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Wilner B, Rickard J. Remote Monitoring of Permanent Pacemakers and Implantable Cardioverter Defibrillators. Card Electrophysiol Clin 2021; 13:449-457. [PMID: 34330372 DOI: 10.1016/j.ccep.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Remote monitoring of permanent pacemakers and implantable cardiac defibrillators has undergone considerable advances over the past several decades. Advancement of technology has created the ability for remote monitoring of implantable cardiac devices; a device can monitor its own function, record arrhythmias, and transmit data to health care providers without frequent in-office checks, shown to be as safe as in-office interrogation. Remote monitoring allows earlier detection of clinically actionable events, reduces incidence of inappropriate shocks, and allows earlier detection of atrial fibrillation. App-based remote monitoring provides patients with rapid access to their cardiac data, which may improve compliance with remote monitoring.
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Affiliation(s)
- Bryan Wilner
- Department of Cardiovascular Medicine, Section of Cardiac Electrophysiology, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue/J2-2, Cleveland, OH 44195, USA
| | - John Rickard
- Department of Cardiovascular Medicine, Section of Cardiac Electrophysiology, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue/J2-2, Cleveland, OH 44195, USA.
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Calò L, Bianchi V, Ferraioli D, Santini L, Dello Russo A, Carriere C, Santobuono VE, Andreoli C, La Greca C, Arena G, Talarico A, Pisanò E, Santoro A, Giammaria M, Ziacchi M, Viscusi M, De Ruvo E, Campari M, Valsecchi S, D'Onofrio A. Multiparametric Implantable Cardioverter-Defibrillator Algorithm for Heart Failure Risk Stratification and Management: An Analysis in Clinical Practice. Circ Heart Fail 2021; 14:e008134. [PMID: 34190592 PMCID: PMC8522625 DOI: 10.1161/circheartfailure.120.008134] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The HeartLogic algorithm combines multiple implantable cardioverter-defibrillator sensors to identify patients at risk of heart failure (HF) events. We sought to evaluate the risk stratification ability of this algorithm in clinical practice. We also analyzed the alert management strategies adopted in the study group and their association with the occurrence of HF events. METHODS The HeartLogic feature was activated in 366 implantable cardioverter-defibrillator and cardiac resynchronization therapy implantable cardioverter-defibrillator patients at 22 centers. The median follow-up was 11 months [25th-75th percentile: 6-16]. The HeartLogic algorithm calculates a daily HF index and identifies periods IN alert state on the basis of a configurable threshold. RESULTS The HeartLogic index crossed the threshold value 273 times (0.76 alerts/patient-year) in 150 patients. The time IN alert state was 11% of the total observation period. Patients experienced 36 HF hospitalizations, and 8 patients died of HF during the observation period. Thirty-five events were associated with the IN alert state (0.92 events/patient-year versus 0.03 events/patient-year in the OUT of alert state). The hazard ratio in the IN/OUT of alert state comparison was (hazard ratio, 24.53 [95% CI, 8.55-70.38], P<0.001), after adjustment for baseline clinical confounders. Alerts followed by clinical actions were associated with less HF events (hazard ratio, 0.37 [95% CI, 0.14-0.99], P=0.047). No differences in event rates were observed between in-office and remote alert management. CONCLUSIONS This multiparametric algorithm identifies patients during periods of significantly increased risk of HF events. The rate of HF events seemed lower when clinical actions were undertaken in response to alerts. Extra in-office visits did not seem to be required to effectively manage HeartLogic alerts. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02275637.
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Affiliation(s)
- Leonardo Calò
- Cardiology Department, Policlinico Casilino, Rome, Italy (L.C., E.D.R.)
| | - Valter Bianchi
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie," Monaldi Hospital, Naples, Italy (V.B., A.D.)
| | - Donatella Ferraioli
- Cardiology Department, OO.RR. San Giovanni di Dio Ruggi d'Aragona, Salerno, Italy (D.F.)
| | - Luca Santini
- Cardiology Department, "Giovan Battista Grassi" Hospital, Rome, Italy (L.S.)
| | - Antonio Dello Russo
- Clinica di Cardiologia e Aritmologia, Università Politecnica delle Marche, "Ospedali Riuniti," Ancona, Italy (A.D.R.)
| | - Cosimo Carriere
- Cardiology Department, Azienda Ospedaliera Universitaria Ospedali Riuniti di Trieste - Cattinara, Trieste, Italy (C.C.)
| | | | - Chiara Andreoli
- Cardiology Department, S. Giovanni Battista Hospital, Foligno, Italy (C.A.)
| | - Carmelo La Greca
- Cardiology Department, Fondazione Poliambulanza, Brescia, Italy (C.L.G.)
| | - Giuseppe Arena
- Cardiology Department, Ospedale Civile Apuane, Massa, Italy (G.A.)
| | | | - Ennio Pisanò
- Cardiology Department, Vito Fazzi Hospital, Lecce, Italy (E.P.)
| | - Amato Santoro
- Cardiology Department, Azienda Ospedaliera Universitaria Senese, Policlinico Santa Maria alle Scotte, Siena, Italy (A.S.)
| | - Massimo Giammaria
- Division of Cardiology, Maria Vittoria Hospital, Turin, Italy (M.G.)
| | - Matteo Ziacchi
- Institute of Cardiology, University of Bologna, S.Orsola-Malpighi University Hospital, Italy (M.Z.)
| | - Miguel Viscusi
- Cardiology Department, S. Anna e S. Sebastiano Hospital, Caserta, Italy (M.V.)
| | | | - Monica Campari
- Rhythm Management Department, Boston Scientific Italia, Milan, Italy (M.C., S.V.)
| | - Sergio Valsecchi
- Rhythm Management Department, Boston Scientific Italia, Milan, Italy (M.C., S.V.)
| | - Antonio D'Onofrio
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie," Monaldi Hospital, Naples, Italy (V.B., A.D.)
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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Adlung L, Cohen Y, Mor U, Elinav E. Machine learning in clinical decision making. MED 2021; 2:642-665. [DOI: 10.1016/j.medj.2021.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/22/2021] [Accepted: 04/06/2021] [Indexed: 12/24/2022]
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Seiler A, Biundo E, Di Bacco M, Rosemas S, Nicolle E, Lanctin D, Hennion J, de Melis M, Van Heel L. Clinic Time Required for Remote and In-person Management of Cardiac Device Patients: Time and Motion Workflow Evaluation. JMIR Cardio 2021; 5:e27720. [PMID: 34156344 PMCID: PMC8556635 DOI: 10.2196/27720] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/02/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The number of patients with cardiac implantable electronic devices (CIEDs) is growing, creating substantial workload for device clinics. OBJECTIVE This study aimed to characterize the workflow and quantify clinic staff time requirements to manage CIED patients. METHODS A time and motion workflow evaluation was performed in 11 US and European CIED clinics. Workflow tasks were repeatedly timed during one business week of observation at each clinic. Observations were inclusive of all device models/manufacturers present. Mean cumulative staff time required to review a Remote device transmission and for an In-person clinic visit were calculated, including all necessary clinical and administrative tasks. Annual staff time for follow-up of 1 CIED patient was modeled using CIED transmission volumes, clinical guidelines, and published literature. RESULTS A total of 276 in-person clinic visits and 2,173 remote monitoring activities were observed. Mean staff time required per remote transmission ranged from 9.4-13.5 minutes for therapeutic devices (pacemaker, ICD, CRT) and 11.3-12.9 mins for diagnostic devices (insertable cardiac monitors (ICMs)). Mean staff time per in-person visit ranged from 37.8-51.0 mins and 39.9-45.8 mins, for therapeutic devices and ICMs respectively. Including all remote and in-person follow-ups, the estimated annual time to manage one CIED patient ranged from 1.6-2.4 hours for therapeutic devices and 7.7-9.3 hours for ICMs. CONCLUSIONS CIED patient management workflow is complex and requires significant staff time. Understanding process steps and time requirements informs implementation of efficiency improvements, including remote solutions. Future research should examine the heterogeneity in patient management processes to identify the most efficient workflows. CLINICALTRIAL
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56
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Theuns DAMJ, Radhoe SP, Brugts JJ. Remote Monitoring of Heart Failure in Patients with Implantable Cardioverter-Defibrillators: Current Status and Future Needs. SENSORS 2021; 21:s21113763. [PMID: 34071624 PMCID: PMC8198327 DOI: 10.3390/s21113763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 12/20/2022]
Abstract
The management of heart failure remains challenging despite evidence-based medical and pharmacological advances, especially in the ambulatory setting. There is an urgent need to develop strategies to reduce hospitalizations and readmission rates due to heart failure. Frequent monitoring of high-risk patients is imperative, and with the development of wireless and remote technology, frequent monitoring is now possible via remote monitoring. Nowadays, remote management of patients with cardiac implantable electronic devices is being increasingly adopted and integrated into clinical practice. Several clinical trials studied the impact of remote monitoring on clinical outcomes in patients with implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization defibrillators (CRT-Ds). This point of view will focus on the remote monitoring of ICDs and CRT-Ds in patients with heart failure and discusses whether remote monitoring can be used as a potential instrument for the early identification of patients at risk of worsening heart failure.
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57
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Maines M, Tomasi G, Moggio P, Poian L, Peruzza F, Catanzariti D, Angheben C, Cont N, Valsecchi S, Del Greco M. Scheduled versus alert transmissions for remote follow-up of cardiac implantable electronic devices: Clinical relevance and resource consumption. Int J Cardiol 2021; 334:49-54. [PMID: 33930512 DOI: 10.1016/j.ijcard.2021.04.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/01/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The remote follow-up of pacemakers and implantable cardiac defibrillators (ICDs) usually includes scheduled checks and alert transmissions. However, this results in a high volume of remote data reviews to be managed. We measured the relative contribution of scheduled and alert transmissions to the detection of relevant conditions, and the workload generated by their management. METHODS At our center, the frequency of remote scheduled transmissions is 4/year. Moreover, all system-integrity and clinical alerts are turned on for wireless notification. We calculated the number of transmissions received from January to December 2020, and identified transmissions that necessitated in-hospital access for further assessment and transmissions that required clinical discussion with the physician. For all alert transmissions, we identified whether the alert was clinically meaningful (i.e. center was not previously aware of the condition and no action had yet been taken to treat it). RESULTS Of 8545 transmissions received from 1697 pacemakers and ICDs, 5766 (67%) were scheduled and 2779 (33%) were alert transmissions received from 764 patients (45%); 499 (9%) scheduled transmissions required clinical discussion with the physician, but only 2 of these necessitated in-hospital visits for further assessment. Of the alert transmissions, 664 (24%) required clinical discussion, and 75 (3%) necessitated in-hospital visits. The proportion of alerts judged clinically meaningful was 7%. CONCLUSION Scheduled transmissions generate 67% of remote data reviews for pacemakers and ICDs, but their ability to detect clinically relevant events is very low. A strategy that relies exclusively on alert transmissions could ensure continuity of patient monitoring while reducing the workload at the center.
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Affiliation(s)
| | | | - Paolo Moggio
- Santa Maria del Carmine Hospital, Rovereto, TN, Italy
| | - Luisa Poian
- Santa Maria del Carmine Hospital, Rovereto, TN, Italy
| | | | | | | | - Natascia Cont
- Santa Maria del Carmine Hospital, Rovereto, TN, Italy
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Matteucci A, Bonanni M, Centioni M, Zanin F, Geuna F, Massaro G, Sangiorgi G. Home Management of Heart Failure and Arrhythmias in Patients with Cardiac Devices during Pandemic. J Clin Med 2021; 10:jcm10081618. [PMID: 33920350 PMCID: PMC8069073 DOI: 10.3390/jcm10081618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 12/22/2022] Open
Abstract
Background: The in-hospital management of patients with cardiac implantable electronic devices (CIEDs) changed early in the COVID-19 pandemic. Routine in-hospital controls of CIEDs were converted into remote home monitoring (HM). The aim of our study was to investigate the impact of the lockdown period on CIEDs patients and its influence on in-hospital admissions through the analysis of HM data. Methods: We analysed data recorded from 312 patients with HM during the national quarantine related to COVID-19 and then compared data from the same period of 2019. Results: We observed a reduction in the number of HM events in 2020 when compared to 2019. Non-sustained ventricular tachycardia episodes decreased (18.3% vs. 9.9% p = 0.002) as well as atrial fibrillation episodes (29.2% vs. 22.4% p = 0.019). In contrast, heart failure (HF) alarm activation was lower in 2019 than in 2020 (17% vs. 25.3% p = 0.012). Hospital admissions for critical events recorded with CIEDs dropped in 2020, including those for HF. Conclusions: HM, combined with telemedicine use, has ensured the surveillance of CIED patients. In 2020, arrhythmic events and hospital admissions decreased significantly compared to 2019. Moreover, in 2020, patients with HF arrived in hospital in a worse clinical condition compared to previous months.
