The Cortrium C3⁺ Holter Monitor is used in the Malaria Heart Study / BRAHIT study as part of a novel Danish-Brazilian research cooperation. The study examines potential correlations between malaria and heart diseases and provides the possibilities to offer healthcare services to remote areas with limited medical coverage.

About the study

The Malaria Heart Study was initiated in October 2019 and Cortrium entered as a novel collaborator providing the Cortrium C3+ Holter to the ongoing study. The Malaria Heart Study aims to identify novel patterns related to malaria and heart diseases and to make a significant contribution on how to deal with heart diseases in malaria regions. As such, the impact of the findings will potentially reach far beyond the Amazonas region. Throughout the study, approximately 900 patients are examined with blood samples, ultrasonography of the heart and a conventional electrocardiogram. Based on these findings, selected patients are equipped with the Cortrium C3⁺ Holter Monitor, that they take home and usually wear for 48 – 72 hours.

BRAHIT (Brazilian Heart Insufficiency with Telemedicine) is a Danish-Brazilian research collaboration, chaired by Helena Domínguez, who is associate professor in the department of biomedicine at the University of Copenhagen (UCPH) and consultant cardiologist in Bispebjerg-Frederiksberg hospital (BFH) The two departments in UCPH and BFH joined forces with The Universidade Federal De Ouro Preto in the Minas Gerais region and the Instituto Nacional de Cardiologia (INC) in Rio de Janeiro for remote management of heart failure, based on a novel collaboration model across primary care and hospital-based cardiologists. The contact between the Malaria Heart Study group and the BRAHIT group was initiated by Innovation Center Denmark in Brazil, that provides support to both groups in Brazil. The Malaria Heart Disease Study is an international collaboration between Federal University of Acre and Herlev-Gentofte Hospital. When Innovation Center Denmark in Brazil presented the Malaria Heart Project for Helena Domínguez, it seemed obvious to facilitate the use of C3+ Holter monitors from Cortrium for the study.

At the forefront of the study are both Brazilian researchers (Odilson Silvestre, Laura Gomes), Danish researchers (Philip Brainin, Anna Engell Holm, Tor Biering-Sørensen, Alma Wegener), and a team of local ambitious medical students. Dr. Brainin first arrived in Brazil in September 2019 and established first collaborations in an area, where clinical research of this scale rarely takes place.

The young team has a high interest in infectious and cardiac diseases. “Right now, there is a big research question as to whether malaria can give cardiac disease”. Despite the fact that malaria is not a common disease in Denmark, Dr. Brainin continues that “Denmark has one of the strongest traditions for research in malaria in the world and several well-established malaria research groups”. 

Delivering healthcare to the Amazon jungle

The Malaria Heart Study is conducted in the Acre state of Brazil, an Amazonian region in the western part of Brazil, adjoining the Peruvian border. As of 2018, 70% of the population was living in rural areas with limited infrastructure. The region is not only one of the poorest regions in Brazil, but is also known for having one of the largest incidences of malaria in south America (1). Patients are not only examined in clinics in cities with existing infrastructure, but also in rural zone areas close to the Amazon forest. In these areas, the team reported that patients may walk for hours through the forest and sometimes even travel with boats to reach the local healthcare clinic. A majority of persons in the rural zone areas do not have access to the internet and live in high-risk malaria zones.


Even though basic healthcare is free in Brazil, the availability of medical services is very limited, especially in such remote areas. “What we see very often is that when we go to rural areas, these clinics only have a single doctor that is available every second week for an hour to two. There is little to no expertise available in cardiology”. As a result, it is very common that the participating patients have never seen cardiology monitors and electrodes before. “Actually, when we do our normal ECGs, in this study, we have experienced that some people are a little bit afraid, as if we’re about to shock them. After explaining about the equipment, they are more relaxed.” 


After all, the motivation of the team is not limited to research purposes. It is also very important to them to “give patients an opportunity that they would probably never have”. Next to collecting data for their study, they deliver specialised care along the way. “That was my motivation to try and offer Holter Monitors to people who need it, but most likely will never have the option because they live very deep in the forest”, said Dr. Brainin. 

Using the Cortrium C3⁺ Holter Monitor

The Cortrium C3⁺ Holter Monitor provides doctors and patients an easy, cablefree and lightweight procedure to conduct long-term ECG recordings (also called Holter recordings) and receive automated analysis reports. Throughout the study, three Cortrium C3+ Holter monitors are used to conduct a recording of two to three days per patient. “We had it on close to 40 people, and they all have a different story to tell” according to Dr. Brainin.

In the beginning of the study, the team had concerns that patients would “disappear into the jungle”, but “they were so trustworthy and trust so much in the benefit of the devices”. Moreover, the device has been reported to be very comfortable to wear by the patients and they could wear it effortlessly throughout their daily activities. One female patient wore the device for two days and as she came back, “she was completely covered in dust, because she had been working in a cassava field. The device had been on her chest for the entire time”. 


After analyzing 40 patients, two cases of ventricular tachycardia have been discovered so far. The patients have been referred to a local cardiologist in the city for further examination.

Moving forward, the researchers consider it a significant advantage that the C3⁺ Holter Monitors potentially enables a more established access to specialist healthcare. “Patients would not have to wait until maybe a family medical doctor or cardiologist comes by”. The researchers are convinced that the Cortrium C3⁺ Holter Monitor has the potential to be used by general practitioners, remotely assisted by cardiologists as in BRAHIT. Starting the final phase of their examination, the researchers want to “implement a structure where these monitors are applied by local healthcare clinics”. The ECG recordings are then analyzed using the integrated cloud-based solution of Cortrium to generate an automated, AI-supported Holter report that is subsequently sent to a specialist in Brazil and used as the basis for a diagnosis. 

The Malaria Heart Disease Study study is supported by the Danish Independent Research Foundation, AP Møllers Lægefond and the Danish Heart Association and the BRAHIT study is supported by the Danish Research Center, under the Danish Ministry of Foreign Affairs.

(1) Padilha, Meyrecler & Melo, Janille & Romano, Guilherme & Lima, Marcos & Alonso, Wladimir & Sallum, Maria & Laporta, Gabriel. (2019). Comparison of malaria incidence rates and socioeconomic-environmental factors between the states of Acre and Rondônia: a spatio-temporal modelling study. Malaria Journal. 18. 10.1186/s12936-019-2938-0.