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Dramatically Improve Your Patients’ Chances of Surviving a Heart Attack

Introducing a New Service that Provides a

Remote Cardiac Assessment and an Emergency Response

CLOUDnCARE

UK HelpLine: +442037945005 INDIA Helpline: +918010700077 Email: [email protected]

eHEALTH TECHNOLOGY

© 2005. E.K.Guard, Inc. All rights reserved.

When “Time is Muscle,” Why is Cardiac Emergency Care Still Taking So Long?

Patient Delay Typically Accounts for Over 60% of Overall Time to Treatment

Patients often delay seeking help at the onset of symptoms, preferring to “wait and see” rather than

go through the hassle of emergency care

35%

25%

9% 8%12%

7%

0%

10%

20%

30%

40%

< 2 hours 2-6hours

6-12hours

12-24hours

24-72hours

>72hours

Ø  Patients wait too long before seeking help (estimates of median delay range from 2 to 6.4 hours2)

Ø  Only 1 in 5 patients gets to the hospital within the crucial one hour window after symptom onset when studies have shown thrombolysis and interventions to be most effective3,4,5,6

Ø  Irreversible damage starts in 2 hours and death rates double; yet 65% of people haven’t even made it to the hospital by 2 hours1,4,5,13

Distribution of Time Delay Between Symptom Onset & Hospital Arrival1

2 out of 3 delay over 2 hours

Patient’s first symptom

Patient finally calls 911

EMS arrive

EMS assess E.R. triage Treatment

begins Doctors mobilized; Patient to treatment

area

12 am 4 am

4:15 am

4:25 am 4:40 am

5:25 am

6:10 am

EMS Response ~40 mins

ER Triage ~45 mins

Cath Prep ~45 mins

Patient Indecision ~4 hours

An All Too Common Timeline: 6+ hours from Onset to Treatment

Irreversible damage starts,

death rates double

2am

Note: 4% wait 6+ hours but exact time unknown.

CLOUDnCARE


‘Atypical’ Symptoms

What Causes Patients to Delay?

66%

16%

47%52% 52%

34%

3% 3%

64%

26%

76%

7%

0 %

2 0 %

4 0 %

6 0 %

8 0 %

10 0 %

Chest Pain Radiating Pain Collapse Shortness ofBreath

Nausea /Vomiting

Dizziness

% Experienced% Expected

Percent (%)

Symptom Experience versus Expectations for Patients with MI7

Heart attack symptoms can be mild, intermittent, or otherwise ambiguous, leaving patients unsure of whether

they are experiencing something serious

•  Patients delay seeking treatment until they are more certain their symptoms warrant the hassle and stress of emergency care

•  Others go to the ER but leave with a false alarm, further reinforcing the instinct to delay

Ø  Patients whose symptoms did not match their expectations of a heart attack delayed longer (mean of 9.3 vs. 4.5 hours)7

Ø  Common reasons cited for delay are “belief that symptoms would go away” and “symptoms were not severe enough to warrant seeking care”8

Ø  Patients in the REACT study refused to call 911 until symptoms became more serious and warranted a trip to the E.R.; Many wanted to avoid the embarrassment of a false alarm13

Ø  Of those who go to the E.R. with suspected MI, 84% are deemed false alarms9

Horne, James, Petrie et al, Heart 2000

CLOUDnCARE


CloudnCare’s Goal: Reduce Time to Treatment and Save Lives

Dramatically reduce patient delay and achieve quicker door-to-treatment times

Patient’s first symptom

Patient finally calls 911

EMS arrive

EMS assess E.R. triage Treatment

begins Doctors mobilized; Patient to treatment

area

12 am 4 am

4:15 am

4:25 am 4:40 am

5:25 am

6:10 am


ER Triage ~45 mins

Cath Prep ~45 mins

Patient Indecision ~4 hours

An All Too Common Timeline: 6+ hours from Onset to Treatment


death rates double

2am

Patient’s first symptom Patient calls

CloudnCare

EMS dispatched

E.R. triage

Treatment begins

Doctors mobilized; Patient to treatment

area

12:05 am

12:15 am 12:55am

1:10 am 1:55 am


ER Triage ~15mins

Cath Prep ~45 mins

What we’re striving to achieve:

EMS arrives 12:30 am

Patient calls CloudnCare

~15 mins

12:00 am

CloudnCare will make it easy and convenient to take action at a patient’s first cause for concern ü The REACT study told us that

education alone is not enough13 ü Service offers a better way to take

action vs. calling an ambulance / 911 ü Removes the factors that cause delay


death rates double

2am

Cardiologist interprets 12-lead ECG and transmits to hospital in advance, an effort to expedite treatment once patient reaches the hospital

ü NRMI subset analysis shows patients with pre-hospital 12-lead ECGs have 25% faster door-to-needle and door-to-balloon times

CLOUDnCARE


CloudnCare Cardiologist Call Center

Ø  Patients calls at the first sign of a symptom, from anywhere at anytime

Ø  Patients equipped with a hand-held, FDA-approved ECG device that can be easily self-administered; 12-lead ECG results are recorded by the patient and transmitted over any phone

The Patient

CloudnCare’s new service combines a remote ECG and 24-hour cardiologists to make it easy for patients to get a fast, accurate evaluation at their first cause for concern.