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Affiliation(s)
- Andrea Matteucci
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.B.); (M.C.); (F.Z.); (F.G.)
- Correspondence: ; Tel.: +39-06-2090-4044
| | - Michela Bonanni
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.B.); (M.C.); (F.Z.); (F.G.)
| | - Marco Centioni
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.B.); (M.C.); (F.Z.); (F.G.)
| | - Federico Zanin
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.B.); (M.C.); (F.Z.); (F.G.)
| | - Francesco Geuna
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.B.); (M.C.); (F.Z.); (F.G.)
| | - Gianluca Massaro
- Division of Cardiology, University Hospital “Tor Vergata”, 00133 Rome, Italy;
| | - Giuseppe Sangiorgi
- Department of Biomedicine and Prevention, Tor Vergata University, 00133 Rome, Italy;
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Zhang X, Ai J, Zou R, Su B. Compressible and Stretchable Magnetoelectric Sensors Based on Liquid Metals for Highly Sensitive, Self-Powered Respiratory Monitoring. ACS APPLIED MATERIALS & INTERFACES 2021; 13:15727-15737. [PMID: 33779131 DOI: 10.1021/acsami.1c04457] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Healthcare monitoring, especially for respiration, has attracted tremendous attention from academics considering the great significance of health information feedback. The respiratory rate, as a critical health indicator, has been used to screen and evaluate potential illness risks in early medical diagnoses. A self-powered sensing system for medical monitoring is critical and imperative due to needless battery replacement and simple assembly. However, the development of a self-powered respiratory sensor with highly sensitive performance is still a daunting challenge. In this work, a compressible and stretchable magnetoelectric sensor (CSMS) with an arch-shaped air gap is reported, enabling self-powered respiratory monitoring driven by exhaled/inhaled breath. The CSMS contains two key functional materials: liquid metals and magnetic powders both with low Young's modulus, allowing for sensing compressibility and stretchability simultaneously. More importantly, such a magnetoelectric sensor exhibits mechanoelectrical converting capacity under an external force, which has been verified by Maxwell numerical simulation. Owing to the air-layer introduction, the magnetoelectric sensors achieve high sensitivity (up to 17.73 kPa-1), fast response, and long-term stability. The highly sensitive and self-powered magnetoelectric sensor can be further applied as a noninvasive, miniaturized, and portable respiratory monitoring system with the aim of warning for potential health risks. We anticipate that this technique will create an avenue for self-powered respiratory monitoring fields.
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Affiliation(s)
- Xuan Zhang
- State Key Laboratory of Material Processing and Die & Mould Technology, School of Materials Science and Engineering, Huazhong University of Science and Technology, Wuhan 430074, Hubei, P. R. China
- ARC Hub for Computational Particle Technology, Department of Chemical Engineering, Monash University, Clayton, Victoria 3800, Australia
| | - Jingwei Ai
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, School of Electrical and Electronic Engineering, Huazhong University of Science and Technology, Wuhan 430074, Hubei, P. R. China
| | - Ruiping Zou
- ARC Hub for Computational Particle Technology, Department of Chemical Engineering, Monash University, Clayton, Victoria 3800, Australia
| | - Bin Su
- State Key Laboratory of Material Processing and Die & Mould Technology, School of Materials Science and Engineering, Huazhong University of Science and Technology, Wuhan 430074, Hubei, P. R. China
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Alotaibi S, Hernandez-Montfort J, Ali OE, El-Chilali K, Perez BA. Remote monitoring of implantable cardiac devices in heart failure patients: a systematic review and meta-analysis of randomized controlled trials. Heart Fail Rev 2021; 25:469-479. [PMID: 32002732 DOI: 10.1007/s10741-020-09923-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study aims to determine whether the use of remote monitoring (RM) in implantable cardiac devices decreases all-cause mortality and heart failure (HF)-related hospitalization. We sought to conduct a systematic review and a meta-analysis of published randomized controlled studies. The population is adult patients with a diagnosis of HF with implantable devices. The intervention is RM using implantable cardiac devices whether added or used alone compared to standard of care. The outcomes are HF-related hospitalization and all-cause mortality. Risk of bias was assessed using the criteria defined in the Revised Cochrane Collaboration's tool for assessment of risk of bias. Data were extracted and validity was assessed independently by two reviewers. Electronic databases EMBASE and MEDLINE (Ovid) were searched up to 14th of October 2019, supplemented by a second search in CENTRAL (Cochrane Central Register of Controlled Trials) and clinicaltrials.gov. Only randomized controlled studies published in peer-reviewed journals with full format text in English of adult HF patients with a minimum follow-up of 6 months reporting mortality and/or hospitalization. Observational studies and studies that did not meet inclusion criteria were excluded. Thirteen randomized controlled studies that enrolled a total of 7015 patients were identified, 7 of which reported on all-cause mortality only and included 4460 patients. Compared with standard of care, the pooled relative risk (RR) of all-cause mortality and HF-related hospitalization in patients with RM compared to those receiving standard of care was 0.88 (95% confidence interval (CI) 0.69 to 1.11) and 0.95 (95% CI 0.78-1.16), respectively. In the subgroup analysis, using pulmonary pressure for RM was associated with a decrease in HF-related hospitalization (RR 0.73; 95% CI 0.60-0.88). RM showed benefit in reducing HF-related hospitalization when compared to standard of care only when using pulmonary pressure monitoring.
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Affiliation(s)
- Sultan Alotaibi
- Cardiac Center, King Fahad Armed Forces Hospital, Jeddah, 23311, Saudi Arabia.,Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Jaime Hernandez-Montfort
- Department of Health Policy, London School of Economics and Political Science, London, UK.,Cleveland Clinic Florida, Weston, FL, USA
| | - Omar E Ali
- Department of Health Policy, London School of Economics and Political Science, London, UK.,School of Medicine, Wayne State University, Detroit, MI, 48202, USA.,Medical Director of Cardiac Catheterization Laboratory, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Karim El-Chilali
- Department of Cardiovascular and Pulmonary Medicine, Prosper Hospital, Recklinghausen, Germany
| | - Bernardo A Perez
- Department of Health Policy, London School of Economics and Political Science, London, UK. .,Wellian Inc., 2060 Broadway B1, Boulder, CO, 80302, USA.
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Taylor ML, Thomas EE, Snoswell CL, Smith AC, Caffery LJ. Does remote patient monitoring reduce acute care use? A systematic review. BMJ Open 2021; 11:e040232. [PMID: 33653740 PMCID: PMC7929874 DOI: 10.1136/bmjopen-2020-040232] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 02/01/2021] [Accepted: 02/10/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Chronic diseases are associated with increased unplanned acute hospital use. Remote patient monitoring (RPM) can detect disease exacerbations and facilitate proactive management, possibly reducing expensive acute hospital usage. Current evidence examining RPM and acute care use mainly involves heart failure and omits automated invasive monitoring. This study aimed to determine if RPM reduces acute hospital use. METHODS A systematic literature review of PubMed, Embase and CINAHL electronic databases was undertaken in July 2019 and updated in October 2020 for studies published from January 2015 to October 2020 reporting RPM and effect on hospitalisations, length of stay or emergency department presentations. All populations and disease conditions were included. Two independent reviewers screened articles. Quality analysis was performed using the Joanna Briggs Institute checklist. Findings were stratified by outcome variable. Subgroup analysis was undertaken on disease condition and RPM technology. RESULTS From 2050 identified records, 91 studies were included. Studies were medium-to-high quality. RPM for all disease conditions was reported to reduce admissions, length of stay and emergency department presentations in 49% (n=44/90), 49% (n=23/47) and 41% (n=13/32) of studies reporting each measure, respectively. Remaining studies largely reported no change. Four studies reported RPM increased acute care use. RPM of chronic obstructive pulmonary disease (COPD) was more effective at reducing emergency presentation than RPM of other disease conditions. Similarly, invasive monitoring of cardiovascular disease was more effective at reducing hospital admissions versus other disease conditions and non-invasive monitoring. CONCLUSION RPM can reduce acute care use for patients with cardiovascular disease and COPD. However, effectiveness varies within and between populations. RPM's effect on other conditions is inconclusive due to limited studies. Further analysis is required to understand underlying mechanisms causing variation in RPM interventions. These findings should be considered alongside other benefits of RPM, including increased quality of life for patients. PROSPERO REGISTRATION NUMBER CRD42020142523.
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Affiliation(s)
- Monica L Taylor
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Emma E Thomas
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Centaine L Snoswell
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Anthony C Smith
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Liam J Caffery
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
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Perego GB, Brasca FM. Remote monitoring of implantable devices: do we need more evidence? J Cardiovasc Med (Hagerstown) 2021; 22:172-174. [PMID: 33278209 DOI: 10.2459/jcm.0000000000001137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Giovanni B Perego
- Istituto Auxologico Italiano - Ospedale San Luca, Piazzale Brescia, Milan, Italy
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63
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Briasoulis A, Alvarez P. Is Ambulatory Hemodynamic Monitoring Beneficial to Patients With Advanced Heart Failure? J Am Heart Assoc 2021; 10:e020817. [PMID: 33626878 PMCID: PMC8174288 DOI: 10.1161/jaha.121.020817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alexandros Briasoulis
- National Kapodistrian University of Athens Medical School Athens Greece.,Section of Heart Failure and Transplant Division of Cardiovascular Diseases University of Iowa Hospitals and Clinics Iowa City IA
| | - Paulino Alvarez
- Department of Cardiovascular Medicine Cleveland Clinic Cleveland OH
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Guédon-Moreau L, Finat L, Klein C, Kouakam C, Marquié C, Klug D, Potelle C, Ninni S, Brigadeau F, Mirabel X, Lacroix D. Usefulness of remote monitoring for the early detection of back-up mode in implantable cardioverter defibrillators. Arch Cardiovasc Dis 2021; 114:287-292. [PMID: 33526375 DOI: 10.1016/j.acvd.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/07/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Reversion of an implantable cardioverter defibrillator (ICD) to back-up mode degrades the operating capabilities of the device, puts patients at risk and requires rapid intervention by a manufacturer's technician. AIM To illustrate the usefulness of remote monitoring of ICDs for the early detection of reversion to back-up mode. METHODS In our centre, all patients implanted with an ICD, with or without resynchronisation, were offered remote monitoring as soon as the technology became available. Alerts triggered by the remote monitoring system were included prospectively in a register. During a mean follow-up of 5.7±1.3 years, a total of 1594 patients with an ICD (441 with resynchronisation function) followed with remote monitoring were included in the register. RESULTS Among 15,874 alerts, only 10 were related to a reversion to back-up mode. Among those, seven reversions were caused by radiotherapy, two were fake events and one was caused by magnetic resonance imaging. Except for the two fake events, the eight other patients had an emergency admission for the resetting and reprogramming of their ICD. None of the reversion to back-up mode alerts was followed by a clinical alert (i.e. a shock alert) before the ICD problem was resolved. CONCLUSIONS Reversion to back-up mode is a very rare event, accounting for 0.06% of total alerts; remote monitoring facilitates the early detection of this critical event to resolve the problem faster than the next scheduled follow-up. Remote monitoring can prevent serious damage to the patient and avoids systematic ambulatory control of the ICD after each radiotherapy session.
