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Bashshur RL, Shannon GW, Smith BR, Alverson DC, Antoniotti N, Barsan WG, Bashshur N, Brown EM, Coye MJ, Doarn CR, Ferguson S, Grigsby J, Krupinski EA, Kvedar JC, Linkous J, Merrell RC, Nesbitt T, Poropatich R, Rheuban KS, Sanders JH, Watson AR, Weinstein RS, Yellowlees P. The empirical foundations of telemedicine interventions for chronic disease management. Telemed J E Health 2014; 20:769-800. [PMID: 24968105 PMCID: PMC4148063 DOI: 10.1089/tmj.2014.9981] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 05/28/2014] [Indexed: 01/18/2023] Open
Abstract
The telemedicine intervention in chronic disease management promises to involve patients in their own care, provides continuous monitoring by their healthcare providers, identifies early symptoms, and responds promptly to exacerbations in their illnesses. This review set out to establish the evidence from the available literature on the impact of telemedicine for the management of three chronic diseases: congestive heart failure, stroke, and chronic obstructive pulmonary disease. By design, the review focuses on a limited set of representative chronic diseases because of their current and increasing importance relative to their prevalence, associated morbidity, mortality, and cost. Furthermore, these three diseases are amenable to timely interventions and secondary prevention through telemonitoring. The preponderance of evidence from studies using rigorous research methods points to beneficial results from telemonitoring in its various manifestations, albeit with a few exceptions. Generally, the benefits include reductions in use of service: hospital admissions/re-admissions, length of hospital stay, and emergency department visits typically declined. It is important that there often were reductions in mortality. Few studies reported neutral or mixed findings.
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Affiliation(s)
- Rashid L. Bashshur
- E-Health Center, University of Michigan Health System, Ann Arbor, Michigan
| | - Gary W. Shannon
- Department of Geography, University of Kentucky, Lexington, Kentucky
| | - Brian R. Smith
- E-Health Center, University of Michigan Health System, Ann Arbor, Michigan
| | | | | | | | - Noura Bashshur
- E-Health Center, University of Michigan Health System, Ann Arbor, Michigan
| | | | - Molly J. Coye
- University of California at Los Angeles, Los Angeles, California
| | - Charles R. Doarn
- Family and Community Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | - Jim Grigsby
- University of Colorado Denver, Denver, Colorado
| | | | - Joseph C. Kvedar
- Partners Health Care, Harvard University, Cambridge, Massachusetts
| | | | | | | | | | | | | | - Andrew R. Watson
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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202
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Ricci RP, Morichelli L, Varma N. Remote Monitoring for Follow-up of Patients with Cardiac Implantable Electronic Devices. Arrhythm Electrophysiol Rev 2014; 3:123-8. [PMID: 26835079 DOI: 10.15420/aer.2014.3.2.123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 08/07/2014] [Indexed: 11/04/2022] Open
Abstract
Follow-up of patients with cardiac implantable electronic devices is challenging due to the increasing number and technical complexity of devices coupled to increasing clinical complexity of patients. Remote monitoring (RM) offers the opportunity to optimise clinic workflow and to improve device monitoring and patient management. Several randomised clinical trials and registries have demonstrated that RM may reduce number of hospital visits, time required for patient follow-up, physician and nurse time, hospital and social costs. Furthermore, patient retention and adherence to follow-up schedule are significantly improved by RM. Continuous wireless monitoring of data stored in the device memory with automatic alerts allows early detection of device malfunctions and of events requiring clinical reaction, such as atrial fibrillation, ventricular arrhythmias and heart failure. Early reaction may improve patient outcome. RM is easy to use and patients showed a high level of acceptance and satisfaction. Implementing RM in daily practice may require changes in clinic workflow. To this purpose, new organisational models have been introduced. In spite of a favourable cost:benefit ratio, RM reimbursement still represents an issue in several European countries.