The Technology

Ø  Staffed with cardiologists and nurses 24 hours a day, 7 days a week

Ø Cardiologist evaluates symptoms using detailed protocol that includes: Ø  Patient’s presenting symptoms Ø  Access to full medical history & baseline ECG Ø  Transmitted ECG (when warranted)

Ø  In acute situation, mobilizes emergency medical care including EMS, alerts patients’ physician and hospital, and sends a copy of any recorded ECG to hospital

CLOUDnCARE CloudnCare can provide the greatest benefit when used in conjunction with the advice of your physician, and is not intended as a substitute for physician care.


If it’s a heart attack or potential cardiac event, the service will reduce delays and speed overall time to treatment to help save their life

If it’s not an emergency, the patient will have the peace of mind of knowing within minutes that they are fine

Non Emergency Heart Attack or Potential Event

CLOUDnCARE

Our

CloudnCare can provide the greatest benefit when used in conjunction with the advice of your physician, and is not intended as a substitute for physician care.


CLOUDnCARE’s Medical Advisory Board: Leading Cardiologists Helping us Reduce Time to Treatment

Joseph S. Alpert, MD Head of Dept. of Medicine, University of Arizona Health Sciences Center. Editor in Chief, The American Journal of Medicine .

Mark Apfelbaum, MD Director, New York Presbyterian System Cardiac Catheterization Laboratories

Christopher P. Cannon, MD Associate Professor of Medicine, Brigham and Women's Hospital, Harvard Medical School

Martin B. Leon, MD Chairman, Cardiovascular Research Foundation® Associate Director, Center for Interventional Vascular Therapy, Columbia University Medical Center

T. Barry Levine, MD Director of Division of Cardiology, West Penn Allegheny Health System

Allan Schwartz, MD, Chair, E.K. Advisory Board Chief, Division of Cardiology, Dept. of Medicine, Columbia University Medical Center

“Now there is a way to dramatically reduce the time to treatment for heart attack victims, while reducing the false alarms that clog our busy ERs. Over the past decade, this type of service has repeatedly been proven in England, Germany, Switzerland and other countries. Now it’s available here in India. We believe the eventual success of CLOUDnCARE will be measured in the thousands of lives it will save.”

CLOUDnCARE


Ø  Device is FDA-approved to record a full 12-lead ECG and transfer the data through any phone

Ø  Works on Smart phones & Real Time Ø  CLOUDnCARE supplies this hand-held, portable ECG device

designed to be with the patient at all times Ø  If experiencing symptoms, the on-duty cardiologist may ask the

patient to record heart and transmit results via phone Ø  Patients report that the device is fast and easy to use.

Ø  Simple preparation, with only 3 cable electrodes. Ø  12-lead ECG recorded by placing device in 3 chest positions. Ø  Ergonomically designed for easy grip. Ø  Full process completed in under 2 minutes (50 seconds for

recording, 50 seconds for data transmission) Ø  Patients will be trained on using the ECG device and acting on

early symptoms

The Technology: Portable 12-Lead ECG Device and Software to Receive Remote Transmissions

Cardiologist Call Center equipped with technology to quickly access full patient history (at their fingertips), receive new 12-Lead ECGs, and compare new information vs. previous ECGs

CLOUDnCARE


Key Results From Similar Service

CLOUDnCARE’s Service is Based on Proven Models from Overseas

Reduced delay times from first symptom to a call for help Ø  Shahal has reported average delay of 44 minutes, with 59% of

customers calling within 1 hour10 Ø 32% of callers “would have waited” had they not been Shahal subscribers11

Ø  Natali has an average delay of under 30 minutes12 Fewer unnecessary trips to the hospital

Ø  Only 21% of Shahal calls result in dispatch of ambulance; with less than half of them ending in hospital admission11

Ø  Yet 45% of surveyed callers “would have sought emergency department care” had they not been subscribers11

Ø  Similar services been in existence for over a decade Ø  Currently, similar programs exist in England, Germany, Switzerland, and other

countries around the globe Ø  In Europe alone, over 100,000 people use this type of service today

Ø  And, hundreds of thousands more people have access to the technology and call center medical staff

Ø  The handheld ECG devices that CLOUDnCARE uses are FDA / CE approved.

CLOUDnCARE


Patients Who Benefit from CLOUDnCARE

Ø  Female, aged 60 Ø  Family history of cardiovascular

disease Ø  Suffers from angina; sometimes has

discomfort that she worries is a heart attack

Ø  Has been to the hospital once to check out her symptoms, but it was a false alarm. Now she doesn’t like to go.