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Affiliation(s)
- Laurence Guédon-Moreau
- Department of cardiovascular medicine, heart & lung institute, Lille university hospital, 59037 Lille, France; Faculty of medicine, Lille university, 59045 Lille, France.
| | - Loïc Finat
- Department of cardiovascular medicine, heart & lung institute, Lille university hospital, 59037 Lille, France
| | - Cédric Klein
- Department of cardiovascular medicine, heart & lung institute, Lille university hospital, 59037 Lille, France
| | - Claude Kouakam
- Department of cardiovascular medicine, heart & lung institute, Lille university hospital, 59037 Lille, France; Centre Oscar-Lambret, Cancer centre, 59000 Lille, France
| | - Christelle Marquié
- Department of cardiovascular medicine, heart & lung institute, Lille university hospital, 59037 Lille, France
| | - Didier Klug
- Department of cardiovascular medicine, heart & lung institute, Lille university hospital, 59037 Lille, France; Faculty of medicine, Lille university, 59045 Lille, France
| | - Charlotte Potelle
- Department of cardiovascular medicine, heart & lung institute, Lille university hospital, 59037 Lille, France
| | - Sandro Ninni
- Department of cardiovascular medicine, heart & lung institute, Lille university hospital, 59037 Lille, France; Faculty of medicine, Lille university, 59045 Lille, France
| | - François Brigadeau
- Department of cardiovascular medicine, heart & lung institute, Lille university hospital, 59037 Lille, France
| | - Xavier Mirabel
- Centre Oscar-Lambret, Cancer centre, 59000 Lille, France
| | - Dominique Lacroix
- Department of cardiovascular medicine, heart & lung institute, Lille university hospital, 59037 Lille, France; Faculty of medicine, Lille university, 59045 Lille, France
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Abstract
PURPOSE OF REVIEW Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is recommended as part of the individualized multidisciplinary follow-up of heart failure (HF) patients. Aim of this article is to critically review recent findings on RM, highlighting potential benefits and barriers to its implementation. RECENT FINDINGS Device-based RM is useful in the early detection of CIEDs technical issues and cardiac arrhythmias. Moreover, RM allows the continuous monitoring of several patients' clinical parameters associated with impending HF decompensation, but there is still uncertainty regarding its effectiveness in reducing mortality and hospitalizations. Implementation of RM strategies, together with a proactive physicians' attitude towards clinical actions in response to RM data reception, will make RM a more valuable tool, potentially leading to better outcomes.
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66
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Versteeg H, Timmermans I, Widdershoven J, Kimman GJ, Prevot S, Rauwolf T, Scholten MF, Zitron E, Mabo P, Denollet J, Pedersen SS, Meine M. Effect of remote monitoring on patient-reported outcomes in European heart failure patients with an implantable cardioverter-defibrillator: primary results of the REMOTE-CIED randomized trial. Europace 2020; 21:1360-1368. [PMID: 31168604 DOI: 10.1093/europace/euz140] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 04/24/2019] [Indexed: 01/26/2023] Open
Abstract
AIMS The European REMOTE-CIED study is the first randomized trial primarily designed to evaluate the effect of remote patient monitoring (RPM) on patient-reported outcomes in the first 2 years after implantation of an implantable cardioverter-defibrillator (ICD). METHODS AND RESULTS The sample consisted of 595 European heart failure patients implanted with an ICD compatible with the Boston Scientific LATITUDE® RPM system. Patients were randomized to RPM plus a yearly in-clinic ICD check-up vs. 3-6-month in-clinic check-ups alone. At five points during the 2-year follow-up, patients completed questionnaires including the Kansas City Cardiomyopathy Questionnaire and Florida Patient Acceptance Survey (FPAS) to assess their heart failure-specific health status and ICD acceptance, respectively. Information on clinical status was obtained from patients' medical records. Linear regression models were used to compare scores between groups over time. Intention-to-treat and per-protocol analyses showed no significant group differences in patients' health status and ICD acceptance (subscale) scores (all Ps > 0.05). Exploratory subgroup analyses indicated a temporary improvement in device acceptance (FPAS total score) at 6-month follow-up for secondary prophylactic in-clinic patients only (P < 0.001). No other significant subgroup differences were observed. CONCLUSION Large clinical trials have indicated that RPM can safely and effectively replace most in-clinic check-ups of ICD patients. The REMOTE-CIED trial results show that patient-reported health status and ICD acceptance do not differ between patients on RPM and patients receiving in-clinic check-ups alone in the first 2 years after ICD implantation.ClinicalTrials.gov Identifier: NCT01691586.
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Affiliation(s)
- Henneke Versteeg
- Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, GA Utrecht, Utrecht, The Netherlands
| | - Ivy Timmermans
- Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, GA Utrecht, Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - Jos Widdershoven
- Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.,Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Geert-Jan Kimman
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Sébastien Prevot
- Department of Cardiology, Hôpital Privé Clairval, Marseille, France
| | - Thomas Rauwolf
- Department of Cardiology and Angiology, Otto von Guericke University, Magdeburg, Germany
| | - Marcoen F Scholten
- Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Edgar Zitron
- Department of Cardiology, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Philippe Mabo
- Department of Cardiology, Centre Hospitalier Universitaire, Rennes, France
| | - Johan Denollet
- Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.,Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Mathias Meine
- Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, GA Utrecht, Utrecht, The Netherlands
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O'Shea CJ, Middeldorp ME, Hendriks JM, Brooks AG, Lau DH, Emami M, Mishima R, Thiyagarajah A, Feigofsky S, Gopinathannair R, Varma N, Campbell K, Sanders P. Remote Monitoring Alert Burden: An Analysis of Transmission in >26,000 Patients. JACC Clin Electrophysiol 2020; 7:226-234. [PMID: 33602404 DOI: 10.1016/j.jacep.2020.08.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/14/2020] [Accepted: 08/16/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study sought to determine the remote monitoring (RM) alert burden in a multicenter cohort of patients with a cardiac implantable electronic device (CIED). BACKGROUND RM of CIEDs allows timely recognition of patient and device events requiring intervention. Most RM involves burdensome manual workflow occurring exclusively on weekdays during office hours. Automated software may reduce such a burden, streamlining real-time alert responses. METHODS We retrospectively analyzed 26,713 consecutive patients with a CIED undergoing managed RM utilizing PaceMate software between November 2018 and November 2019. Alerts were analyzed according to type, acuity (red indicates urgent, and yellow indicates nonurgent) and CIED category. RESULTS In total, 12,473 (46.7%) patients had a permanent pacemaker (PPM), 9,208 (34.5%) had an implantable cardioverter-defibrillator (ICD), and 5,032 (18.8%) had an implantable loop recorder (ILR). Overall, 82,797 of the 205,804 RM transmissions were alerts, with the remainder being scheduled transmissions. A total of 14,638 (54.8%) patients transmitted at least 1 alert. Permanent pacemakers were responsible for 25,700 (31.0%) alerts, ICDs for 15,643 (18.9%) alerts, and ILRs for 41,454 (50.1%) alerts, with 3,935 (4.8%) red alerts and 78,862 (95.2%) yellow alerts. ICDs transmitted 2,073 (52.7%) red alerts; 5,024 (32.1%) ICD alerts were for ventricular tachyarrhythmias and antitachycardia pacing/shock delivery. CONCLUSIONS In an RM cohort of 26,713 patients with CIEDs, 54.8% of patients transmitted at least 1 alert during a 12-month period, totaling over 82,000 alerts. ILRs were overrepresented, and ICDs were underrepresented, in these alerts. The enormity of the number of transmissions and the growing ILR alert burden highlight the need for new management pathways for RM.
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Affiliation(s)
- Catherine J O'Shea
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Melissa E Middeldorp
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Jeroen M Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia; College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Anthony G Brooks
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Mehrdad Emami
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Ricardo Mishima
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Anand Thiyagarajah
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Niraj Varma
- Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kevin Campbell
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA; Pacemate, Bradenton, Florida, USA
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia.
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Pluta S, Piotrowicz E, Piotrowicz R, Lewicka E, Zaręba W, Kozieł M, Kowalik I, Pencina MJ, Oręziak A, Cacko A, Szalewska D, Główczyńska R, Banach M, Opolski G, Orzechowski P, Irzmański R, Kalarus Z. Remote Monitoring of Cardiac Implantable Electronic Devices in Patients Undergoing Hybrid Comprehensive Telerehabilitation in Comparison to the Usual Care. Subanalysis from Telerehabilitation in Heart Failure Patients (TELEREH-HF) Randomised Clinical Trial. J Clin Med 2020; 9:E3729. [PMID: 33233613 PMCID: PMC7699808 DOI: 10.3390/jcm9113729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The impact of cardiac rehabilitation on the number of alerts in patients with remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is unknown. We compared alerts in RM and outcomes in patients with CIEDs undergoing hybrid comprehensive telerehabilitation (HCTR) versus usual care (UC). METHODS Patients with heart failure (HF) after a hospitalization due to worsening HF within the last 6 months (New York Heart Association (NYHA) class I-III and left ventricular ejection fraction (LVEF) ≤40%) were enrolled in the TELEREH-HF study and randomised 1:1 to HCTR or UC. Patients with HCTR and CIEDs received RM (HCTR-RM). Patients with UC and CIEDs were offered RM optionally (UC-RM). Data from the initial 9 weeks of the study were analysed. RESULTS Of 850 enrolled patients, 208 were in the HCTR-RM group and 62 in the UC-RM group. The HCTR-RM group was less likely to have alerts of intrathoracic impedance (TI) decrease (p < 0.001), atrial fibrillation (AF) occurrence (p = 0.031) and lower mean number of alerts per patient associated with TI decrease (p < 0.0001) and AF (p = 0.019) than the UC-RM group. HCTR significantly decreased the occurrence of alerts in RM of CIEDs, 0.360 (95%CI, 0.189-0.686; p = 0.002), in multivariable regression analysis. There were two deaths in the HCTR-RM group (0.96%) and no deaths in the UC-RM group (p = 1.0). There were no differences in the number of hospitalised patients between the HCTR-RM and UC-RM group (p = 1.0). CONCLUSIONS HCTR significantly reduced the number of patients with RM alerts of CIEDs related to TI decrease and AF occurrence. There were no differences in mortality or hospitalisation rates between HCTR-RM and UC-RM groups.
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Affiliation(s)
- Sławomir Pluta
- Department of Cardiology and Angiology, Silesian Centre for Heart Disease, 41-800 Zabrze, Poland; (S.P.); (M.K.)
| | - Ewa Piotrowicz
- Telecardiology Center, National Institute of Cardiology, 04-628 Warsaw, Poland;
| | - Ryszard Piotrowicz
- National Institute of Cardiology, 04-628 Warsaw, Poland; (R.P.); (I.K.)
- Warsaw Academy of Medicine Rehabilitation, 02-091 Warsaw, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, 80-211 Gdańsk, Poland;
| | - Wojciech Zaręba
- Department of Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA;
| | - Monika Kozieł
- Department of Cardiology and Angiology, Silesian Centre for Heart Disease, 41-800 Zabrze, Poland; (S.P.); (M.K.)
| | - Ilona Kowalik
- National Institute of Cardiology, 04-628 Warsaw, Poland; (R.P.); (I.K.)
| | - Michael J. Pencina
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27707, USA;
| | - Artur Oręziak
- Department of Arrhythmia, National Institute of Cardiology, 04-628 Warsaw, Poland;
| | - Andrzej Cacko
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Dominika Szalewska
- Rehabilitation Medicine, Medical University of Gdańsk, 80-211 Gdańsk, Poland;
| | - Renata Główczyńska
- Department of Cardiology, Medical University of Warsaw, 02-091Warsaw, Poland; (R.G.); (G.O.)
| | - Maciej Banach
- Department of Hypertension, Medical University of Łódź, 92-213 Łódź, Poland;
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, 02-091Warsaw, Poland; (R.G.); (G.O.)
| | - Piotr Orzechowski
- Telecardiology Center, National Institute of Cardiology, 04-628 Warsaw, Poland;
| | - Robert Irzmański
- Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Łódź, 92-213 Łódź, Poland;
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Division of Medical Sciences in Zabrze, Medical University of Silesia, 41-800 Zabrze, Poland;
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Palmisano P, Melissano D, Zanotto G, Perego GB, Toselli T, Landolina M, Ricci RP. Change in the use of remote monitoring of cardiac implantable electronic devices in Italian clinical practice over a 5-year period: results of two surveys promoted by the AIAC (Italian Association of Arrhythmology and Cardiac Pacing). J Cardiovasc Med (Hagerstown) 2020; 21:305-314. [PMID: 32073430 DOI: 10.2459/jcm.0000000000000950] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to evaluate the use of remote monitoring in Italian clinical practice and its trend over the last 5 years. METHODS In 2012 and 2017, two surveys were conducted. Both were open to all Italian implanting centres and consisted of 25 questions on the characteristics of the centre, their actual use of remote monitoring, applied organizational models and administrative and legal aspects. RESULTS The questionnaires were completed by 132 and 108 centres in 2012 and 2017, respectively (30.6 and 24.7% of all Italian implanting centres). In 2017, significantly fewer centres followed up fewer than 200 patients by remote monitoring than in 2012, while more followed up more than 500 patients (all P < 0.005). In most of the centres (77.6%) that responded to both surveys, the number of patients remotely monitored significantly increased from 2012 to 2017.In both surveys, remote monitoring was usually managed by physicians and nurses. Over the period, primary review of transmissions by physicians declined, while it was increasingly performed by nurses; the involvement of technicians rose, while that of manufacturers' technical personnel decreased. The percentage of centres in which transmissions were submitted to the physician only in critical cases rose (from 28.3 to 64.3%; P < 0.001). In 86.7% of centres, the lack of a reimbursement system was deemed the main barrier to implementing remote monitoring. CONCLUSION In the last 5 years, the number of patients followed up by remote monitoring has increased markedly. In most Italian centres, remote monitoring has increasingly been managed through a primary nursing model. The lack of a specific reimbursement system is perceived as the main barrier to implementing remote monitoring .
