Cardiology was one of the first specialties to incorporate remote patient monitoring (RPM), and as a result, they are now uniquely positioned to reap the short and long-term benefits associated with the adoption of RPM services and tackle the increased need and demand for virtual care solutions in the pandemic era.
Sports cardiology is a new and developing sub-specialty and the evidence is still being gathered regarding the natural history of disease progression or risk of death in people with cardiovascular disease during intense exercise and competitive sport. Rapid advances in healthcare services and low-cost wireless connectivity have tremendously helped in dealing with the problem. The combination of mobile communications with wearable sensors has aided the shift from clinic-centered treatment to patient-centered healthcare services. Furthermore, wearable technology has made significant contributions to the evolution of healthcare monitoring systems.
What is sports cardiology?
Sports cardiology is the growing discipline that covers athletes and active people with known or previously undiscovered cardiovascular diseases who want to engage in intense exercise and physical activity. Many facets of cardiology are covered in this field, including cardiac imaging, electrophysiology, structural heart disease, and exercise physiology.
The significant health benefits provided by regular physical activity and intense exercise may paradoxically act as a trigger for life-threatening ventricular arrhythmias in the presence of underlying cardiovascular disease. In the presence of underlying cardiovascular disease, higher levels of physical activity and overall fitness are associated with lower all-cause mortality, lower rates of cardiovascular disease, and lower prevalence of several known malignancies. But, on the other hand, sudden cardiac death is the major cause of sports and exercise-related mortality in athletes. To avoid catastrophic and frequently preventable sudden cardiac death, cardiovascular safety during sports participation for individuals of all levels and ages has been a common aim across medical and sports-governing organizations.
What is the difference between recreational and competitive athletes?
The European Society of Cardiology defines an athlete as “a person of any age, amateur or professional, who engages in regular exercise training and competes in official sports competitions. Similarly, the American Heart Association and others define a competitive athlete as “a person who engages in regular and intense training in organized individual or team sports with an emphasis on competition and performance.” A recreational athlete participates in sports for enjoyment and leisure, whereas a competitive athlete is highly trained and places a larger focus on performance and winning. Both recreational and competitive athletes are covered under sports cardiology.
What are exercise-related major adverse cardiovascular events?
Exercise-related major adverse cardiovascular outcomes include sudden cardiac arrest, sudden cardiac death, acute coronary syndromes, cerebrovascular accidents, and cardiac arrhythmias.
- Sudden cardiac arrest refers to a sudden cessation of cardiac electrical signals accompanied by hemodynamic collapse, usually caused by prolonged ventricular tachycardia or ventricular fibrillation.
- Sudden cardiac death is defined as a sudden unexpected death due to a cardiac cause, or a sudden death in a structurally normal heart at autopsy with no other explanation for death and a history consistent with cardiac-related death. The incidence of SCD in competitive athletes is currently estimated to be between 1 in a million and 1 in 5000 every year.
- Acute coronary syndrome refers to a group of disorders characterized by a rapid decrease in blood flow to the heart, popularly known as heart attack.
- Cerebrovascular accident, also known as stroke, occurs when blood flow to a portion of your brain is interrupted by a blockage or a blood vessel rupture.
- Arrhythmia is deviation from the typical and normal heartbeat. The heartbeat may occur too fast, too slowly, or in an irregular manner.
Remote Patient Monitoring Technology in Sports Cardiology
Sports cardiology is a branch of cardiology that identifies, treats cardiac diseases in athletes, and determines whether an individual is fit to engage in sports. Clinicians can help patients using the data supplied via RPM to create a closer relationship with patients. RPM can also improve patient experience via shared decision making to achieve better quality outcomes and personalized treatment plan. The American Heart Association (AHA) is a non-profit organization that encourages and supports activities that improve access and use of evidence based remote patient monitoring systems for cardiac diseases.
Wearable remote patient monitoring devices are progressively assisting people in better monitoring of their health state, both at a self-health level for self-tracking and at a medical level by sending more data to clinicians, potentially allowing for earlier diagnosis and treatment recommendations. The reduction in the size of electronic devices is enabling the development of more dependable and flexible wearables. The field of sports cardiology widely uses these devices for monitoring since these devices can be used during activities in fitness and wellness purposes in monitoring the human body. Wearable remote patient monitoring devices are also beneficial in sports and fitness to monitor athlete performance, as well as by first responders to medical emergencies to analyze and monitor body response in various risky conditions.
Even in athletes, atrial fibrillation is the most common arrhythmia, and remote patient monitoring has several advantages in this illness. Rate control, antiarrhythmic medication therapy, and catheter or surgical ablation methods can all benefit from continuous real-time remote monitoring. Aside from advances in clinical care, early detection and treatment of atrial fibrillation could lower healthcare expenses related to atrial fibrillation. Next-generation remote monitoring devices can be worn or implanted for longer periods of time, allowing for continuous ECG data collection for longer periods of time with less burden to the patient. These devices are more likely to identify subclinical atrial fibrillation and its associated triggers and symptoms.
Additionally, remote patient monitoring combined with smartphone technology is simple to use in the real world and actively engages patients in self-management. The way healthcare providers care for this subgroup of patients is changing because of wireless remote patient monitoring devices. Having a remote patient monitoring platform that can integrate wristwatch transmissions into a daily workflow, where the information can be triaged, subcategorized, and integrated into specialized alarm systems, allows clinicians to filter down the information that are truly essential. This is something that is plainly required for the hectic schedules of healthcare providers and will result in improved results.
Hypertrophic cardiomyopathy (HCM) is one of the leading causes of sudden death during and after exercise. Some experts prohibit competitive sports; on the other hand, they have recently suggested that aerobic exercise is not contraindicated, and cardiac rehabilitation with supervised exercise, which is strongly recommended for patients with ischemic heart disease, may be similarly recommended for HCM patients. Therefore, establishing monitoring procedures to visualize hemodynamic abnormalities during exercise is important so that HCM patients can safely exercise. Several remote patient monitoring systems for HCM are now available and can be connected to cellphones. This may come in the form of a phone app or a desk device. The monitoring system collects data from your cardiac device and sends it to the cardiac device team via wireless transmission.
Remote patient monitoring devices serve a vital role in sports cardiology, allowing ambulatory vital sign and health status monitoring for longer periods of time and outside of clinical settings. This function enables the collection of crucial data during various daily activities including exercise, allowing for improved medical diagnosis and aiding in a quicker and faster recovery after medical intervention.
The field of sports cardiology mainly encompasses the prevention of cardiac arrest and sudden cardiac death in people who exercise and the management of athletes and other physically active people who have a history of heart disease. In this regard, remote patient monitoring can help individuals better control their personal health and engage in care. RPM can provide a more holistic and timely view of a patient’s health. It monitors a patient’s health status, encourages adherence to treatment regimens, and allows for early intervention before a negative event occurs.
- European Heart Journal, Volume 42, Issue 1, 1 January 2021, Pages 17 – 96, https://doi.org/10.1093/eurheartj/ehaa605