Susan

Ø  Male, aged 67 Ø  Previous MI two years ago Ø  Prior heart attack developed

slowly, with ‘symptoms such as nausea & dizziness

Ø  Now is concerned whenever he feels something unusual: calls the office frequently, and has gone to the ER several times

Ø  Male, aged 55 Ø  Previous MI five years ago Ø  High risk of secondary event

(diabetes, high blood pressure) Ø  Sometimes has symptoms that

worry him, but rarely calls for help. You don’t find out about them until his next appointment.

Robert

“I don’t want to bother my doctor for every little thing.”

“I don’t want to go near the E.R. unless I’m sure it’s

serious.”

“I don’t hesitate, I call my doctor every time I feel

something strange.”

Jose

CLOUDnCARE


Enhanced Patient Care Ø  Patients seek immediate evaluation for even the slightest symptom — anytime,

anywhere Ø Early treatment: those who previously did not call for help now seek immediate advice Ø Patients having an event arrive at hospital within 1 hour of first symptom Ø Patients with “false alarms” get comfort of knowing they are not in danger

Ø  Improved speed & quality of emergency room care Ø E.R. alerted & mobilized to expedite treatment Ø Relevant patient data (including latest ECG) sent to E.R. physician Ø Attending physician given more complete patient information than before

Eases the Burden on You and Your Practice Ø CLOUDnCARE extends your ability to provide care 24-hours a day, every day,

which includes your busy hours and your evenings and holidays Ø Confidence that patients are being accurately assessed after hours, even when you’re

not on-call Ø CLOUDnCARE encourages your patients to call our service at the first onset of

symptoms, which will reducing you having to deal with false alarms Ø More efficient outlet for patients who call frequently with questions

A Vision for the Future of Cardiac Care

We want to reduce the time it takes to seek & receive effective treatment… …and thereby improve heart attack

survival rates

TIME IS MUSCLE

“This new service doesn’t replace you, the doctor… It extends your ability to provide care”

-- Allan Schwartz, Advisor

CLOUDnCARE


Interacting with CLOUDnCARE

We’ll be speaking with patients directly about our service. ?  However, they will likely come to you for questions and advice.

1

When one of your patients becomes a member, we will need to have a copy of his or her records for our system and periodic

updates thereafter. ?  We will provide an Enrolment charge for registration.

2

Your service-provider can be trained in proper use of the portable ECG device by CLOUDnCARE, or your office staff.

?  If selected, this in-office training can be coded for reimbursement.

3

We will notify you immediately if your patient is sent to the hospital. ?  We will also keep you informed of any non-emergency calls to the

service within six hours.

4

Sources

1Gurwitz JH, McLaughlin TJ, Willison DJ, et al. Delayed hospital presentation in patients who have had acute myocardial infarction. Annals of Internal Medicine. 1997;126(8):593-9. 2Dracup K, Alonzo A, Atkins JM, et al. The physician’s role in minimizing prehospital delay in patients at high risk for acute myocardial infarction. Annals of Internal Medicine. 1997;126(8):645-51. 3Goldberg RJ, Gurwitz JH, Gore JM. Duration of, and temporal trends (1994-1997) in, prehospital delay in patients with acute myocardial infarction: the second National Registry of Myocardial Infarction. Arch Intern Med. 1999;159:2141-7. 4The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med. 1993;329:673-82. 5Berger PB, Ellis SG, Holmes DR Jr., et al. Relationship between delay in performing direct coronary angioplasty and early clinical outcomes in patients with acute myocardial infarction: results from the global use of strategies to open occluded arteries in Acute Coronary Syndromes (GUSTO-IIb). Circulation. 1999;100:14-20. 6Weaver WD, Cerqueira M, Hallstrom AP, et al, for the Myocardial Infarction Triage and Intervention Project Group. Prehospital-initiated vs. hospital-initiated thrombolytic therapy: the Myocardial Infarction Triage and Intervention Trial. JAMA. 1993;270:1211-6. 7Horne R, James D, Petrie K, et al. Patients’ interpretation of symptoms as a cause of delay in reaching hospital during acute myocardial infarction. Heart. 2000;83:388-93. 8Meischke H, Ho MT, Eisenberg MS, et al. Reasons patients with chest pain delay or do not call 911. Annals of Emerg Med. 1995; 25(2):193-7. 9Qamar A, McPherson C, Babb J, et al. The Goldman Algorithm Revisited: Prospective Evaluation of a Computer-Derived Algorithm Versus Unaided Physician Judgment in Suspected Acute Myocardial Infarction. Am Heart J. 1999;138(4):705-9. 10Roth A, Carthy Z, Benedek M. Telemedicine in emergency home care -- the ‘Shahal’ experience. J of Telemed & Telecare. 1997;3:58-60. 11Roth A, Malov N, Carthy Z, et al. Potential reduction of costs and hospital emergency department visits resulting from prehospital transtelephonic triage -- the Shahal experience in Israel. Clin. Cardiol. 2000;23:271-6. 12Interviews with Natali executives. 13 REACT Project (Rapid Early Action for Coronary Treatment) Osganian, Stavroula et al. Rapid Early Action of Coronary Treatment (REACT) JAMA, 2000

CLOUDnCARE

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