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Affiliation(s)
| | | | | | - Giovanni Battista Perego
- Istituto Auxologico Italiano, IRCCS, Dipartimento di Scienze Cardiovascolari, Neurologiche, Metaboliche, Ospedale S. Luca, Milan
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Jang JP, Lin HT, Chen YJ, Hsieh MH, Huang YC. Role of Remote Monitoring in Detection of Atrial Arrhythmia, Stroke Reduction, and Use of Anticoagulation Therapy - A Systematic Review and Meta-Analysis. Circ J 2020; 84:1922-1930. [PMID: 33012748 DOI: 10.1253/circj.cj-20-0633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effect of remote monitoring (RM) in atrial arrhythmia detection, stroke reduction, and anticoagulation therapy remains unknown, particularly for patients with implantable or wearable cardiac devices.Methods and Results:We performed a systematic review and meta-analysis to evaluate the role of RM in atrial arrhythmia detection, stroke reduction and anticoagulation therapeutic intervention. Online databases were queried to include randomized controlled trials comparing detection of atrial arrhythmia and stroke risk between patients undergoing RM and those receiving in-office (IO) follow-up. Outcomes and complications of RM-guided anticoagulation therapy and conventional therapy in patients with atrial fibrillation were also reviewed. A total of 16 studies were included. Compared with patients receiving IO follow-up, patients undergoing RM had a significantly higher detection rate of atrial arrhythmia (risk ratio [RR], 1.363; 95% confidence interval [CI], 1.147-1.619), and a lower risk of stroke (RR, 0.539; 95% CI, 0.301-0.936). The higher rate of atrial arrhythmia was only noted in patients with wearable devices (RR, 4.070; 95% CI, 2.408-6.877), and the lower risk of stroke was only noted in patients with cardiovascular implantable electronic devices (CIED) (RR, 0.513; 95% CI, 0.265-0.996). CONCLUSIONS RM is effective for atrial arrhythmia detection in patients using wearable devices and for reducing the risk of stroke in patients with CIED.
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Affiliation(s)
- Jia-Pei Jang
- Center of Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University
| | - Hui-Ting Lin
- Center of Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University
| | - Yu-Jen Chen
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University.,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University.,Institute of Public Health, National Yang-Ming University
| | - Ming-Hsiung Hsieh
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University.,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University
| | - Yu-Chen Huang
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University.,Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University.,Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University
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Braunschweig F, Anker SD, Proff J, Varma N. Remote monitoring of implantable cardioverter-defibrillators and resynchronization devices to improve patient outcomes: dead end or way ahead? Europace 2020; 21:846-855. [PMID: 30903152 PMCID: PMC6545502 DOI: 10.1093/europace/euz011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/24/2019] [Indexed: 12/11/2022] Open
Abstract
Remote monitoring (RM) has become a new standard of care in the follow-up of patients with implantable pacemakers and defibrillators. While it has been consistently shown that RM enables earlier detection of clinically actionable events compared with traditional in-patient evaluation, this advantage did not translate into improved patient outcomes in clinical trials of RM except one study using daily multiparameter telemonitoring in heart failure (HF) patients. Therefore, this review, focusing on RM studies of implantable cardioverter-defibrillators and cardiac resynchronization therapy defibrillators in patients with HF, discusses possible explanations for the differences in trial outcomes. Patient selection may play an important role as more severe HF and concomitant atrial fibrillation have been associated with improved outcomes by RM. Furthermore, the technical set-up of RM may have an important impact as a higher level of connectivity with more frequent data transmission can be linked to better outcomes. Finally, there is growing evidence as to the need of effective algorithms ensuring a fast and well-structured clinical response to the events detected by RM. These factors re-emphasize the potential of remote management of device patients with HF and call for continued clinical research and technical development in the field.
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Affiliation(s)
| | - Stefan D Anker
- Department of Cardiology and Pneumology, Innovative Clinical Trials, University Medical Centre Göttingen, Göttingen, Germany
| | | | - Niraj Varma
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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Liljeroos M, Thylén I, Strömberg A. Patients' and Nurses' Experiences and Perceptions of Remote Monitoring of Implantable Cardiac Defibrillators in Heart Failure: Cross-Sectional, Descriptive, Mixed Methods Study. J Med Internet Res 2020; 22:e19550. [PMID: 32985997 PMCID: PMC7551113 DOI: 10.2196/19550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/08/2020] [Accepted: 07/26/2020] [Indexed: 12/28/2022] Open
Abstract
Background The new generation of implantable cardioverter-defibrillators (ICDs) supports wireless technology, which enables remote patient monitoring (RPM) of the device. In Sweden, it is mainly registered nurses with advanced education and training in ICD devices who handle the arrhythmias and technical issues of the remote transmissions. Previous studies have largely focused on the perceptions of physicians, and it has not been explored how the patients’ and nurses’ experiences of RPM correspond to each other. Objective Our objective is to describe, explore, and compare the experiences and perceptions, concerning RPM of ICD, of patients with heart failure (HF) and nurses performing ICD follow-up. Methods This study has a cross-sectional, descriptive, mixed methods design. All patients with HF and an ICD with RPM from one region in Sweden, who had transitioned from office-based visits to implementing RPM, and ICD nurses from all ICD clinics in Sweden were invited to complete a purpose-designed, 8-item questionnaire to assess experiences of RPM. The questionnaire started with a neutral question: “What are your experiences of RPM in general?” This was followed by one positive subscale with three questions (score range 3-12), with higher scores reflecting more positive experiences, and one negative subscale with three questions (score range 3-12), with lower scores reflecting more negative experiences. One open-ended question was analyzed with qualitative content analysis. Results The sample consisted of 175 patients (response rate 98.9%) and 30 ICD nurses (response rate 60%). The majority of patients (154/175, 88.0%) and nurses (23/30, 77%) experienced RPM as very good; however, the nurses noted more downsides than did the patients. The mean scores of the negative experiences subscale were 11.5 (SD 1.1) for the patients and 10.7 (SD 0.9) for the nurses (P=.08). The mean scores of the positive experiences subscale were 11.1 (SD 1.6) for the patients and 8.5 (SD 1.9) for the nurses (P=.04). A total of 11 out of 175 patients (6.3%) were worried or anxious about what the RPM entailed, while 15 out of 30 nurses (50%) felt distressed by the responsibility that accompanied their work with RPM (P=.04). Patients found that RPM increased their own (173/175, 98.9%) and their relatives’ (169/175, 96.6%) security, and all nurses (30/30, 100%) answered that they found RPM to be necessary from a safety perspective. Most patients found it to be an advantage with fewer office-based visits. Nurses found it difficult to handle different systems with different platforms, especially for smaller clinics with few patients. Another difficulty was to set the correct number of alarms for the individual patient. This caused a high number of transmissions and a risk to miss important information. Conclusions Both patients and nurses found that RPM increased assurance, reliance, and safety. Few patients were anxious about what the RPM entailed, while about half of the nurses felt distressed by the responsibility that accompanied their work with RPM. To increase nurses’ sense of security, it seems important to adjust organizational routines and reimbursement systems and to balance the workload.
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Affiliation(s)
- Maria Liljeroos
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Ingela Thylén
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden
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Maines M, Tomasi G, Moggio P, Peruzza F, Catanzariti D, Angheben C, Simoncelli M, Degiampietro M, Piffer L, Valsecchi S, Del Greco M. Implementation of remote follow-up of cardiac implantable electronic devices in clinical practice: organizational implications and resource consumption. J Cardiovasc Med (Hagerstown) 2020; 21:648-653. [DOI: 10.2459/jcm.0000000000001011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Leppert F, Siebermair J, Wesemann U, Martens E, Sattler SM, Scholz S, Veith S, Greiner W, Rassaf T, Kääb S, Wakili R. The INFluence of Remote monitoring on Anxiety/depRession, quality of lifE, and Device acceptance in ICD patients: a prospective, randomized, controlled, single-center trial. Clin Res Cardiol 2020; 110:789-800. [PMID: 32417952 PMCID: PMC8166667 DOI: 10.1007/s00392-020-01667-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 05/07/2020] [Indexed: 11/27/2022]
Abstract
Background Impact of telemedicine with remote patient monitoring (RPM) in implantable cardioverter–defibrillator (ICD) patients on clinical outcomes has been investigated in various clinical settings with divergent results. However, role of RPM on patient-reported-outcomes (PRO) is unclear. The INFRARED-ICD trial aimed to investigate the effect of RPM in addition to standard-of-care on PRO in a mixed ICD patient cohort. Methods and results Patients were randomized to RPM (n = 92) or standard in-office-FU (n = 88) serving as control group (CTL). At baseline and on a monthly basis over 1 year, study participants completed the EQ-5D questionnaire for the primary outcome Quality of Life (QoL), the Hospital Anxiety and Depression Scale, and the Florida Patient Acceptance Survey questionnaire for secondary outcomes. Demographic characteristics (82% men, mean age 62.3 years) and PRO at baseline were not different between RPM and CTL. Primary outcome analysis showed that additional RPM was not superior to CTL with respect to QoL over 12 months [+ 1.2 vs. + 3.9 points in CTL and RPM group, respectively (p = 0.24)]. Pre-specified analyses could not identify subgroups with improved QoL by the use of RPM. Neither levels of anxiety (− 0.4 vs. − 0.3, p = 0.88), depression (+ 0.3 vs. ± 0.0, p = 0.38), nor device acceptance (+ 1.1 vs. + 1.6, p = 0.20) were influenced by additional use of RPM. Conclusion The results of the present study show that PRO were not improved by RPM in addition to standard-of-care FU. Careful evaluation and planning of future trials in selected ICD patients are warranted before implementing RPM in routine practice. Graphic abstract ![]()
Electronic supplementary material The online version of this article (10.1007/s00392-020-01667-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Florian Leppert
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Johannes Siebermair
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany.,Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany.,Deutsches Zentrum für Herz-Kreislauferkrankungen (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Ulrich Wesemann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital, Berlin, Germany
| | - Eimo Martens
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany.,Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stefan M Sattler
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany.,Department of Cardiology, Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Stefan Scholz
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Stefan Veith
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Wolfgang Greiner
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany
| | - Stefan Kääb
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany.,Deutsches Zentrum für Herz-Kreislauferkrankungen (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Reza Wakili
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany. .,Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany. .,Deutsches Zentrum für Herz-Kreislauferkrankungen (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.