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Affiliation(s)
| | | | - Niraj Varma
- Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, US
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203
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Hindricks G, Taborsky M, Glikson M, Heinrich U, Schumacher B, Katz A, Brachmann J, Lewalter T, Goette A, Block M, Kautzner J, Sack S, Husser D, Piorkowski C, Søgaard P. Implant-based multiparameter telemonitoring of patients with heart failure (IN-TIME): a randomised controlled trial. Lancet 2014; 384:583-590. [PMID: 25131977 DOI: 10.1016/s0140-6736(14)61176-4] [Citation(s) in RCA: 502] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND An increasing number of patients with heart failure receive implantable cardioverter-defibrillators (ICDs) or cardiac resynchronisation defibrillators (CRT-Ds) with telemonitoring function. Early detection of worsening heart failure, or upstream factors predisposing to worsening heart failure, by implant-based telemonitoring might enable pre-emptive intervention and improve outcomes, but the evidence is weak. We investigated this possibility in IN-TIME, a clinical trial. METHODS We did this randomised, controlled trial at 36 tertiary clinical centres and hospitals in Australia, Europe, and Israel. We enrolled patients with chronic heart failure, NYHA class II-III symptoms, ejection fraction of no more than 35%, optimal drug treatment, no permanent atrial fibrillation, and a recent dual-chamber ICD or CRT-D implantation. After a 1 month run-in phase, patients were randomly assigned (1:1) to either automatic, daily, implant-based, multiparameter telemonitoring in addition to standard care or standard care without telemonitoring. Investigators were not masked to treatment allocation. Patients were masked to allocation unless they were contacted because of telemonitoring findings. Follow-up was 1 year. The primary outcome measure was a composite clinical score combining all-cause death, overnight hospital admission for heart failure, change in NYHA class, and change in patient global self-assessment, for the intention-to-treat population. The trial is registered with ClinicalTrials.gov, number NCT00538356. FINDINGS We enrolled 716 patients, of whom 664 were randomly assigned (333 to telemonitoring, 331 to control). Mean age was 65·5 years and mean ejection fraction was 26%. 285 (43%) of patients had NYHA functional class II and 378 (57%) had NYHA class III. Most patients received CRT-Ds (390; 58·7%). At 1 year, 63 (18·9%) of 333 patients in the telemonitoring group versus 90 (27·2%) of 331 in the control group (p=0·013) had worsened composite score (odds ratio 0·63, 95% CI 0·43-0·90). Ten versus 27 patients died during follow-up. INTERPRETATION Automatic, daily, implant-based, multiparameter telemonitoring can significantly improve clinical outcomes for patients with heart failure. Such telemonitoring is feasible and should be used in clinical practice. FUNDING Biotronik SE & Co. KG.
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Affiliation(s)
| | - Milos Taborsky
- Department of Internal Medicine I-Cardiology, Faculty of Medicine and Dentistry, Olomouc, Czech Republic
| | | | | | | | - Amos Katz
- Barzilai Medical Center, Ashkelon, Israel
| | | | | | | | | | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | | | | | - Peter Søgaard
- Heart Centre and Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
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204
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Abraham WT, Stough WG, Piña IL, Linde C, Borer JS, De Ferrari GM, Mehran R, Stein KM, Vincent A, Yadav JS, Anker SD, Zannad F. Trials of implantable monitoring devices in heart failure: which design is optimal? Nat Rev Cardiol 2014; 11:576-85. [DOI: 10.1038/nrcardio.2014.114] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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205
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Ricci RP, Morichelli L, D'Onofrio A, Calò L, Vaccari D, Zanotto G, Curnis A, Buja G, Rovai N, Gargaro A. Manpower and outpatient clinic workload for remote monitoring of patients with cardiac implantable electronic devices: data from the HomeGuide Registry. J Cardiovasc Electrophysiol 2014; 25:1216-23. [PMID: 24964380 DOI: 10.1111/jce.12482] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/22/2014] [Accepted: 05/30/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to assess manpower and resource consumption of the HomeGuide workflow model for remote monitoring (Biotronik Home Monitoring [HM], Biotronik SE & Co. KG, Berlin, Germany) of cardiac implantable electronic devices in daily clinical practice. METHODS The model established a cooperative interaction between a reference nurse (RN) for ordinary management, and a responsible physician (RP) for medical decisions in each outpatient clinic. RN