[Home Monitoring with implantable ICD--a diagnostic innovation?]

[Medical devices and patient safety from the clinicians' view]

In daily routine, clinically orientated physicians are confronted with various, often highly sophisticated medical devices. To ensure safe handling and usage, licensees and operators of those devices have to follow regulations and laws given by the German medical device legislation. For the clinician as an active user of the technology, basic knowledge of these regulations is essential. Quality-based health care focuses on the important issue of patient safety. Medical devices have made their way into virtually every sector of patient care. However, despite usage of these devices bearing substantial risk of adverse events, the problem of safe handling of sophisticated technology plays only a minor part in medical academic studies, medical specialist training, and manda nottory continuing education of physicians. The option of further education is needed to ensure patient safety and protect operators of medical devices.

Assessment of a remote monitoring system for implantable cardioverter defibrillators

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.