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Use of cell phone adapters is associated with reduction in disparities in remote monitoring of cardiac implantable electronic devices. J Interv Card Electrophysiol 2020; 60:469-475. [DOI: 10.1007/s10840-020-00743-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 03/31/2020] [Indexed: 11/27/2022]
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Daley C, Rohani Ghahari R, Drouin M, Ahmed R, Wagner S, Reining L, Coupe A, Toscos T, Mirro M. Involving patients as key stakeholders in the design of cardiovascular implantable electronic device data dashboards: Implications for patient care. Heart Rhythm O2 2020; 1:136-146. [PMID: 34113868 PMCID: PMC8183860 DOI: 10.1016/j.hroo.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Data from remote monitoring (RM) of cardiovascular implantable electronic devices (CIEDs) currently are not accessible to patients despite demand. The typical RM report contains multiple pages of data for trained technicians to read and interpret and requires a patient-centered approach to be curated to meet individual user needs. Objective The purpose of this study was to understand which RM data elements are important to patients and to gain design insights for displaying meaningful data in a digital dashboard. Methods Adults with implantable cardioverter–defibrillators (ICDs) and pacemakers (PMs) participated in this 2-phase, user-centered design study. Phase 1 included a card-sorting activity to prioritize device data elements. Phase 2 included one-on-one design sessions to gather insights and feedback about a visual display (labels and icons). Results Twenty-nine adults (mean age 71.8 ± 11.6 years; 51.7% female; 89.7% white) participated. Priority data elements for both ICD and PM groups in phase 1 (n = 19) were related to cardiac episodes, device activity, and impedance values. Recommended replacement time for battery was high priority for the PM group but not the ICD group. Phase 2 (n = 10) revealed that patients would like descriptive, nontechnical terms to depict the data and icons that are intuitive and informative. Conclusion This user-centered design study demonstrated that patients with ICDs and PMs were able to prioritize specific data from a comprehensive list of data elements that they had never seen before. This work contributes to the goal of sharing RM data with patients in a way that optimizes the RM feature of CIEDs for improving patient outcomes and clinical care.
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Affiliation(s)
- Carly Daley
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, Indiana.,Department of BioHealth Informatics, IUPUI School of Informatics and Computing, Indianapolis Indiana
| | - Romisa Rohani Ghahari
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, Indiana
| | - Michelle Drouin
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, Indiana
| | - Ryan Ahmed
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, Indiana
| | - Shauna Wagner
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, Indiana
| | - Lauren Reining
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, Indiana
| | - Amanda Coupe
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, Indiana
| | - Tammy Toscos
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, Indiana.,Department of BioHealth Informatics, IUPUI School of Informatics and Computing, Indianapolis Indiana
| | - Michael Mirro
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, Indiana.,Department of BioHealth Informatics, IUPUI School of Informatics and Computing, Indianapolis Indiana.,Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Iellamo F, Sposato B, Volterrani M. Telemonitoring for the Management of Patients with Heart Failure. Card Fail Rev 2020; 6:e07. [PMID: 32377386 PMCID: PMC7199126 DOI: 10.15420/cfr.2019.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/23/2020] [Indexed: 11/04/2022] Open
Abstract
Advances in technology now make it possible to manage heart failure (HF) from a remote to a telemonitoring approach using either noninvasive solutions or implantable devices. Nowadays, it is possible to monitor at-home parameters that can be recorded, stored and remotely transmitted to physicians, allowing them to make decisions for therapeutic modification, hospitalization or access to the emergency room. Standalone systems are available that are equipped with self-intelligence and are able to acquire and elaborate data that can inform the remote physician of impending decompensation before it results in additional complications. The development of miniature implantable devices, which could measure haemodynamic variables and transmit them to a monitor outside the body, offers the possibility for the physician to obtain more frequent evaluations of HF patients and the opportunity to take these data into account in management decisions. At present, several telemonitoring devices are available, but the only Food and Drug Administration-approved system is the cardio-microelectromechanical system, which is an implantable pulmonary arterial pressure (PAP) monitoring device that allows a direct monitoring of the PAP via a sensor implanted in the pulmonary artery. This information is then uploaded to a web-based interface from which healthcare providers can track the results and manage patients. At present, the challenge point for telemedicine management of HF is to find the more relevant biological parameter to monitor the clinical status.
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Affiliation(s)
- Ferdinando Iellamo
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Pisana Rome, Italy.,Department of Clinical Science and Translational Medicine, University Tor Vergata Rome, Italy
| | - Barbara Sposato
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Pisana Rome, Italy
| | - Maurizio Volterrani
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Pisana Rome, Italy
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Santini L, D'Onofrio A, Dello Russo A, Calò L, Pecora D, Favale S, Petracci B, Molon G, Bianchi V, De Ruvo E, Ammirati F, La Greca C, Campari M, Valsecchi S, Capucci A. Prospective evaluation of the multisensor HeartLogic algorithm for heart failure monitoring. Clin Cardiol 2020; 43:691-697. [PMID: 32304098 PMCID: PMC7368302 DOI: 10.1002/clc.23366] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/15/2022] Open
Abstract
Background The HeartLogic algorithm measures data from multiple implantable cardioverter‐defibrillator‐based sensors and combines them into a single index. The associated alert has proved to be a sensitive and timely predictor of impending heart failure (HF) decompensation. Hypothesis We describe a multicenter experience of remote HF management by means of HeartLogic and appraise the value of an alert‐based follow‐up strategy. Methods The alert was activated in 104 patients. All patients were followed up according to a standardized protocol that included remote data reviews and patient phone contacts every month and at the time of alerts. In‐office examinations were performed every 6 months or when deemed necessary. Results During a median follow‐up of 13 (10–16) months, the overall number of HF hospitalizations was 16 (rate 0.15 hospitalizations/patient‐year) and 100 alerts were reported in 53 patients. Sixty alerts were judged clinically meaningful, and were associated with multiple HF‐related conditions. In 48 of the 60 alerts, the clinician was not previously aware of the condition. Of these 48 alerts, 43 triggered clinical actions. The rate of alerts judged nonclinically meaningful was 0.37/patient‐year, and the rate of hospitalizations not associated with an alert was 0.05/patient‐year. Centers performed remote follow‐up assessments of 1113 scheduled monthly transmissions (10.3/patient‐year) and 100 alerts (0.93/patient‐year). Monthly remote data review allowed to detect 11 (1%) HF events requiring clinical actions (vs 43% actionable alerts, P < .001). Conclusions HeartLogic allowed relevant HF‐related clinical conditions to be identified remotely and enabled effective clinical actions to be taken; the rates of unexplained alerts and undetected HF events were low. An alert‐based management strategy seemed more efficient than a scheduled monthly remote follow‐up scheme.
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Affiliation(s)
- Luca Santini
- Cardiology Division, "Giovan Battista Grassi" Hospital, Rome, Italy
| | - Antonio D'Onofrio
- "Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie", Monaldi Hospital, Naples, Italy
| | | | - Leonardo Calò
- Cardiology Division, Policlinico Casilino, Rome, Italy
| | - Domenico Pecora
- Cardiology Division, Fondazione Poliambulanza, Brescia, Italy
| | | | - Barbara Petracci
- Cardiology Division, Fondazione Policlinico S. Matteo IRCCS, Pavia, Italy
| | - Giulio Molon
- Cardiology Division, Sacro Cuore-Don Calabria Hospital, Verona, Italy
| | - Valter Bianchi
- "Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie", Monaldi Hospital, Naples, Italy
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Sze S. Rise of the machines: will heart failure become the first cyber-specialty? THE BRITISH JOURNAL OF CARDIOLOGY 2020; 27:06. [PMID: 35747417 PMCID: PMC9205253 DOI: 10.5837/bjc.2020.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Digital healthcare is being introduced to the management of heart failure as a consequence of innovations in information technology. Advancement in technology enables remote symptom and device monitoring, and facilitates early detection and treatment of heart failure exacerbation, potentially improving patient outcomes and quality of life. It also provides the potential to redesign our heart failure healthcare system to one with greater efficacy through resource-sparing, computer-aided decision-making systems. Although promising, there is, as yet, insufficient evidence to support the widespread implementation of digital healthcare. Patient-related barriers include user characteristics and health status; privacy and security concerns; financial costs and lack of accessibility of digital resources. Physician-related barriers include the lack of infrastructure, incentive, knowledge and training. There are also a multitude of technical challenges in maintaining system efficiency and data quality. Furthermore, the lack of regulation and legislation regarding digital healthcare also prevents its large-scale deployment. Further education and support and a comprehensive workable evaluation framework are needed to facilitate confident and widespread use of digital healthcare in managing patients with heart failure.
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Affiliation(s)
- Shirley Sze
- NIHR Academic Clinical Fellow in Cardiology, Core Medical Trainee, Cardiovascular Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP
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81
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Srivatsa UN, Joy KC, Zhang XJ, Fan D, Oesterle A, Birgersdotter-Green U. Patient Perception of the Remote Versus Clinic Visits for Interrogation of Implantable Cardioverter Defibrillators. Crit Pathw Cardiol 2020; 19:22-25. [PMID: 31599784 DOI: 10.1097/hpc.0000000000000201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Implantable Cardioverter Defibrillators (ICDs) are used in the management of sudden cardiac arrest. Compared with clinic visits, remote interrogation of these devices has shown clinical benefit and lower cost. We hypothesize that demographic and socioeconomic factors influence patient satisfaction with remote monitoring and therefore the choice of a pathway for follow-up. Questionnaires were mailed to 85 patients (mean age 63 ± 13.5 years, 73% male), with ICDs implanted for primary prevention of sudden cardiac arrest. Information regarding education, social support, employment, and income was collected. To compare clinic and remote monitoring, patients were given questionnaires to assess which parameters they consider important: convenience, accuracy, human contact, scheduling, and cost. Of the 34 responders, patients rated clinic visit to be as accurate with better opportunity to ask questions and better human contact, but there was no difference in perception of convenience, scheduling, or cost between the 2 groups. Significant number of patients dropped from the labor market after ICD implantation; however labor status, education, or income did not influence the preference of clinic appointment. Survey respondents preferred clinic to remote interrogation because they believe clinic appointments allow better interaction. Educating patients about the benefits of remote interrogation and improved communication will enhance utilization of this sophisticated technology for superior patient care.
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Affiliation(s)
- Uma N Srivatsa
- From the Division of Cardiovascular Medicine, University of California Davis, Davis, CA
| | - Kelly C Joy
- From the Division of Cardiovascular Medicine, University of California Davis, Davis, CA
| | - Xin J Zhang
- From the Division of Cardiovascular Medicine, University of California Davis, Davis, CA
| | - Dali Fan
- From the Division of Cardiovascular Medicine, University of California Davis, Davis, CA
| | - Adam Oesterle
- From the Division of Cardiovascular Medicine, University of California Davis, Davis, CA
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Lopez-Villegas A, Catalan-Matamoros D, Peiro S, Lappegard KT, Lopez-Liria R. Cost-utility analysis of telemonitoring versus conventional hospital-based follow-up of patients with pacemakers. The NORDLAND randomized clinical trial. PLoS One 2020; 15:e0226188. [PMID: 31995558 PMCID: PMC6988929 DOI: 10.1371/journal.pone.0226188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/04/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The aim of our study was to perform an economic assessment in order to check whether or not telemonitoring of users with pacemakers offers a cost-effective alternative to traditional follow-up in outpatient clinics. METHODS We used effectiveness and cost data from the NORDLAND trial, which is a controlled, randomized, non-masked clinical trial. Fifty patients were assigned to receive either telemonitoring (TM; n = 25) or conventional monitoring (CM; n = 25) and were followed up for 12 months after the implantation. A cost-utility analysis was performed in terms of additional costs per additional Quality-Adjusted Life Year (QALY) attained from the perspectives of the Norwegian National Healthcare System and patients and their caregivers. RESULTS Effectiveness was similar between alternatives (TM: 0.7804 [CI: 0.6864 to 0.8745] vs. CM: 0.7465 [CI: 0.6543 to 0.8387]), while cost per patient was higher in the RM group, both from the Norwegian NHS perspective (TM: €2,079.84 [CI: 0.00 to 4,610.58] vs. €271.97 [CI: 158.18 to 385.76]; p = 0.147) and including the patient/family perspective (TM: €2,295.91 [CI: 0.00 to 4,843.28] vs. CM: €430.39 [CI: 0.00 to 4,841.48]), although these large differences-mainly due to a few patients being hospitalized in the TM group, as opposed to none in the CM group-did not reach statistical significance. The Incremental Cost-Effectiveness Ratio (ICER) from the Norwegian NHS perspective (€53,345.27/QALY) and including the patient/caregiver perspective (€55,046.40/QALY), as well as the Incremental Net Benefit (INB), favors the CM alternative, albeit with very broad 95%CIs. The probabilistic analysis confirmed inconclusive results due to the wide CIs even suggesting that TM was not cost-effective in this study. Supplemental analysis excluding the hospitalization costs shows positive INBs, whereby suggesting a discrete superiority of the RM alternative if hospitalization costs were not considered, albeit also with broad CIs. CONCLUSIONS Cost-utility analysis of TM vs. CM shows inconclusive results because of broad confidence intervals with ICER and INB figures ranging from potential savings to high costs for an additional QALY, with the majority of ICERs being above the usual NHS thresholds for coverage decisions. TRIAL REGISTRATION ClinicalTrials.gov NCT02237404.