reviewed remote transmissions and alerts, addressing critical cases to the RP. RESULTS A total of 1,650 patients were enrolled in 75 sites: 25% pacemakers (PM), 22% dual-, 27% single-chamber implantable defibrillators (ICD), 2% PM with cardiac resynchronization therapy (CRT), and 24% ICD-CRT. During a median follow-up of 18 (10-31) months, 3,364 HM sessions were performed (74% by the RN, 26% by the RP) to complete 18,478 remote follow-ups. Median duration of remote follow-ups was 1.2 (0.6-2.0) minutes, corresponding to a manpower of 43.3 (4.2-94.8) minutes/month every 100 patients for nurses and 10.2 (0.1-31.1) for physicians (P < 0.0001). RN submitted 15% of remote transmissions to RP, who decided unscheduled follow-ups in 12% of the cases. The median manpower for phone calls was 1.9 (0.8-16.5) minutes/month every 100 contacted patients. There were 2.84 in-hospital visits/patient, 0.46 of which triggered by HM findings. A cumulative per-patient HM follow-up time of 15.4 minutes (20% of total follow-up time) allowed remote detection of 73% of actionable events. CONCLUSIONS HM implemented in the HomeGuide workflow model required <1 hour/month every 100 patients to detect the majority of actionable events with limited administrative workload.
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206
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Dierckx R, Pellicori P, Cleland JGF, Clark AL. Telemonitoring in heart failure: Big Brother watching over you. Heart Fail Rev 2014; 20:107-16. [DOI: 10.1007/s10741-014-9449-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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207
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Remote monitoring of implantable cardioverter-defibrillators. Problems and implications using a telemonitoring system. Herz 2014; 40 Suppl 2:110-8. [PMID: 24848864 DOI: 10.1007/s00059-014-4080-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 01/02/2014] [Accepted: 02/07/2014] [Indexed: 10/25/2022]
Abstract
The rising number of implantable devices has led to an increase in device-related workload, e.g., regular interrogation follow-up visits. Telemonitoring systems for implantable cardioverter-defibrillators (ICDs) seem to be a promising tool for reducing workload and costs, and they have the potential of optimizing patient care. However, issues such as practical functionality of ICD telemonitoring in daily routine may affect its broad implementation. The objective of this study was to evaluate potential problems during the implementation of a telemonitoring system, Medtronic CareLink™ (CL™) with respect to the installation and data transmission process. A total of 159 patients with ICDs who were equipped with the CL™ system were evaluated and followed up for 16 months regarding the success rate of the first data transmission via the telemonitoring system. In this cohort, a high rate of nontransmission of 23.9 % was observed after the 16-month follow-up. A detailed interview of these patients (no transmission) revealed that the main reasons for failed transmissions were due to the patients' loss of interest in the concept (approximately 50 %) as well as technical problems (approximately 25 %) with setting up the system. These results indicate that telemonitoring systems bear potential problems and that the evaluation of patient motivation and technical support options seems to play an important role in establishing the functionality of these systems.
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208
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FREEDBERG NAHUMA, FELDMAN ALEXANDER. Remote Monitoring of Patients with Implantable Cardioverter Defibrillators (ICD): A Cute Gimmick or an Essential Tool for Clinical Excellence? J Cardiovasc Electrophysiol 2014; 25:771-3. [DOI: 10.1111/jce.12415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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209
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Almendral J, Pombo M, Martínez-Alday J, González-Rebollo JM, Rodríguez-Font E, Martínez-Ferrer J, Castellanos E, García-Fernández FJ, Ruiz-Mateas F. Update on arrhythmias and cardiac pacing 2013. ACTA ACUST UNITED AC 2014; 67:294-304. [PMID: 24774592 DOI: 10.1016/j.rec.2013.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 12/12/2013] [Indexed: 11/19/2022]
Abstract
This report discusses a selection of the most relevant articles on cardiac arrhythmias and pacing published in 2013. The first section discusses arrhythmias, classified as regular paroxysmal supraventricular tachyarrhythmias, atrial fibrillation, and ventricular arrhythmias, together with their treatment by means of an implantable cardioverter defibrillator. The next section reviews cardiac pacing, subdivided into resynchronization therapy, remote monitoring of implantable devices, and pacemakers. The final section discusses syncope.
