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Papavasileiou LP, Forleo GB, Panattoni G, Schirripa V, Minni V, Magliano G, Bellos K, Santini L, Romeo F. Work burden with remote monitoring of implantable cardioverter defibrillator: is it time for reimbursement policies? J Cardiovasc Med (Hagerstown) 2013; 14:114-9. [PMID: 22644407 DOI: 10.2459/jcm.0b013e328354e3e1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The efficacy and accuracy, as well as patients' satisfaction, of device remote monitoring are well demonstrated. However, the workload of remote monitoring management has not been estimated and reimbursement schemes are currently unavailable in most European countries. This study evaluates the workload associated with remote monitoring systems. METHODS A total of 154 consecutive implantable cardioverter defibrillator patients (age 66±12 years; 86.5% men) with a remote monitoring system were enrolled. Data on the clinician's workload required for the management of the patients were analyzed. RESULTS A total of 1744 transmissions were received during a mean follow-up of 15.3±12.4 months. Median number of transmissions per patient was 11.3. There were 993 event-free transmissions, whereas 638 transmissions regarded one or more events (113 missed transmissions, 141 atrial events, 132 ventricular episodes, 299 heart failure-related transmissions, 14 transmissions regarding lead malfunction and 164 transmissions related to other events). In 402 cases telephonic contact was necessary, whereas in 68 cases an in-clinic visit was necessary and in 23 of them an in-clinic visit was prompted by the manufacturer due to technical issues of the transmitter. During follow-up, 316 work hours were required to manage the enrolled patients. Each month, a total of 14.9 h were spent on the remote monitoring of 154 patients (9.7 h for 100 patients monthly) with approximately 1.1±0.15 h per year for each patient. CONCLUSION The clinician's work burden is high in patients with remote monitoring. In order to expand remote monitoring in all patients, reimbursement policies should be considered.
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Affiliation(s)
- Lida P Papavasileiou
- Cardiology Department, University Hospital of Rome, Tor Vergata, Viale Oxford 81, Rome, Italy.
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Laleci G, Dogac A, Yuksel M, Kabak Y, Arbelo E, Danmayr F, Hinterbuchner L, Chronaki C, Eichelberg M, Lüpkes C. Personalized Remote Monitoring of the Atrial Fibrillation Patients with Electronic Implant Devices. JOURNAL OF HEALTHCARE ENGINEERING 2011. [DOI: 10.1260/2040-2295.2.2.183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Perings C, Bauer WR, Bondke HJ, Mewis C, James M, Böcker D, Broadhurst P, Korte T, Toft E, Hintringer F, Clémenty J, Schwab JO. Remote monitoring of implantable-cardioverter defibrillators: results from the Reliability of IEGM Online Interpretation (RIONI) study. Europace 2011; 13:221-9. [PMID: 21252195 DOI: 10.1093/europace/euq447] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Intracardiac electrograms (IEGMs) recorded by implantable cardioverter-defibrillators (ICDs) are essential for arrhythmia diagnosis and ICD therapy assessment. Short IEGM snapshots showing 3-10 s before arrhythmia detection were added to the Biotronik Home Monitoring system in 2005 as the first-generation IEGM Online. The RIONI study tested the primary hypothesis that experts' ratings regarding the appropriateness of ICD therapy based on IEGM Online and on standard 30 s IEGM differ in <10% of arrhythmia events. METHODS AND RESULTS A total of 619 ICD patients were enrolled and followed for 1 year. According to a predefined procedure, 210 events recorded by the ICDs were selected for evaluation. Three expert board members rated the appropriateness of ICD therapy and classified the underlying arrhythmia using coded IEGM Online and standard IEGM to avoid bias. The average duration of IEGM Online was 4.4±1.5 s. According to standard IEGM, the underlying arrhythmia was ventricular in 135 episodes (64.3%), supraventricular in 53 episodes (25.2%), oversensing in 17 episodes (8.1%), and uncertain in 5 episodes (2.4%). The expert board's rating diverged between determinable IEGM Online tracings and standard IEGM in 4.6% of episodes regarding the appropriateness of ICD therapy (95% CI up to 8.0%) and in 6.6% of episodes regarding arrhythmia classification (95% CI up to 10.5%). CONCLUSION By enabling accurate evaluation of the appropriateness of ICD therapy and the underlying arrhythmia, the first-generation IEGM Online provided a clinically effective basis for timely interventions and for optimized patient management schemes, which was comparable with current IEGM recordings.
