Download The Petpace Collar in Action Continuous, Remote Pulse Monitoring

Case Study
The Petpace Collar in Action
Continuous, Remote Pulse Monitoring Of Cardiac Patients
At Home
Patient Condition and History
Lucas, a 10 years old, neutered male Beagle, was adopted from a
shelter several months previously. His new owner, Mrs. Michelle
Saltzman of Bedford, MA, witnessed episodes of weakness, exercise
intolerance, disorientation, collapse and syncope (fainting). Dr.
Patricia Berchtold from Chelmsford Animal Hospital, MA, examined
Lucas and also consulted with a cardiologist to conclude that Lucas
has a Chronic Valvular Heart Disease (stage B2 according to the
ACVIM Classification of Heart Disease and Heart Failure). Lucas was
placed on medications (Benazepril), ordered to avoid excessive
activity, and it was recommended to further examine Lucas’ heart
rhythm through a Holter monitor or an event recorder.
A Holter monitor and Event recorder are devices used to record
ECG, the electrical signal of the heart, in order to diagnose
arrhythmia (abnormal heart pace) and assess its severity. However,
these devices have several limitations. They involve wires, known
as leads that attach to the body. Therefore, when worn by a dog or
a cat they require shaving, attaching leads to the chest, and
bandaging, to protect the device from the pet chewing or pawing at
it. In addition, the devices only record data for a few days, and in
the case of event monitors, require the pet owner to activate it
when an event is occurring. Moreover, the devices do not provide
real time data. Instead, after the recording period has ended the
devices are sent to a specialized laboratory for data extraction and
interpretation.
For all of these reasons, Michelle Saltzman chose to also buy a
PetPace smart collar. The collar, worn conveniently on the neck like
a regular collar, provides multiple physiologic and behavior
attributes, including vital signs such as pulse rate. The collar
collects the data noninvasively, continuously and is designed to be
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worn long term. The data is accessible anytime, anywhere, and
alerts for suspicious events are sent in real time.
The collar has additional advantages that are useful for the
monitoring of patients with heart disease. It reports respiratory
rates, heart rate variability (HRV), and activity level and it creates
sophisticated analytical reports, all contributing to the assessment
of the disease severity and its prognosis.
Michelle placed a PetPace smart collar on Lucas to complement the
treatment protocol instructed by Dr. Berchtold.
Monitoring Data
The PetPace smart collar worn by Lucas revealed that a few times
every day he has brief episodes of high pulse rate, reaching the 160180 beats per minute range. These events usually follow some
moderate activity but the pulse rate appears higher than expected for
this level and pattern of activity.
* Typical pulse rate tracing chart of Lucas, a 10 y.o. Beagle with heart disease
and syncopal episodes, showing occasional brief tachycardia (elevated heart
rate) events.
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* Activity chart from the same time as the pulse chart above. Moderate or low
activity levels precede the tachycardia events.
Statistical analysis of Lucas’ data, available through the PetPace
Health Report, provided additional insights into Lucas’ condition.
• The daily average pulse rate, calculated from hundreds of
measurements every day, was slightly higher than normal
(87.8 beats per minute).
• The minimum pulse rate (58.6 beats per minute) was normal,
meaning the heart was able to relax during rest.
• Overall daily average respiratory rate (18.4 breaths per
minute) was normal, as was the minimal respiratory rate
(11.4 breaths per minute). Respiratory rates are commonly
used to monitor patients with heart disease.
• HRV (Heart Rate Variability), a marker of cardiac disease, was
slightly lower than normal (high HRV is good).
• All values were relatively stable and consistent through time,
and did not show worsening trends.
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* Tracing of Lucas’ daily minimal respiratory rate showing normal low respiratory
rates during rest. Elevation of resting respiratory rate is a negative indicator of
heart condition.
It is interesting to note, that Lucas is a fairly active dog, despite his
condition. Just looking at his activity data it would have been
impossible to know that he has a serious cardiac disease.
* Accumulated daily activity chart of Lucas, showing consistent, good activity
level.
An additional analytical tool, an HRV Vs. Pulse plot chart, is
attached below. For creating this chart, an HRV index called VVTI
(Vaso-Vagal Tonus index) is plotted against the corresponding pulse
data recorded at the same time. Preliminary investigation is
showing a statistical correlation between excessive numbers of plot
points below the normal range (red dots) and various serious
diseases. Lucas’ chart shows that 3.6%, a higher then normal
percentage of data points (red points), fall below the normal range.
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*Lucas VVTI Vs. Pulse chart showing abnormally high amount of points below the
normal range (red points).
Following Dr. Berchtold advice, Lucas wore a Holter monitor for 24
hours to measure his heart rhythm and rate and correlate it with
the periods of high heart rates recorded by the Pet Pace Collar. The
average pulse values measured by the Holter precisely match those
reported by the collar.
Discussion
Holter monitor and event recorder are important diagnostic tools in
certain heart diseases. Unfortunately, they are not used frequently
enough due to practical reasons. The PetPace collar, used in this
case to complement the management of Lucas’ heart disease,
correlated well with the heart rate values reported by the Holter.
Moreover, the collar provided additional valuable information
regarding the patient’s condition, including respiratory rate values,
activity patterns, and HRV analysis.
“The PetPace smart collar provides a range of clinically relevant
attributes for the monitoring of dogs and cats with heart diseases”
said Dr. Asaf Dagan, DVM, Diplomate ABVP (Canine and Feline
practice), and PetPace’s Chief Veterinarian. “It adds a new level of
objective, quantifiable data and together with analytical tools it will
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advance our understanding of these pathologies and enhance our
ability to treat them,” he added.
“I loved seeing the data provided by the collar, which complements
the owner’s reports, blood tests, imaging and ECG data that we
collected on Lucas,” said Dr. Patricia Berchtold, from Chelmsford
Animal Hospital in Chelmsford, MA, and Lucas’ veterinarian. “It
helps me as a clinician to produce a comprehensive picture of his
condition, monitor it over time and guide my clinical decisions”, she
continued.
Conclusions
Chronic heart diseases are common in dogs and cats. They
frequently require medications, long-term monitoring and periodic
clinical assessment. The current home monitoring techniques,
including owner observations and wearable ECG devices, have
limitations. The PetPace collar significantly improves this situation.
The fact that the collar can be easily worn long term, and that its
data and reports are available in real time to both pet owners and
caretakers, make it a worthy addition to the home management of
cardiac patients.
While activity data is important to complete the picture it lacks
sensitivity and specificity. Monitoring activity alone falls short of
being a clinically useful tool in the context of cardiac patients.
“This collar gives very cool information that I can share with my vet”,
says Michelle Saltzman, Lucas owner. “Lucas has no problems wearing
it and I know he needs it. I only wish we had it for some of our other
senior pups we adopted in the past”.
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