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Affiliation(s)
- Jesús Almendral
- Unidad de Arritmias, Centro Integral de Enfermedades Cardiovasculares, Grupo HM Hospitales, Universidad CEU San Pablo, Madrid, Spain.
| | - Marta Pombo
- Unidad de Estimulación Cardiaca, Área de Cardiología, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Jesús Martínez-Alday
- Unidad de Arritmias, Servicio de Cardiología, Hospital de Basurto, Bilbao, Vizcaya, Spain
| | - José M González-Rebollo
- Unidad de Arritmias, Servicio de Cardiología, Complejo Asistencial Universitario de León, León, Spain
| | - Enrique Rodríguez-Font
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José Martínez-Ferrer
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario de Araba, Vitoria, Álava, Spain
| | - Eduardo Castellanos
- Unidad de Arritmias, Centro Integral de Enfermedades Cardiovasculares, Grupo HM Hospitales, Universidad CEU San Pablo, Madrid, Spain
| | | | - Francisco Ruiz-Mateas
- Unidad de Estimulación Cardiaca, Área de Cardiología, Hospital Costa del Sol, Marbella, Málaga, Spain
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210
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Affiliation(s)
- Chu-Pak Lau
- Cardiology Division, Department of Medicine, Queen Mary Hospital (C.-P.L., C.-W.S., H.-F.T.) and Research Center of Heart, Brain, Hormone and Healthy Ageing, Li Ka Shing Faculty of Medicine (C.-W.S., H.-F.T.), University of Hong Kong, Hong Kong SAR, China
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211
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Boriani G, Diemberger I, Ziacchi M, Valzania C, Gardini B, Cimaglia P, Martignani C, Biffi M. AF burden is important - fact or fiction? Int J Clin Pract 2014; 68:444-52. [PMID: 24499075 DOI: 10.1111/ijcp.12326] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Asymptomatic atrial fibrillation (AF) is common and in view of its prognostic impact (the same as of clinically overt AF) knowledge of the overall AF burden (defined as the amount of time spent in AF) appears to be important, both for scientific and clinical reasons. Data collected on more than 12,000 patients indicate that cardiac implantable electrical devices (CIEDs) are validated tools for measuring AF burden and that AF burden is associated with an increased risk of stroke. A maximum daily AF burden of ≥ 1 h carries important negative prognostic implications and may be a clinically relevant parameter for improving risk stratification for stroke. Decision-making should primarily consider the context in which asymptomatic, subclinical arrhythmias are detected (i.e. primary or secondary prevention of stroke and systemic embolism) and the risk profile of every individual patient with regard to thromboembolic and haemorrhagic risk, as well as patient preferences and values. Continuous monitoring using CIEDs with extensive data storage capabilities allow in-depth study of the temporal relationship between AF and ischaemic stroke. The relationships between AF and stroke are complex. AF is certainly a risk factor for cardioembolic stroke, with a cause-effect relationship between the arrhythmia and a thromboembolic event, the latter being related to atrial thrombi. However, AF can also be a simple 'marker of risk', with a non-causal association between the arrhythmia and stroke, the latter being possibly related to atheroemboli from the aorta, the carotid arteries or from other sources.
