A number of technological breakthroughs and advancements, including the digitization of the electrocardiogram (ECG) signal, the miniaturization of electronic components, and the propagation of communication networks have made possible cardiac telemetry, the wireless transmission of ECG recordings to central servers, to be evaluated remotely by a physician or other trained personnel. This constitutes a paradigm shift in modern healthcare, considering that for the first time important healthcare decisions can be systematically made without having the patient and the caregiver in the same room.

From a technological point of view, remote monitoring systems are long past their infancy. They have advanced past most issues of security and reliability and their use is steadily on the rise. However, there are still several questions regarding their cost-effectiveness, the patient populations that could benefit from them, as well as how the transmitted data should be interpreted and acted upon by the patient's physician. Inherent problems in designing blind and bias-free trials for implantable devices, together with heterogeneity in study protocols, pose extra difficulties in their assessment.

Indian Market Dynamics

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The Indian ECG equipment market grew by about 11 percent in volume and value terms. GE, Philips, and Schiller continue to dominate with a combined market share of about 65 percent. BPL is aggressive in this segment. Mindray, Nihon Kohden, Nasan, JK Medical (Bionet), Silver Meditech, Krishna Medi, and Nidek continue to have major presence. Many Chinese brands also co-exist with other brands.

2016 saw an upward revision of 7 percent in customs duty, from 11 percent in 2015 to 19 percent in 2016. Philips and Schiller passed on the increase in customs dutywhereas other brands absorbed the hike.

The total occlusion of epicardial coronary artery leads to myocardial infarction (MI). It is being manifested in ECG as ST segment elevation in the leads records electrical activity from that region. Because there can be topographic variations in blood supply of the three major epicardial coronary arteries from person-to-person, and the predilection of involvement of particular sites of conduction system with different coronary arteries, the clinical presentation, morbidity, and mortality vary with the artery involved, in cases of acute MI. Hence, early identification of the culprit artery gives a bird's eye view for the clinician in managing the life-threatening disease. A 12-lead ECG is a simple noninvasive tool used for diagnosing the acute MI. By adding algorithm to identify the culprit artery in ECG, it empowers it into a more efficient modality. Schiller and Philips offer the CCAA (culprit coronary artery algorithm) software that helps correctly identify the site of obstruction in the coronary artery. However, these systems have yet to gain popularity with the physicians, who often prefer alternatives as angioplasty and angiography.

The low-end stress machines are typically procured by private cardiologists, while the discerning corporate chains of hospitals buy dedicated high-end systems.

Global Scenario

The global ECG equipment market is projected to grow to USD 4831.5 million by 2021, at a CAGR of 7 percent over the next 5 years, predicts Technavio. The resting ECG devices segment dominated the ECG equipment market and accounted for a major part of the overall market share in 2016.

The growing numbers of insurance providers who cover ECG tests are boosting the growth of the global market. The advances in technology and product upgrades are expected to increase competition among vendors. Vendors adopt various strategies and competitive pricing to sustain themselves in the market and increase their shares. The introduction of wireless technologies and user-friendly apps for the collection of cardiac rhythm data from end-users will significantly change the market landscape.

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One of the primary drivers for this market is the rapid increase in the number of incidences of cardiac disorders. Hypertension is the most common cause of heart failure and is caused due to rise in blood pressure in arteries. These health risks mainly arise because of unhealthy dietary habits, increased stress, and lack of physical activity due to hectic lifestyles. As observed by experts, the primary reason responsible for the majority of cardiac disorders is hypertension. In the United States, the incidences of cardiovascular diseases (CVDs), such as coronary heart disease (CHD), stroke, and heart attack are increasing. These chronic diseases require diagnosis and treatment to monitor the severity of the patient's medical condition daily and maintain medical health records. Moreover, the growing hospitalization of the older population for the treatment of cardiac diseases has also increased the need for ECG diagnosis, which in turn, is expected to propel the growth of the global ECG devices market over the next 5 years.

Integration of technologies to develop advanced ECG devices is one of the latest trends gaining traction in the ECG market. The introduction of advanced technologies in CVD testing has led to higher sales of ECG devices. The development of new monitoring technologies has helped improve disease diagnosis and treatment. Technological advances have also allowed flexibility and portability of these systems. For instance, the continuous advances in wireless data systems have allowed a more flexible placement of individuals and equipment within examination rooms. Instead of tethering individuals to the machine, physicians can place their workstations in a more convenient location while the concerned person is doing exercises. Furthermore, continuous digitization of record systems in physicians' offices and cardiology departments has induced vendors to improve data connectivity for a range of management solutions – from ECG management systems and CVISs to PACSs. These technological advancements in ECG devices are expected to augment growth in the global ECG equipment market in the coming years.

Outlook

The biggest demand today in ECG management systems is workflow efficiency and interoperability between EMRs, CVIS, and various vendors' ECG systems. Thanks to the development of mobile internet and wireless sensor networks (WSNs), wearable ECG monitoring systems have emerged which are able to detect ECG signals using a nonintrusive sensor and transmit the signal to the smartphone through wireless transmission techniques. For the sake of portability, electrodes of the WSN-based ECG monitoring systems are usually less than those used in traditional methods. These portable sensors are usually embedded into some wearable textiles, which have little impact on the user's daily activities. With the aid of these systems, long-term ECG can be monitored in a cost-effective manner. However, to the best of our knowledge, nearly all existing systems cannot work without a smartphone, which is used as a receiver and processor of the ECG data. Due to limited power and computational capabilities, the complex tasks of data transportation and processing may have a great impact on the daily use of the smart phone. Furthermore, in order to support all the OS platforms of smart terminals, great efforts are required for the cross-platform development of the mobile application. Increasing demand for miniaturization and portability will give a momentous boost to technological innovations.

With development of miniaturized devices and wireless communication, the way in which doctors care for patients will change dramatically and the role patients play in their own healthcare will increase. Healthcare will become more personalized through tailoring of interventions to individual patients. The increasing number of mobile devices, ubiquitous Internet, and cloud computing will progressively emerge into a new domain called Wearable Internet of Things (WIoT). This will lead to increased capability of sensing, computing, and communication. Future generations of WIoT promise to transform the healthcare sector, wherein individuals are seamlessly tracked by wearable sensors for personalized health and wellness information. Looking forward to a future of wearable ECG devices, it is more than clear that IoT and smartphones with multifunctionality medicinal features will bring intelligence, ease, and smartness into the devices of future.


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