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Affiliation(s)
- Antonio Lopez-Villegas
- Social Involvement of Critical and Emergency Medicine, CTS-609 Research Group, Hospital de Poniente, Almería, Spain
- Division of Medicine, Nordland Hospital, Bodø, Norway
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Daniel Catalan-Matamoros
- Department of Journalism and Communication, Universidad Carlos III de Madrid, Madrid, Spain
- Health Sciences CTS-451 Research Group, University of Almería, Almería, Spain
| | - Salvador Peiro
- Health Services Research Unit, FISABIO-PUBLIC HEALTH, Valencia, Spain
| | - Knut Tore Lappegard
- Division of Medicine, Nordland Hospital, Bodø, Norway
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Remedios Lopez-Liria
- Nursing Science, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Almería, Spain
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Artico J, Zecchin M, Zorzin Fantasia A, Skerl G, Ortis B, Franco S, Albani S, Barbati G, Cristallini J, Cannata' A, Sinagra G. Long-term patient satisfaction with implanted device remote monitoring: a comparison among different systems. J Cardiovasc Med (Hagerstown) 2020; 20:542-550. [PMID: 31107287 DOI: 10.2459/jcm.0000000000000818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Remote monitoring is an effective strategy to improve patients' outcomes and reduce hospitalization in patients with cardiac implantable electronic devices. However, data on patients' satisfaction are scarce. The aim of the current study was to assess patients' satisfaction, ease of use and impact on daily activities of the remote monitoring and to investigate whether there are differences among different devices and different manufacturers. METHODS A modified Home Monitoring Acceptance and Satisfaction Questionnaire telephone survey on the perceived quality of the different systems was performed with all patients followed with remote monitoring for at least 3 months. RESULTS Among 604 patients with remote monitoring screened by telephone, 466 patients (77%) answered the questionnaire [142 patients (30.5%) had a pacemaker, 317 patients (68%) had an implantable cardioverter defibrillator, and seven patients (1.5%) had an implantable loop recorder]. Ninety-seven percent of patients were satisfied by the remote monitoring system during the entire follow-up and found it easy to use. Similarly, 85% of patients did not experience any restriction in daily activities, and for 99% of patients it did not affect their privacy. Importantly, for the vast majority of patients, remote monitoring gave a great (56.7%) or moderate (33.4%) sense of security. CONCLUSION Daily impact of cardiac implantable electronic devices still remains a challenging issue for caregivers. The introduction of remote monitoring allowed closer follow-up and improved outcomes. Our results highlighted patients' satisfaction, who also felt safer, with the remote monitoring, its ease of use, and the absence of any disturbances in patients' everyday activities or in their privacy.
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Affiliation(s)
- Jessica Artico
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste
| | - Massimo Zecchin
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste
| | - Anna Zorzin Fantasia
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste
| | - Giulia Skerl
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste
| | - Benedetta Ortis
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste
| | - Stefania Franco
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste
| | - Stefano Albani
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste
| | - Giulia Barbati
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Jacopo Cristallini
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste
| | - Antonio Cannata'
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste
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Volterrani M, Spoletini I, Angermann C, Rosano G, Coats AJ. Implantable devices for heart failure monitoring: the CardioMEMS™ system. Eur Heart J Suppl 2019; 21:M50-M53. [PMID: 31908617 PMCID: PMC6937499 DOI: 10.1093/eurheartj/suz265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Several devices have been developed for heart failure (HF) treatment and monitoring. Among device-based monitoring tools, CardioMEMS™ has received growing research attention. This document reflects the key points of an ESC consensus meeting on implantable devices for monitoring in HF, with a particular focus on CardioMEMS™.
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Affiliation(s)
- Maurizio Volterrani
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
| | - Ilaria Spoletini
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
| | - Christiane Angermann
- Department of Medicine I, Cardiology and Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Würzburg, Germany
| | - Giuseppe Rosano
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
| | - Andrew Js Coats
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
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Giannola G, Torcivia R, Airò Farulla R, Cipolla T. Outsourcing the Remote Management of Cardiac Implantable Electronic Devices: Medical Care Quality Improvement Project. JMIR Cardio 2019; 3:e9815. [PMID: 31845898 PMCID: PMC6938593 DOI: 10.2196/cardio.9815] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 09/05/2018] [Accepted: 10/10/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Remote management is partially replacing routine follow-up in patients implanted with cardiac implantable electronic devices (CIEDs). Although it reduces clinical staff time compared with standard in-office follow-up, a new definition of roles and responsibilities may be needed to review remote transmissions in an effective, efficient, and timely manner. Whether remote triage may be outsourced to an external remote monitoring center (ERMC) is still unclear. OBJECTIVE The aim of this health care quality improvement project was to evaluate the feasibility of outsourcing remote triage to an ERMC to improve patient care and health care resource utilization. METHODS Patients (N=153) with implanted CIEDs were followed up for 8 months. An ERMC composed of nurses and physicians reviewed remote transmissions daily following a specific remote monitoring (RM) protocol. A 6-month benchmarking phase where patients' transmissions were managed directly by hospital staff was evaluated as a term of comparison. RESULTS A total of 654 transmissions were recorded in the RM system and managed by the ERMC team within 2 working days, showing a significant time reduction compared with standard RM management (100% vs 11%, respectively, within 2 days; P<.001). A total of 84.3% (551/654) of the transmissions did not include a prioritized event and did not require escalation to the hospital clinician. High priority was assigned to 2.3% (15/654) of transmissions, which were communicated to the hospital team by email within 1 working day. Nonurgent device status events occurred in 88 cases and were communicated to the hospital within 2 working days. Of these, 11% (10/88) were followed by a hospitalization. CONCLUSIONS The outsourcing of RM management to an ERMC safely provides efficacy and efficiency gains in patients' care compared with a standard in-hospital management. Moreover, the externalization of RM management could be a key tool for saving dedicated staff and facility time with possible positive economic impact. TRIAL REGISTRATION ClinicalTrials.gov NCT01007474; http://clinicaltrials.gov/ct2/show/NCT01007474.
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86
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Apakama DU, Slovis BH. Using Data Science to Predict Readmissions in Heart Failure. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2019. [DOI: 10.1007/s40138-019-00197-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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87
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Andersen TO, Nielsen KD, Moll J, Svendsen JH. Unpacking telemonitoring work: Workload and telephone calls to patients in implanted cardiac device care. Int J Med Inform 2019; 129:381-387. [DOI: 10.1016/j.ijmedinf.2019.06.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/30/2019] [Accepted: 06/20/2019] [Indexed: 11/17/2022]
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Lucà F, Cipolletta L, Di Fusco SA, Iorio A, Pozzi A, Rao CM, Ingianni N, Benvenuto M, Madeo A, Fiscella D, Benedetto D, Francese GM, Gelsomino S, Zecchin M, Gabrielli D, Gulizia MM. Remote monitoring: Doomed to let down or an attractive promise? IJC HEART & VASCULATURE 2019; 24:100380. [PMID: 31193998 PMCID: PMC6545403 DOI: 10.1016/j.ijcha.2019.100380] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 11/25/2022]
Abstract
Device interrogation and management are time consuming, representing a relevant burden for pacing centers. In several situations, patients' management requires additional follow up visits. Remote Monitoring (RM) allows an optimal recall management and a rapid diagnosis of device or lead failure, without the need of additional in office visits. Further it allows a significant delay reduction between the adverse event and the reaction to the alarm, shortening the time needed to make a clinical decision. A role in risk-predicting patient-related outcomes has also been shown. RM permits detection of the arrhythmia from 1 to 5 months in advance compared to in-office visits. Importantly, by using specific algorithms with multiparametric analysis, RM has been studied as a potential instrument to identify early patients on risk of worsening HF using specific algorithms. Although the use of RM in HF setting remains controversial, it has been proposed to improve HF clinical outcomes and survival in clinical trials. In this sense, RM success could require a standardization of process within a management model, that may involve different health care professionals. In this review, we examine recent advances of RM providing an update of this tool through different clinical scenarios.
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Key Words
- AHRE, Atrial High Rate Episodes
- ARTESIA, Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation
- ASSERT, ASymptomatic atrial fibrillation and Stroke Evaluation in pacemaker patients and atrial fibrillation Reduction atrial pacing Trial
- Atrial fibrillation
- CHAMPION, CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients
- CIED, Cardiac Implantable Electronic Devices
- COMPAS, COMPArative follow-up Schedule with home monitoring
- CONNECT, Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision
- CRT, Cardiac Resynchronization Therapy
- ECOST, Effectiveness and Cost of ICDs Follow-up Schedule with Telecardiology
- EHRA, European Heart Rhythm Association
- EVOLVO, Evolution of Management Strategies of Heart Failure Patients With Implantable Defibrillators
- Heart failure
- ICD, Implantable Cardioverter Defibrillator
- IMPACT, Combined Use of BIOTRONIK Home Monitoring and Predefined Anticoagulation to Reduce Stroke Risk
- IN-TIME, Influence of Home Monitoring on the Clinical Status of Heart Failure Patients With an Impaired Left Ventricular Function
- ISHNE, International Society for Holter and Noninvasive Electrocardiology
- Implantable devices
- MORE-CARE, MOnitoring Resynchronization dEvices and CARdiac patiEnts
- MULTISENSE HF, Multisensor Chronic Evaluation in Ambulatory Heart Failure Patients
- MoniC, Model Project Monitor Centre
- NOAH, Non–vitamin K antagonist Oral anticoagulants in patients with Atrial High rate episodes
- NYHA, New York Heart Association
- OPTILINK-HF, Optimization of Heart Failure Management Using Medtronic OptiVol Fluid Status Monitoring and CareLink Network
- PARTNERS HF, Program to Access and Review Trending Information and Evaluate Correlation to Symptoms in Patients With Heart Failure
- PMK, Pacemaker
- REFORM Trial, Remote Follow-Up for ICD-Therapy in Patients Meeting MADIT II Criteria
- RM, Remote Monitoring
- RM-HF, REmote Monitoring: an evaluation of implantable devices for management of Heart Failure patients
- Remote telemonitoring
- SELENE, Selection of potential predictors of worsening Heart Failure
- TARIFF, Evaluation Registry for Remote Follow-up
- TRUST, Lumos-T Safely Reduces Routine Office Device Follow-up
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Affiliation(s)
- Fabiana Lucà
- UTIC e Cardiologia Interventistica, Azienda Ospedaliera “Bianchi Melacrino Morelli”, Reggio Calabria, Italy
| | - Laura Cipolletta
- Dipartimento di Scienze Cardiovascolari, Clinica di Cardiologia, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Italy
| | | | - Annamaria Iorio
- UO di Cardiologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea Pozzi
- UO di Cardiologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Carmelo Massimiliano Rao
- UTIC e Cardiologia Interventistica, Azienda Ospedaliera “Bianchi Melacrino Morelli”, Reggio Calabria, Italy
| | - Nadia Ingianni
- UOC Cardiologia e UTIC, P.O. Paolo Borsellino, ASP Trapani, Marsala, Italy
| | | | - Andrea Madeo
- UOC Cardiologia, Ospedale di Castrovillari, Cosenza, Italy
| | - Damiana Fiscella
- UOC Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilevo Nazionale e Alta Specialità, Catania, Italy
| | | | - Giuseppina Maura Francese
- UOC Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilevo Nazionale e Alta Specialità, Catania, Italy
| | - Sandro Gelsomino
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, the Netherlands
| | - Massimo Zecchin
- U.O. Cardiologia, Azienda Ospedaliero Universitaria “Ospedali Riuniti”, Trieste, Italy
| | | | - Michele Massimo Gulizia
- UOC Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilevo Nazionale e Alta Specialità, Catania, Italy
- Fondazione per il Tuo Cuore, Italy
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Hindricks G, Varma N, Kacet S, Lewalter T, Søgaard P, Guédon-Moreau L, Proff J, Gerds TA, Anker SD, Torp-Pedersen C. Daily remote monitoring of implantable cardioverter-defibrillators: insights from the pooled patient-level data from three randomized controlled trials (IN-TIME, ECOST, TRUST). Eur Heart J 2019; 38:1749-1755. [PMID: 29688304 PMCID: PMC5461472 DOI: 10.1093/eurheartj/ehx015] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 04/18/2017] [Indexed: 11/26/2022] Open
Abstract
Aims Remote monitoring of implantable cardioverter-defibrillators may improve clinical outcome. A recent meta-analysis of three randomized controlled trials (TRUST, ECOST, IN-TIME) using a specific remote monitoring system with daily transmissions [Biotronik Home Monitoring (HM)] demonstrated improved survival. We performed a patient-level analysis to verify this result with appropriate time-to-event statistics and to investigate further clinical endpoints. Methods and results Individual data of the TRUST, ECOST, and IN-TIME patients were pooled to calculate absolute risks of endpoints at 1-year follow-up for HM vs. conventional follow-up. All-cause mortality analysis involved all three trials (2405 patients). Other endpoints involved two trials, ECOST and IN-TIME (1078 patients), in which an independent blinded endpoint committee adjudicated the underlying causes of hospitalizations and deaths. The absolute risk of death at 1 year was reduced by 1.9% in the HM group (95% CI: 0.1–3.8%; P = 0.037), equivalent to a risk ratio of 0.62. Also the combined endpoint of all-cause mortality or hospitalization for worsening heart failure (WHF) was significantly reduced (by 5.6%; P = 0.007; risk ratio 0.64). The composite endpoint of all-cause mortality or cardiovascular (CV) hospitalization tended to be reduced by a similar degree (4.1%; P = 0.13; risk ratio 0.85) but without statistical significance. Conclusion In a pooled analysis of the three trials, HM reduced all-cause mortality and the composite endpoint of all-cause mortality or WHF hospitalization. The similar magnitudes of absolute risk reductions for WHF and CV endpoints suggest that the benefit of HM is driven by the prevention of heart failure exacerbation.