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Affiliation(s)
- G Boriani
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
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212
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Telemonitoring in heart failure: A state-of-the-art review. Rev Port Cardiol 2014; 33:229-39. [DOI: 10.1016/j.repc.2013.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 10/19/2013] [Indexed: 11/21/2022] Open
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213
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Almendral J, Pombo M, Martínez-Alday J, González-Rebollo JM, Rodríguez-Font E, Martínez-Ferrer J, Castellanos E, García-Fernández FJ, Ruiz-Mateas F. Novedades en arritmias y estimulación cardiaca en 2013. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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214
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Sousa C, Leite S, Lagido R, Ferreira L, Silva‐Cardoso J, Maciel MJ. Telemonitoring in heart failure: A state‐of‐the‐art review. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2013.10.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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215
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Auricchio A, Gold MR, Brugada J, Nölker G, Arunasalam S, Leclercq C, Defaye P, Calò L, Baumann O, Leyva F. Long-term effectiveness of the combined minute ventilation and patient activity sensors as predictor of heart failure events in patients treated with cardiac resynchronization therapy: Results of the Clinical Evaluation of the Physiological Diagnosis Function in the PARADYM CRT device Trial (CLEPSYDRA) study. Eur J Heart Fail 2014; 16:663-70. [PMID: 24639140 DOI: 10.1002/ejhf.79] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/03/2014] [Accepted: 02/07/2014] [Indexed: 11/09/2022] Open
Abstract
AIMS Monitoring early signs of clinical deterioration could allow physicians to adjust medical treatment for patients at risk of acute heart failure decompensation. To date, several strategies using different surrogate measures of clinical status emerged, but none has yet been proven to predict clinical events. We hypothesized that the Physiological Diagnostic feature, which combines data from minute ventilation and physical activity sensors, predicts heart failure events in patients implanted with cardiac resynchronization therapy with defibrillation (CRT-D) devices. METHODS AND RESULTS The Clinical Evaluation of the Physiological Diagnostic feature in the PARADYM CRT device (CLEPSYDRA) trial is a multicentre, prospective, non-randomized, double-blind study comprising 521 CRT-D patients with heart failure [67.4 ± 10.1 years (mean ± SD), 82% male, New York Heart Association class III/IV 85.0%/6.7%, QRS 155.3 ± 26.6 ms, left ventricular ejection fraction 25.7 ± 7.7%]. The objective of the study was the sensitivity and false positive rate of the Physiological Diagnostic algorithm to predict heart failure events within the following month. After a mean follow-up of 17.0 ± 8.7 months, 130 (25.6%) patients experienced a heart failure event. The sensitivity of the algorithm to predict an event was 34% and the false positive rate was 2.4 per patient-year. CONCLUSION Thirty-four per cent of heart failure events occurring within a month were predicted by the Physiological Diagnostic algorithm, and 2.4 alerts per patient per year were not followed by an heart failure event within the subsequent month.
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Affiliation(s)
- Angelo Auricchio
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
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216
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Guédon-Moreau L, Lacroix D, Sadoul N, Clémenty J, Kouakam C, Hermida JS, Aliot E, Kacet S. Costs of remote monitoring vs. ambulatory follow-ups of implanted cardioverter defibrillators in the randomized ECOST study. Europace 2014; 16:1181-8. [PMID: 24614572 PMCID: PMC4114330 DOI: 10.1093/europace/euu012] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS The Effectiveness and Cost of ICD follow-up Schedule with Telecardiology (ECOST) trial evaluated prospectively the economic impact of long-term remote monitoring (RM) of implantable cardioverter defibrillators (ICDs). METHODS AND RESULTS The analysis included 310 patients randomly assigned to RM (active group) vs. ambulatory follow-ups (control group). Patients in the active group were seen once a year unless the system reported an event mandating an ambulatory visit, while patients in the control group were seen in the ambulatory department every 6 months. The costs of each follow-up strategy were compared, using the actual billing documents issued by the French health insurance system, including costs of (i) (a) ICD-related ambulatory visits and transportation, (b) other ambulatory visits, (c) cardiovascular treatments and procedures, and (ii) hospitalizations for the management of cardiovascular events. The ICD and RM system costs were calculated on the basis of the device remaining longevity at the end of the study. The characteristics of the study groups were similar. Over a follow-up of 27 months, the mean non-hospital costs per patient-year were €1695 ± 1131 in the active, vs. €1952 ± 1023 in the control group (P = 0.04), a €257 difference mainly due to device management. The hospitalization costs per patient-year were €2829 ± 6382 and €3549 ± 9714 in the active and control groups, respectively (P = 0.46). Adding the ICD to the non-hospital costs, the savings were €494 (P = 0.005) or, when the monitoring system was included, €315 (P = 0.05) per patient-year. CONCLUSION From the French health insurance perspective, the remote management of ICD patients is cost saving. CLINICAL TRIALS REGISTRATION NCT00989417, www.clinicaltrials.gov.
