Here's a few pages of one I read not too long ago that disclosed some, shall we say, interesting findings and a considerable clinical conundrum.
To orient the reader, when a doctor reads the information collected by the Xio XT patch, he or she first reviews a summary sheet of all the heart rhythm data measured by the device. A clever graphic is supplied that permits rapid overview of the tracing with parallel vertical lines closely arranged next to each other. Each tiny vertical line represents a 20-minute interval of heart rate whose ends represent the minimum and maximum heart rate over those 20 minutes. A dot in the center of the line represents the mean heart rate. Below these closely-arranged parallel lines are other dots that fall on a row representing an arrhythmia or action taken by the patient. Here's what the overview picture of the patient I reviewed looked like (note that only 5 days of heart rhythm data were collected):
|Click to enlarge. Note the increase in average heart rate that occurred at the arrow.|
|Click to enlarge|
The bottom part of the tracing continues on to the next page:
|Click to enlarge (Note the artifact at the arrow)|
Finally, on the next page, the wide complex rhythm stops, but a more rapid supraventricular rhythm is discovered:
|Click to enlarge|
So now what? Clearly, one of the rhythms appears to be a rapid, potentially life-threatening episode of a wide-complex tachycardia. So I called the doctor who ordered the study, a solo doctor (yes, some still exist) and reach his answering service. I have him paged. There was no answer, so I leave a voicemail message urging a return of my phone call. I then attempt to call the patient. No answer. I call again. No answer to either the doctor or the patient's home/work/cell phone.
So here's a question: When reading such a study, how much more should the reading doctor be expected to do?