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Affiliation(s)
- Gerhard Hindricks
- Internal Medicine and Cardiology Division, University of Leipzig Heart Center, Strümpellstrasse 39, D-04289 Leipzig, Germany
| | - Niraj Varma
- Department of Cardiovascular Medicine, Cleveland Clinic, 44195 Cleveland, OH, USA
| | - Salem Kacet
- Centre Hospitalier Régional et Universitaire, Lille, France
| | | | - Peter Søgaard
- Heart Centre and Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Thomas A Gerds
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany
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90
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Halawa A, Enezate T, Flaker G. Device monitoring in heart failure management: outcomes based on a systematic review and meta-analysis. Cardiovasc Diagn Ther 2019; 9:386-393. [PMID: 31555544 DOI: 10.21037/cdt.2019.01.02] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Implantable devices have been developed for continuous monitoring of heart failure. We investigated the effect of fluids and hemodynamic monitoring, using these devices, on heart failure clinical outcomes. Literature search was performed January 2000 through May 2017 of studies comparing device monitored patients with control group. Random-effects meta-analysis was used to pool outcomes across the studies. A total of 5,454 patients were included from 14 studies. There was no difference in heart failure (HF)-related admissions rate [odds ratio (OR) 1.25, 95% CI: 0.92-1.69, P=0.15], all-cause mortality (OR 1.21, 95% CI: 0.91-1.61, P=0.20) or combined admission rate and all-cause mortality (OR 1.21, 95% CI: 0.89-1.64, P=0.22) between the device monitored and the control group. In a subgroup analysis including only pressure sensors devices, there was no difference in all-cause mortality (OR 1.04, 95% CI: 0.62-1.74, P=0.89), however, there was a lower admissions rate (OR 1.63, 95% CI: 1.10-2.41, P=0.02). In a subgroup of only impedance monitoring devices, there was no difference in all-cause mortality or admissions rate. Pressure monitoring was associated with lower HF admissions rate. No improvement in these outcomes was noted with impedance monitoring.
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Affiliation(s)
- Ahmad Halawa
- Division of Cardiovascular Medicine, University of Missouri, Columbia, MO, USA
| | - Tariq Enezate
- Division of Cardiovascular Medicine, University of Missouri, Columbia, MO, USA
| | - Greg Flaker
- Division of Cardiovascular Medicine, University of Missouri, Columbia, MO, USA
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91
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Bogyi P, Vamos M, Bari Z, Polgar B, Muk B, Nyolczas N, Kiss RG, Duray GZ. Association of Remote Monitoring With Survival in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy: Retrospective Observational Study. J Med Internet Res 2019; 21:e14142. [PMID: 31350836 PMCID: PMC6688436 DOI: 10.2196/14142] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 12/28/2022] Open
Abstract
Background Remote monitoring is an established, guideline-recommended technology with unequivocal clinical benefits; however, its ability to improve survival is contradictory. Objective The aim of our study was to investigate the effects of remote monitoring on mortality in an optimally treated heart failure patient population undergoing cardiac resynchronization defibrillator therapy (CRT-D) implantation in a large-volume tertiary referral center. Methods The population of this single-center, retrospective, observational study included 231 consecutive patients receiving CRT-D devices in the Medical Centre of the Hungarian Defence Forces (Budapest, Hungary) from January 2011 to June 2016. Clinical outcomes were compared between patients on remote monitoring and conventional follow-up. Results The mean follow-up time was 28.4 (SD 18.1) months. Patients on remote monitoring were more likely to have atrial fibrillation, received heart failure management at our dedicated heart failure outpatient clinic more often, and have a slightly lower functional capacity. Crude all-cause mortality of remote-monitored patients was significantly lower compared with patients followed conventionally (hazard ratio [HR] 0.368, 95% CI 0.186-0.727, P=.004). The survival benefit remained statistically significant after adjustment for important baseline parameters (adjusted HR 0.361, 95% CI 0.181-0.722, P=.004). Conclusions In this single-center, retrospective study of optimally treated heart failure patients undergoing CRT-D implantation, the use of remote monitoring systems was associated with a significantly better survival rate.
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Affiliation(s)
- Peter Bogyi
- Department of Cardiology, Hungarian Defence Forces Medical Centre, Budapest, Hungary.,Basic and Translational Medicine, Karoly Racz School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Mate Vamos
- Department of Cardiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Zsolt Bari
- Department of Cardiology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
| | - Balazs Polgar
- Department of Cardiology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
| | - Balazs Muk
- Department of Cardiology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
| | - Noemi Nyolczas
- Department of Cardiology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
| | - Robert Gabor Kiss
- Department of Cardiology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
| | - Gabor Zoltan Duray
- Department of Cardiology, Hungarian Defence Forces Medical Centre, Budapest, Hungary.,Basic and Translational Medicine, Karoly Racz School of PhD Studies, Semmelweis University, Budapest, Hungary
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92
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Grustam AS, Buyukkaramikli N, Koymans R, Vrijhoef HJM, Severens JL. Value of information analysis in telehealth for chronic heart failure management. PLoS One 2019; 14:e0218083. [PMID: 31220101 PMCID: PMC6586290 DOI: 10.1371/journal.pone.0218083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 05/26/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Value of information (VOI) analysis provides information on opportunity cost of a decision in healthcare by estimating the cost of reducing parametric uncertainty and quantifying the value of generating additional evidence. This study is an application of the VOI methodology to the problem of choosing between home telemonitoring and nurse telephone support over usual care in chronic heart failure management in the Netherlands. METHODS The expected value of perfect information (EVPI) and the expected value of partially perfect information (EVPPI) analyses were based on an informal threshold of €20K per quality-adjusted life-year. These VOI-analyses were applied to a probabilistic Markov model comparing the 20-year costs and effects in three interventions. The EVPPI explored the value of decision uncertainty caused by the following group of parameters: treatment-specific transition probabilities between New York Heart Association (NYHA) defined disease states, utilities associated with the disease states, number of hospitalizations and ER visits, health state specific costs, and the distribution of patients per NYHA group. We performed the analysis for two population sizes in the Netherlands-patients in all NYHA classes of severity, and patients in NYHA IV class only. RESULTS The population EVPI for an effective population of 2,841,567 CHF patients in All NYHA classes of severity over the next 20 years is more than €4.5B, implying that further research is highly cost-effective. In the NYHA IV only analysis, for the effective population of 208,003 patients over next 20 years, the population EVPI at the same informal threshold is approx. €590M. The EVPPI analysis showed that the only relevant group of parameters that contribute to the overall decision uncertainty are transition probabilities, in both All NYHA and NYHA IV analyses. CONCLUSIONS Results of our VOI exercise show that the cost of uncertainty regarding the decision on reimbursement of telehealth interventions for chronic heart failure patients is high in the Netherlands, and that future research is needed, mainly on the transition probabilities.
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Affiliation(s)
- Andrija S. Grustam
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Professional Health Solutions & Services Department, Philips Research, Eindhoven, the Netherlands
- * E-mail:
| | - Nasuh Buyukkaramikli
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Institute of Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Ron Koymans
- Professional Health Solutions & Services Department, Philips Research, Eindhoven, the Netherlands
| | - Hubertus J. M. Vrijhoef
- Department of Patient & Care, Maastricht UMC, Maastricht, the Netherlands
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussels, Brussels, Belgium
- Panaxea b.v., Amsterdam, the Netherlands
| | - Johan L. Severens
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Institute of Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
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93
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Simova II, Petrov IS. What do our patients expect of mobile health? Eur J Prev Cardiol 2019; 26:917-919. [DOI: 10.1177/2047487319830169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Iana I Simova
- Clinic of Cardiology and Angiology, Acibadem City Clinic Cardiovascular Center University Hospital, Sofia, Bulgaria
| | - Ivo S Petrov
- Clinic of Cardiology and Angiology, Acibadem City Clinic Cardiovascular Center University Hospital, Sofia, Bulgaria
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Husser D, Christoph Geller J, Taborsky M, Schomburg R, Bode F, Nielsen JC, Stellbrink C, Meincke C, Hjortshøj SP, Schrader J, Lewalter T, Hindricks G. Remote monitoring and clinical outcomes: details on information flow and workflow in the IN-TIME study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:136-144. [PMID: 30016396 PMCID: PMC6440440 DOI: 10.1093/ehjqcco/qcy031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/02/2018] [Accepted: 07/11/2018] [Indexed: 12/02/2022]
Abstract
Aims Randomized clinical trials investigating a possible outcome effect of remote monitoring in patients with implantable defibrillators have shown conflicting results. This study analyses the information flow and workflow details from the IN-TIME study and discusses whether differences of message content, information speed and completeness, and workflow may contribute to the heterogeneous results. Methods and results IN-TIME randomized 664 patients with an implantable cardioverter/defibrillator indication to daily remote monitoring vs. control. After 12 months, a composite clinical score and all-cause mortality were improved in the remote monitoring arm. Messages were received on 83.1% of out-of-hospital days. Daily transmissions were interrupted 2.3 times per patient-year for more than 3 days. During 1 year, absolute transmission success declined by 3.3%. Information on medical events was available after 1 day (3 days) in 83.1% (94.3%) of the cases. On all working days, a central monitoring unit informed investigators of protocol defined events. Investigators contacted patients with a median delay of 1 day and arranged follow-ups, the majority of which took place within 1 week of the event being available. Conclusion Only limited data on the information flow and workflow have been published from other studies which failed to improve outcome. However, a comparison of those data to IN-TIME suggest that the ability to see a patient early after clinical events may be inferior to the set-up in IN-TIME. These differences may be responsible for the heterogeneity found in clinical effectiveness of remote monitoring concepts.