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Affiliation(s)
| | | | - Nicolas Sadoul
- Centre Hospitalier Universitaire Brabois, F-54500 Nancy, France
| | - Jacques Clémenty
- Centre Hospitalier Universitaire Haut-Lévêque, F-33064 Pessac, France
| | - Claude Kouakam
- Centre Hospitalier Régional Universitaire, F-59037 Lille, France
| | | | - Etienne Aliot
- Centre Hospitalier Universitaire Brabois, F-54500 Nancy, France
| | - Salem Kacet
- Centre Hospitalier Régional Universitaire, F-59037 Lille, France
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217
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Gillis AM. Expert commentary: how well has the call from Heart Rhythm Society/European Heart Rhythm Association for improved device monitoring been answered? Europace 2014; 15 Suppl 1:i32-i34. [PMID: 23737227 DOI: 10.1093/europace/eut111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This commentary highlights the benefits of remote device monitoring and explores some of the challenges implementation of this technology worldwide.
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Affiliation(s)
- Anne M Gillis
- Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, 3280 Hospital Drive NW, Calgary, AB, Canada.
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218
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Chronaki CE, Vardas P. Remote monitoring costs, benefits, and reimbursement: a European perspective. Europace 2014; 15 Suppl 1:i59-i64. [PMID: 23737233 DOI: 10.1093/europace/eut110] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
AIMS To provide a European perspective on reimbursement issues surrounding remote monitoring of cardiac implantable electronic devices in view of the anticipated costs and benefits. METHODS AND RESULTS Review of recent literature addressing clinical, economic, sociocultural, and technological factors associated with remote monitoring. When healthcare transformation is urgently needed, remote monitoring offers opportunities to innovate and cope with escalating costs and constrained resources, while improving patient safety, quality, and access to care as reflected in clinical studies. The introduction of remote monitoring into daily practice requires analysis of reimbursement policies to address funding scope, payment method, payer, price and allocation, and alignment with health system objectives and goals to ensure financial and operational sustainability of resources, infrastructure, and processes. Remote monitoring policies should gradually transition from activity-based, added-value services in a care-and-cure setting, to performance and outcome-oriented highlighting prevention, surveillance, and empowerment. By encouraging and rewarding innovation and interoperability, proprietary remote monitoring technologies can open up using standards and connect to support a growing evidence base that guides clinical decision support and planning of future policies. CONCLUSION Careful planning, sharing of experiences, and gradual adoption of reimbursement models that focus on outcome, performance, and cost-effectiveness are key aspects of containing escalating costs and improving quality and access to healthcare. Despite differences in health systems and payment methods in Europe, policy-makers, professional societies, payers, providers, and the industry need to join forces to transform healthcare and make innovation happen.
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Abstract
BACKGROUND Appropriate ICD programming is the key to prevent inappropriate shock delivery, that is closely associated to a negative patients' outcome. METHODS Review of the literature on ICD therapy to generate ICD programmings that can be applied to the broad population of ICD and CRT-D carriers. RESULTS Arrhythmia detection should occur with a detection time ranging 9″-12″ in the VF zone, and 15″-60″ in the VT zone. Discriminator should be applied at least up to 200 bpm. ATP therapy is applied to all VTs up to 250 bpm, with a success rate of 70%. Inappropriate shocks should occur in <3.6% of patients. CONCLUSION Tailored ICD programming can be achieved following evidence from large ICD trials. Pre-defined settings that are saved on the programmer and that can be uploaded at device implantation help to ensure optimal programming and to avoid random errors.
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Affiliation(s)
- Mauro Biffi
- Institute of Cardiology, Policlinico S. Orsola-Malpighi, University of Bologna, Italy.
