are symptomatic.
Weighing in at a lean 130g, this device is portable and patient friendly. No larger than a hand-held computer, it has an electrode at either end of the unit and an LCD display on the front along with a clearly marked 'start' button.
The beauty of the HeartScan is its simplicity. When faced with palpitations, the patient finds a private place to sit, switches the unit on and exposes their left lower chest.
Animated on-screen instructions remind the user to place their right index finger on the curved electrode and the flat end of the unit is held against their chest, five centimetres below their left nipple.
When the patient is relaxed, the start button is pressed at which time recording commences for a period of 30 seconds. Each second is accompanied by a bleep, which should not be mistaken for the pulse. The ECG can be viewed in real time on the LCD. The time of day, date and pulse rate are also displayed.
Once the recording period is complete, the device will spend a few moments analysing the recording. If 'stable waveform' is concluded, there is an option to save or discard the data. Any abnormal results will be stored.
The unit comes with a secure digital memory card to allow data storage and for readings to be transferred to a computer. Software that accompanies the device allows the readings stored on the memory card to be displayed and printed.
Patients can keep the unit on their person for a period of time until their condition has been diagnosed. It is imperative that patients are taught to relax before recording in order to minimise movement artefact.
Alternatively, rather than giving the HeartScan to patients to take away, the device may be an invaluable addition to the doctor's bag. A rhythm strip can be obtained from patients presenting with palpitations in surgery or when visiting at home.
Using the HeartScan ECG monitor, I have documented sinus arrhythmia, AF, supraventricular tachycardia and ventricular ectopics. Points are awarded in the GMS quality framework for ECG documentation of AF.
Patients can be investigated to a high standard using the Omron HeartScan allowing, when appropriate, treatment options to be explored before referral to secondary care is considered. This allows for a comprehensive and cost-effective patient pathway.
Overall the HeartScan is easy to use, highly portable and invaluable when investigating patients with palpitations.
- An independent review by Dr Thakkar, a GP in Woodburn Green, Buckinghamshire
- Equipment supplied by Williams Medical Supplies
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Model: Omron HCG-801 HeartScan ECG monitor
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