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Affiliation(s)
- Christian Perings
- Department of Cardiology and Angiology, Marienhospital Herne, University of Bochum, Bochum, Germany.
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Reinsch N, Woydowski D, Schön H, Buddensiek M, Weissenberger W, Erbel R, Konorza T. [Home monitoring of an incessant VT in an ICD patient]. Herz 2010; 36:28-32. [PMID: 21181096 DOI: 10.1007/s00059-010-3411-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 11/11/2010] [Indexed: 11/28/2022]
Abstract
Due to the increasing number of patients and complexity of modern tachycardia devices, efficient therapy monitoring as offered by telemedicine monitoring is of increasing importance. The potential advantages of remote control for patient management include early detection of device-related technical problems and arrhythmias. We report the case of an ICD patient with incessant ventricular tachycardia in whom immediate arrhythmia transmission was monitored by remote control.
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Affiliation(s)
- N Reinsch
- Klinik für Kardiologie, Westdeutsches Herzzentrum Essen, Universitätsklinikum Essen, Hufelandstr. 55, 45122 Essen.
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Masella C, Zanaboni P, Di Stasi F, Gilardi S, Ponzi P, Valsecchi S. Assessment of a remote monitoring system for implantable cardioverter defibrillators. J Telemed Telecare 2008; 14:290-4. [PMID: 18776073 DOI: 10.1258/jtt.2008.080202] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We conducted a multicentre study in five Italian hospitals to assess the feasibility of a remote monitoring service for the follow-up of implanted cardiac devices. The system was designed to monitor device performance as well as physiological aspects of the patient's condition. Sixty-seven patients (mean age 64 years) affected by chronic heart failure and with a biventricular implantable cardioverter defibrillator for cardiac re-synchronization therapy (CRT-D) were enrolled for a three-month observation period. A total of 267 device recordings were transmitted through the ordinary telephone network, with a success rate of 99%. The telemonitoring service was more efficient than conventional face-to-face follow-up in terms of the time savings: both for physicians (4.7 minutes versus 15 minutes for remote and conventional monitoring) and for patients (6.6 minutes versus 116.3 minutes). In addition, a total of 23 clinical events occurred during the study, but only two cases required a clinic visit, thus reducing inappropriate hospital admissions. Finally, the service was well accepted by all the users.