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220
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Al-Zaiti SS, Shusterman V, Carey MG. Novel technical solutions for wireless ECG transmission & analysis in the age of the internet cloud. J Electrocardiol 2013; 46:540-5. [DOI: 10.1016/j.jelectrocard.2013.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Indexed: 10/26/2022]
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221
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Abstract
Modern pacemakers and implantable defibrillators are able to automatically perform tests executed manually during in-office visits; such as measurement of sensing and pacing thresholds. In addition, the devices also record a wealth of diagnostic data that are of clinical relevance. The advent of wireless technology in these devices allows automatic transmission of these data that can be consulted remotely by the physician. There is now solid evidence indicating that remote device follow-up can safely reduce the number of in-office visits, thereby improving convenience for patients and caregivers alike. Remote monitoring with automatic alerts for arrhythmias, heart failure and technical issues, has been shown to dramatically reduce delay to diagnosis of these events compared with standard follow-up; potentially improving patient safety and outcome. For these reasons, remote device management is becoming the standard of care.
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Affiliation(s)
- Haran Burri
- Cardiology Service, University Hospital of Geneva, Geneva, Switzerland
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222
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Abstract
Ventricular arrhythmias may be benign, requiring only evaluation for associated risks and then reassurance, or associated with a risk of sudden death or significant morbidity. Therapies for these arrhythmias have evolved considerably over the past 20 years. For some, a definitive, curative therapy is available in the form of catheter ablation. Others are best managed with an implantable cardioverter-defibrillator that provides effective arrhythmia termination and protection from sudden death, with antiarrhythmic drugs or ablation to control recurrent arrhythmias. Although progress has been substantial, many challenges remain.
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223
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Abstract
"The Teledactyl (Tele, far; Dactyl, finger--from the Greek) is a future instrument by which it will be possible for us to 'feel at a distance.' This idea is not at all impossible, for the instrument can be built today with means available right now. It is simply the well known telautograph, translated into radio terms, with additional refinements. The doctor of the future, by means of this instrument, will be able to feel his patient, as it were, at a distance...The doctor manipulates his controls, which are then manipulated at the patient's room in exactly the same manner. The doctor sees what is going on in the patient's room by means of a television screen." -Hugo Gernsback, Science and Invention Magazine, February 1925 Heart failure continues to be a major burden on our health care system. As the number of patients with heart failure increases, the cost of hospitalization alone is contributing significantly to the overall cost of this disease. Readmission rate and hospital length of stay are emerging as quality markers of heart failure care along with reimbursement policies that force hospitals to optimize these outcomes. Apart from maintaining quality assurance, the disease process of heart failure per-se requires demanding and close attention to vitals, diet, and medication compliance to prevent acute decompensation episodes. Remote patient monitoring is morphing into a key disease management strategy to optimize care for heart failure. Innovative implantable technologies to monitor intracardiac hemodynamics also are evolving, which potentially could offer better and substantial parameters to monitor.
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Affiliation(s)
- Arvind Bhimaraj
- Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, Texas, USA
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224
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Impact of in-clinic follow-up visits in patients with implantable cardioverter defibrillators: demographic and socioeconomic analysis of the TARIFF study population. J Interv Card Electrophysiol 2013; 38:101-6. [DOI: 10.1007/s10840-013-9823-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 07/22/2013] [Indexed: 12/28/2022]
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225
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Luzi M, De Simone A, Leoni L, Amellone C, Pisanò E, Favale S, Iacoviello M, Luise R, Bongiorni MG, Stabile G, La Rocca V, Folino F, Capucci A, D'Onofrio A, Accardi F, Valsecchi S, Buia G. Remote monitoring for implantable defibrillators: a nationwide survey in Italy. Interact J Med Res 2013; 2:e27. [PMID: 24055720 PMCID: PMC3786126 DOI: 10.2196/ijmr.2824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 08/01/2013] [Accepted: 08/09/2013] [Indexed: 11/13/2022] Open
Abstract
Background Remote monitoring (RM) permits home interrogation of implantable cardioverter defibrillator (ICD) and provides an alternative option to frequent in-person visits. Objective The Italia-RM survey aimed to investigate the current practice of ICD follow-up in Italy and to evaluate the adoption and routine use of RM. Methods An ad hoc questionnaire on RM adoption and resource use during in-clinic and remote follow-up sessions was completed in 206 Italian implanting centers. Results The frequency of routine in-clinic ICD visits was 2 per year in 158/206 (76.7%) centers, 3 per year in 37/206 (18.0%) centers, and 4 per year in 10/206 (4.9%) centers. Follow-up examinations were performed by a cardiologist in 203/206 (98.5%) centers, and by more than one health care worker in 184/206 (89.3%) centers. There were 137/206 (66.5%) responding centers that had already adopted an RM system, the proportion of ICD patients remotely monitored being 15% for single- and dual-chamber ICD and 20% for cardiac resynchronization therapy ICD. Remote ICD interrogations were scheduled every 3 months, and were performed by a cardiologist in 124/137 (90.5%) centers. After the adoption of RM, the mean time between in-clinic visits increased from 5 (SD 1) to 8 (SD 3) months (P<.001). Conclusions In current clinical practice, in-clinic ICD follow-up visits consume a large amount of health care resources. The results of this survey show that RM has only partially been adopted in Italy and, although many centers have begun to implement RM in their clinical practice, the majority of their patients continue to be routinely followed-up by means of in-clinic visits.
