C.Net5000 24-hour ECG monitor: designed specifically for use in primary care

NAME: Cardionetics C.Net5000
PRICE: £2,350 plus VAT for complete package (monitor, lead, patient diaries, electrode pads, batteries, software, USB adaptor, manual and carry case)
SUPPLIER: Cardionetics Limited
WEBSITE: www.cardionetics.com

It is not unusual for patients to present to their GP with palpitations. A benign history, with a normal examination, bloods and ECG are sometimes all you need to reassure patients. Other, more sinister cases require the opinion of a cardiologist. Grey cases, however, pose a diagnostic dilemma for GPs.

A normal ambulatory ECG may be enough to satisfy the GP that there is no serious underlying pathology. But without access to such a device, patients may have to be referred to secondary care. According to some data, up to 60 per cent of those referred to secondary care for palpitations have no worrying arrhythmia.

In a large number of cases, the cardiology team will organise ambulatory ECG monitoring, which, if normal, will be referred back to the GP. Referral to secondary care creates anxiety, inconvenience and delay. It is expensive and puts pressure on hospitals. An alternative is monitoring in the community. The C.Net5000 is an ambulatory ECG monitor specifically designed for use in primary care. The unit comes with a case, holder and belt, cables, batteries, software, patient diary and instruction manual. GPs can also obtain technical advice by telephone, if required.

Up to 24 hours of data can be continuously monitored by the device. It may also be used if a patient presents with palpitations during a busy morning surgery, when only a short recording is required. Being portable, it is ideal for use in the patient's home and the data are acceptable when gathering ECG evidence of AF for quality and outcomes framework purposes.

Easy to use
Three leads are attached to the patient and the unit. The device reminds the user where to place each lead on the torso. No initial patient data input is required, making it easy to use. The simple menu allows a test to start in less than a minute.

Artefacts are removed and the signal is refined during the initial stages of the test. 'Test in Progress' is then displayed and a live ECG is viewed on the LCD screen.

The buttons can be locked to prevent patients from accidentally pressing them during the test, although they can activate a symptom button each time they experience palpitations. After 24 hours, the unit will hibernate, with very little drain on the batteries. Tests can therefore be run over the weekend with confidence. A warning will appear if the batteries will not last for a full 24-hour test.

Once the test is complete, an integrated neural network analyses the data, saving the GP hours of work. The network, developed at Brunel University, has been tried against a number of cardiologists and scored a 96 per cent accuracy rate, beating the cardiologists' score by more than 6 per cent.

Rather than having to review the full 24 hours, the network will display salient results via the unit's screen or a PC. Data include average heart rate, episodes of tachycardia, bradycardia and arrhythmia, type of arrhythmia, ischaemic changes and summary of any patient-activated events. Patient-activated events can then be compared with diary entries. Menus allow the user to review abnormal ECGs. If more than 30 per cent of the ECG cannot be analysed, the unit signals a warning because dangerous rhythms may not have been recorded.

If the C.Net5000 is connected to a PC, the software supplied with the unit can be used to display a summary of the test and all anomalies. A full report may be generated, with each page dedicated to each type of anomaly. The report can be printed out or saved electronically and attached to the electronic patient record. If anomalies are found and the patient requires referral, the report can be sent to the cardiologist, saving resources and streamlining the patient pathway.

Much thought has gone into developing this device. It is portable and easy to use, transforming patients' care pathways and experiences. As more and more medicine is moving into the community, the C.Net5000 is a piece of equipment no practice should be without.

- Dr Raj Thakkar is a GP in Wooburn Green, Buckinghamshire, and a hospital practitioner in echocardiography at Stoke Mandeville Hospital, Buckinghamshire Hospitals NHS Trust.