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Affiliation(s)
- Cristina Masella
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
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Santini M, Ricci RP, Lunati M, Landolina M, Perego GB, Marzegalli M, Schirru M, Belvito C, Brambilla R, Guenzati G, Gilardi S, Valsecchi S. Remote monitoring of patients with biventricular defibrillators through the CareLink system improves clinical management of arrhythmias and heart failure episodes. J Interv Card Electrophysiol 2008; 24:53-61. [PMID: 18975066 DOI: 10.1007/s10840-008-9321-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 09/15/2008] [Indexed: 10/21/2022]
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Jung W, Rillig A, Birkemeyer R, Miljak T, Meyerfeldt U. Advances in remote monitoring of implantable pacemakers, cardioverter defibrillators and cardiac resynchronization therapy systems. J Interv Card Electrophysiol 2008; 23:73-85. [DOI: 10.1007/s10840-008-9311-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2008] [Accepted: 08/11/2008] [Indexed: 11/24/2022]
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Hauck M, Bauer A, Voss F, Weretka S, Katus HA, Becker R. "Home monitoring" for early detection of implantable cardioverter-defibrillator failure: a single-center prospective observational study. Clin Res Cardiol 2008; 98:19-24. [PMID: 18776998 DOI: 10.1007/s00392-008-0712-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Accepted: 08/08/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Telemedical ICD monitoring has the potential to enhance patient safety. The "home-monitoring" (HM) feature transmits selected device-related data to a service-center via mobile phone network. In case of a potential emergency situation, event reports are generated automatically. This prospective observational study was designed to test whether HM is effective and reliable in early detection of device failure. METHODS Consecutive patients receiving ICD, CRT-D or CRT pacemaker systems with HM feature were included. Regular follow-up visits were performed 1, 3, 6, 9 and 12 months after implantation in the first year, and every 6 months thereafter. All event reports transmitted by HM were analyzed and severe device-related events (serious lead or device dysfunction, hospitalization, death) were documented including timing, type and mode of detection. RESULTS Sixty-nine patients were included and followed for 18 +/- 9 months. A total of 206 event reports were transmitted, prompted by VF/VT-episodes (n = 193), ineffective ICD shocks (n = 7), abnormal pacing impedance (n = 4) or battery depletion (n = 2). 8 SAEs were observed (RV lead fracture; n = 5, connector defect; n = 1, sensing defect, n = 1, RV lead dislodgement, n = 1). There was no device-related death. 6 out of 8 SAEs were discovered by HM (sensitivity, 75%). Without HM, these events would have been detected with a theoretical delay of 1.9 +/- 0.5 months in the first year (3 monthly FU) and 4.9 +/- 0.5 months in the following years (6 monthly FU). CONCLUSIONS This pilot study demonstrates that HM enables early detection of ICD failure and appears to enhance patient safety.
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Affiliation(s)
- Melanie Hauck
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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Brugada P. What evidence do we have to replace in-hospital implantable cardioverter defibrillator follow-up? Clin Res Cardiol 2007; 95 Suppl 3:III3-9. [PMID: 16598602 DOI: 10.1007/s00392-006-1302-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Due to the increasing number of patients with an implantable cardioverter defibrillator (ICD), new options for ICD patient follow-up management are required. METHODS Patients with ICD indication according to the guidelines received an ICD with Home Monitoring technology. The devices enabled the transmission of the relevant episode, therapy, and system integrity data. Patients were followed for 12 months with routine controls every 3 months. The physician analyzed the Home Monitoring data before the routine follow-up visit (FU) and gave a forecast on the necessity of the pending FU, which was compared with the evaluation after the FU. Based on the derived forecast reliability, a patient management scheme was developed and its impact on patient safety was assessed retrospectively. RESULTS A total of 271 patients were enrolled (40 f, mean age 62+/-12 years, mean LVEF 39+/-15%, 65% ischemic heart disease, 20% cardiomyopathy) and followed for 339+/-109 days. Of 908 pairs of Home Monitoring data and FU data evaluation, 129 there were false negative results for 92 patients. Safety concerns from false negative forecasts can be minimized with a patient management scheme containing the following elements: 1) never skip the first routine FU; 2) never skip a routine FU for a patient having already shown pacing threshold problems; 3) perform FU following hospitalizations; 4) perform FU following episode detection by the ICD; and 5) perform a routine FU if the patient reports symptoms. The retrospective analysis showed, that if the patients had been managed using this scheme, 503 of 1079 routine FU could have been skipped with only one safety concern, a three month delay in the detection of silent paroxysmal atrial fibrillation in one patient. CONCLUSIONS Home Monitoring in ICD therapy over 12 months is feasible. The data transmitted relevantly contribute to a remarkable reduction of follow-up burden and enable the individualization of routine follow-up.