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Affiliation(s)
- Daniela Husser
- Heart Center Leipzig, Strümpelstr., 39, Leipzig, Germany
| | | | - Miloš Taborsky
- Olomouc University Hospital, I.P., Pavlova 6, Olomouc, Czech Republic
| | - Rolf Schomburg
- Segeberger Kliniken, Am Kurpark 1, Bad Segeberg, Germany
| | - Frank Bode
- Sana Kliniken Ostholstein, Mühlenkamp 5, Oldenburg, Germany
| | | | | | - Carsten Meincke
- Vivantes Klinikum Neukölln, Rudower Straße 48, Berlin, Germany
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Hummel JP, Leipold RJ, Amorosi SL, Bao H, Deger KA, Jones PW, Kansal AR, Ott LS, Stern S, Stein K, Curtis JP, Akar JG. Outcomes and costs of remote patient monitoring among patients with implanted cardiac defibrillators: An economic model based on the PREDICT RM database. J Cardiovasc Electrophysiol 2019; 30:1066-1077. [PMID: 30938894 PMCID: PMC6850124 DOI: 10.1111/jce.13934] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 01/08/2023]
Abstract
Background Remote monitoring of implantable cardioverter‐defibrillators has been associated with reduced rates of all‐cause rehospitalizations and mortality among device recipients, but long‐term economic benefits have not been studied. Methods and Results An economic model was developed using the PREDICT RM database comparing outcomes with and without remote monitoring. The database included patients ages 65 to 89 who received a Boston Scientific device from 2006 to 2010. Parametric survival equations were derived for rehospitalization and mortality to predict outcomes over a maximum time horizon of 25 years. The analysis assessed rehospitalization, mortality, and the cost‐effectiveness (expressed as the incremental cost per quality‐adjusted life year) of remote monitoring versus no remote monitoring. Remote monitoring was associated with reduced mortality; average life expectancy and average quality‐adjusted life years increased by 0.77 years and 0.64, respectively (6.85 life years and 5.65 quality‐adjusted life years). When expressed per patient‐year, remote monitoring patients had fewer subsequent rehospitalizations (by 0.08 per patient‐year) and lower hospitalization costs (by $554 per patient year). With longer life expectancies, remote monitoring patients experienced an average of 0.64 additional subsequent rehospitalizations with increased average lifetime hospitalization costs of $2784. Total costs of outpatient and physician claims were higher with remote monitoring ($47 515 vs $42 792), but average per patient‐year costs were lower ($6232 vs $6244). The base‐case incremental cost‐effectiveness ratio was $10 752 per quality‐adjusted life year, making remote monitoring high‐value care. Conclusion Remote monitoring is a cost‐effective approach for the lifetime management of patients with implantable cardioverter‐defibrillators.
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Affiliation(s)
- James P Hummel
- Division of Cardiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | | - Haikun Bao
- Yale University School of Medicine and Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; and on behalf of the NCDR
| | | | - Paul W Jones
- Boston Scientific Corporation, Marlborough, Massachusetts
| | | | - Lesli S Ott
- Yale University School of Medicine and Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; and on behalf of the NCDR
| | | | - Kenneth Stein
- Boston Scientific Corporation, Marlborough, Massachusetts
| | - Jeptha P Curtis
- Yale University School of Medicine and Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; and on behalf of the NCDR
| | - Joseph G Akar
- Yale University School of Medicine and Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; and on behalf of the NCDR
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Palese A, Cracina A, Purino M, Urli N, Fabris S, Danielis M. The experiences of patients electrically shocked by an implantable cardioverter defibrillator: Findings from a descriptive qualitative study. Nurs Crit Care 2019; 25:229-237. [DOI: 10.1111/nicc.12424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/28/2019] [Accepted: 02/07/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Alvisa Palese
- Department of Medical SciencesUdine University Udine Italy
| | | | - Michela Purino
- Neonatal Intensive Care UnitAzienda Sanitaria Universitaria Integrata di Udine Udine Italy
| | - Nadia Urli
- Pediatric UnitAzienda per l'Assistenza Sanitaria Udine Italy
| | - Stefano Fabris
- Department of Medical SciencesUdine University Udine Italy
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Frederix I, Caiani EG, Dendale P, Anker S, Bax J, Böhm A, Cowie M, Crawford J, de Groot N, Dilaveris P, Hansen T, Koehler F, Krstačić G, Lambrinou E, Lancellotti P, Meier P, Neubeck L, Parati G, Piotrowicz E, Tubaro M, van der Velde E. ESC e-Cardiology Working Group Position Paper: Overcoming challenges in digital health implementation in cardiovascular medicine. Eur J Prev Cardiol 2019; 26:1166-1177. [DOI: 10.1177/2047487319832394] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Ines Frederix
- Department of Cardiology, Jessa Hospital, Belgium
- Antwerp University Hospital (UZA), Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Belgium
- Faculty of Medicine and Health Sciences, Antwerp University, Belgium
| | - Enrico G Caiani
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Italy
- Institute of Electronics and Information and Telecommunication Engineering, Consiglio Nazionale delle Ricerche, Italy
| | - Paul Dendale
- Department of Cardiology, Jessa Hospital, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Belgium
| | - Stefan Anker
- Division of Cardiology and Metabolism, Berlin–Brandenburg Center for Regenerative Therapies (BCRT), partner site Berlin, Charité Universitätsmedizin Berlin, Germany
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Centre (LUMC), The Netherlands
| | - Alan Böhm
- Department of Acute Cardiology, The National Institute of Cardiovascular Diseases, Slovakia
- Faculty of Medicine, Slovak Medical University, Slovakia
| | - Martin Cowie
- National Heart and Lung Institute, Imperial College London, UK
| | - John Crawford
- International Advisory Group, Healthcare Information and Management Systems Society (HIMSS), UK
| | - Natasja de Groot
- Department of Cardiology, Erasmus Medical Center, The Netherlands
| | | | - Tina Hansen
- Department of Cardiology, Zealand University Hospital, Denmark
| | - Friedrich Koehler
- Centre for Cardiovascular Telemedicine, Charité – Universitätsmedizin, Germany
| | | | | | - Patrizio Lancellotti
- University of Liège Hospital, GIGA CardioVascular Sciences, Belgium
- Gruppo Villa Maria Care and Research, Anthea Hospital, Italy
| | - Pascal Meier
- Department of Cardiology, University Hospital Geneva HUG, Switzerland
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, UK
| | - Gianfranco Parati
- IRCCS Istituto Auxologico Italiano, University of Milano-Bicocca, Italy
| | | | - Marco Tubaro
- ICCU – Cardiology Division, San Filippo Neri Hospital, Italy
| | - Enno van der Velde
- Department of Cardiology, Leiden University Medical Centre (LUMC), The Netherlands
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98
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Villani GQ, Villani A, Zanni A, Sticozzi C, Maceda DP, Rossi L, Pisati MS, Piepoli MF. Mobile health and implantable cardiac devices: Patients' expectations. Eur J Prev Cardiol 2019; 26:920-927. [PMID: 30823864 DOI: 10.1177/2047487319830531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mobile computing and communication technologies in health services and information (so-called mHealth) have modified the traditional approach in the follow-up of patients with implantable cardiac devices, increased patient engagement and empowerment, reduced healthcare costs and improved patients' outcome. Recent developments in mobile technology, with the introduction of smartphone-compatible devices that can measure various health parameters and transfer automatically generated data, have increased the potential application of remote monitoring and the interest towards mHealth. However, little is known about the patients' interest and expectations of this new technology. OBJECTIVE The patients' interest in the possibility of receiving data from their implantable cardiac device, clinical and health advice via remote monitoring on their smartphones were investigated. METHODS A questionnaire entitled 'Expectations for future possibility of self-management of device data' (Likert scale scored) was submitted to 300 consecutive implantable cardiac device outpatients. The questionnaire was focused on collecting patients' expectations in receiving direct information regarding their implantable cardiac device status (item 1, five questions), their own clinical status (item 2, seven questions) and advice on healthy lifestyle promotion (item 3, nine questions). Patient characteristics associated with greater interest towards mHealth were also investigated. RESULTS Questionnaires were completed by 268 patients (221 men, aged 69 ± 14 years). The Cronbach test reported an alpha value of 0.98 for item 1, 0.94 for item 2 and 0.97 for item 3. Patients declared to be mainly interested in the device interventions (62%) and in severe arrhythmia occurrence (61%), followed by data on heart failure severity (54%) and their performed physical activity (48%). Patients showed very little interest in ECG tracing (37%), but the lowest interest was expressed towards healthy lifestyle promotion advice (<40%). A higher education degree and the presence of the caregiver positively affected the interest towards remote monitoring information ( P < 0.001). CONCLUSIONS The patients' interests were mainly directed at receiving information related to technical data of the implantable cardiac device and not to the overall management of the disease, underlying the insufficient awareness of patients towards the key role of self-control health status and the promotion of a healthy lifestyle.
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Affiliation(s)
| | - Andrea Villani
- Cardiology Unit, Guglielmo da Saliceto Hospital Unit, Italy
| | - Alessia Zanni
- Cardiology Unit, Guglielmo da Saliceto Hospital Unit, Italy
| | | | | | - Luca Rossi
- Cardiology Unit, Guglielmo da Saliceto Hospital Unit, Italy
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99
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Ninni S, Delahaye C, Klein C, Marquie C, Klug D, Lacroix D, Brigadeau F, Potelle C, Kouakam C, Finat L, Guedon-Moreau L. A report on the impact of remote monitoring in patients with S-ICD: Insights from a prospective registry. Pacing Clin Electrophysiol 2019; 42:349-355. [DOI: 10.1111/pace.13598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/17/2018] [Accepted: 12/21/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Sandro Ninni
- CHRU Lille; Institut Cœur-Poumon - Bd du Professeur Jules Leclercq - CHU Lille; F59037-Lille France
- Institut Pasteur de Lille; UMR1011, F59000-Lille France
| | - Camille Delahaye
- CHRU Lille; Institut Cœur-Poumon - Bd du Professeur Jules Leclercq - CHU Lille; F59037-Lille France
| | - Cédric Klein
- CHRU Lille; Institut Cœur-Poumon - Bd du Professeur Jules Leclercq - CHU Lille; F59037-Lille France
| | - Christelle Marquie
- CHRU Lille; Institut Cœur-Poumon - Bd du Professeur Jules Leclercq - CHU Lille; F59037-Lille France
| | - Didier Klug
- CHRU Lille; Institut Cœur-Poumon - Bd du Professeur Jules Leclercq - CHU Lille; F59037-Lille France
| | - Dominique Lacroix
- CHRU Lille; Institut Cœur-Poumon - Bd du Professeur Jules Leclercq - CHU Lille; F59037-Lille France
| | - François Brigadeau
- CHRU Lille; Institut Cœur-Poumon - Bd du Professeur Jules Leclercq - CHU Lille; F59037-Lille France
| | - Charlotte Potelle
- CHRU Lille; Institut Cœur-Poumon - Bd du Professeur Jules Leclercq - CHU Lille; F59037-Lille France
| | - Claude Kouakam
- CHRU Lille; Institut Cœur-Poumon - Bd du Professeur Jules Leclercq - CHU Lille; F59037-Lille France
| | - Loïc Finat
- CHRU Lille; Institut Cœur-Poumon - Bd du Professeur Jules Leclercq - CHU Lille; F59037-Lille France
| | - Laurence Guedon-Moreau
- CHRU Lille; Institut Cœur-Poumon - Bd du Professeur Jules Leclercq - CHU Lille; F59037-Lille France
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100
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[Basic structural features of a cardiac telemedicine center for patients with heart failure and implanted devices, cardiac arrhythmias, and increased risk of sudden cardiac death : Recommendations of the working group 33 Telemonitoring of the German Cardiac Society]. Herzschrittmacherther Elektrophysiol 2019; 30:136-142. [PMID: 30637467 DOI: 10.1007/s00399-018-0606-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 01/24/2023]
Abstract
Heart failure is one of the most common diseases. It is associated with high morbidity and mortality. Since heart failure is age-associated, the number of patients with heart failure is constantly increasing. At the same time, the imbalance between the need for treatment and the provision of care is growing. Telemonitoring/telemedicine offers patients in rural or remote areas access to high-quality health care and enables fast access to specialists. The working group 33 Telemonitoring of the German Cardiac Society describes the characteristics and possible applications of telemonitoring/telemedicine in the treatment of patients with heart failure. Furthermore, quality criteria for cardiological telemedicine centres are defined. In addition to the personnel structure of a telemedicine centre and the competencies of employees, requirements for the technical infrastructure and the management of incoming data and alarms are described.
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