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Affiliation(s)
- P Brugada
- O. L. V. Hospital, Cardiovascular Center, Moorselbaan 164, 9300 Aalst, Belgium
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Toft E. Implantable electrocardiographic monitoring--clinical experiences. J Electrocardiol 2006; 39:S47-9. [PMID: 17015068 DOI: 10.1016/j.jelectrocard.2006.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Accepted: 05/17/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Egon Toft
- Department of Cardiology, Aalborg Hospital, Arhus University Hospitals, 9000 Aalborg, Denmark.
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MESH Headings
- Aged
- Bundle-Branch Block/complications
- Bundle-Branch Block/physiopathology
- Bundle-Branch Block/therapy
- Cardiac Pacing, Artificial
- Cardiomyopathy, Dilated/complications
- Cardiomyopathy, Dilated/physiopathology
- Cardiomyopathy, Dilated/therapy
- Defibrillators, Implantable/adverse effects
- Electrocardiography, Ambulatory
- Electrophysiologic Techniques, Cardiac
- Female
- Heart Conduction System/physiopathology
- Heart Conduction System/surgery
- Heart Failure/etiology
- Heart Failure/physiopathology
- Heart Failure/therapy
- Humans
- Male
- Middle Aged
- Sensitivity and Specificity
- Tachycardia, Ventricular/etiology
- Tachycardia, Ventricular/physiopathology
- Tachycardia, Ventricular/therapy
- Time Factors
- Ventricular Fibrillation/diagnosis
- Ventricular Fibrillation/etiology
- Ventricular Fibrillation/therapy
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Affiliation(s)
- Oliver Ritter
- Department of Medicine I, Cardiovascular Center, University of Wuerzburg, Josef Schneider Str. 2, 97080, Wuerzburg, Germany.
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Res JCJ, Theuns DAMJ, Jordaens L. The role of remote monitoring in the reduction of inappropriate implantable cardioverter defibrillator therapies. Clin Res Cardiol 2006; 95 Suppl 3:III17-21. [PMID: 16598599 DOI: 10.1007/s00392-006-1304-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Implantable cardioverter defibrillators (ICDs) with the integrated Home Monitoring feature use dedicated mobile phone and internet links to provide the physicians and technicians in the ICD clinic with the essential device- and arrhythmia-related data stored in the ICD diagnostic memory. Various counters, graphs and intracardiac electrograms are automatically transmitted via Home Monitoring each day to allow prompt, remote presentation of arrhythmias or detection of technical problems. One of the most inconvenient side-effects of the ICD therapy is inappropriate intervention of the device. Home Monitoring data can help the physician to identify and subsequently reduce the incidence of inappropriate ICD therapy.
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Affiliation(s)
- J C J Res
- Department of Electrophysiology, Erasmus Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands.
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Abstract
PURPOSE OF REVIEW The aim of this article is to forecast a major imminent change in the clinical practice of cardiac rhythm management, which is argued to be remote patient monitoring, its potential benefits to clinical practitioners and its barriers to widespread diffusion. RECENT FINDINGS All four major manufacturers of cardiac rhythm management devices have recently introduced varying types of systems that allow remote patient monitoring. These remote patient monitoring systems promise more efficient patient management in today's clinical setting of rapidly growing numbers of patients with increasingly heterogeneous etiology, varying indications and comorbidities. The major differences between current systems are related to the degree of patient involvement in remote patient monitoring and limits on patient mobility. Other important factors that influence the value of remote patient monitoring are the degree to which remote follow-up would completely fulfill the requirements of an in-office follow-up and the inclusion of sensors that enable the prediction of major clinical events such as heart failure decompensation with a high degree of accuracy. SUMMARY Even if the different remote patient monitoring systems currently available offer several clinical benefits such as early detection of cardiac events and complications, reduced follow-up costs and increased safety, the full potential of such systems requires the possibility to easily transfer relevant patient data to common patient databases that are linked to hospital information systems or electronic patient records. Only then will it be possible to gain a complete picture of patient conditions. This will require the development of common protocols for data communication and may involve issues of patient data ownership and integrity.
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