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Affiliation(s)
- Mario Luzi
- Azienda Ospedaliero Universitaria Ospedali Riuniti, Cardiology Clinic, Ancona, Italy.
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Boriani G, Da Costa A, Ricci RP, Quesada A, Favale S, Iacopino S, Romeo F, Risi A, Mangoni di S Stefano L, Navarro X, Biffi M, Santini M, Burri H. The MOnitoring Resynchronization dEvices and CARdiac patiEnts (MORE-CARE) randomized controlled trial: phase 1 results on dynamics of early intervention with remote monitoring. J Med Internet Res 2013; 15:e167. [PMID: 23965236 PMCID: PMC3758044 DOI: 10.2196/jmir.2608] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 05/20/2013] [Accepted: 06/09/2013] [Indexed: 11/13/2022] Open
Abstract
Background Remote monitoring (RM) in patients with advanced heart failure and cardiac resynchronization therapy defibrillators (CRT-D) may reduce delays in clinical decisions by transmitting automatic alerts. However, this strategy has never been tested specifically in this patient population, with alerts for lung fluid overload, and in a European setting. Objective The main objective of Phase 1 (presented here) is to evaluate if RM strategy is able to reduce time from device-detected events to clinical decisions. Methods In this multicenter randomized controlled trial, patients with moderate to severe heart failure implanted with CRT-D devices were randomized to a Remote group (with remote follow-up and wireless automatic alerts) or to a Control group (with standard follow-up without alerts). The primary endpoint of Phase 1 was the delay between an alert event and clinical decisions related to the event in the first 154 enrolled patients followed for 1 year. Results The median delay from device-detected events to clinical decisions was considerably shorter in the Remote group compared to the Control group: 2 (25th-75th percentile, 1-4) days vs 29 (25th-75th percentile, 3-51) days respectively, P=.004. In-hospital visits were reduced in the Remote group (2.0 visits/patient/year vs 3.2 visits/patient/year in the Control group, 37.5% relative reduction, P<.001). Automatic alerts were successfully transmitted in 93% of events occurring outside the hospital in the Remote group. The annual rate of all-cause hospitalizations per patient did not differ between the two groups (P=.65). Conclusions RM in CRT-D patients with advanced heart failure allows physicians to promptly react to clinically relevant automatic alerts and significantly reduces the burden of in-hospital visits. Trial Registration Clinicaltrials.gov NCT00885677; http://clinicaltrials.gov/show/NCT00885677 (Archived by WebCite at http://www.webcitation.org/6IkcCJ7NF).
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Affiliation(s)
- Giuseppe Boriani
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S Orsola-Malpighi University Hospital, Bologna, Italy.
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228
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Hindricks G, Elsner C, Piorkowski C, Taborsky M, Geller JC, Schumacher B, Bytesnik J, Kottkamp H. Quarterly vs. yearly clinical follow-up of remotely monitored recipients of prophylactic implantable cardioverter-defibrillators: results of the REFORM trial. Eur Heart J 2013; 35:98-105. [PMID: 23868932 PMCID: PMC3882723 DOI: 10.1093/eurheartj/eht207] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aims The rapidly increasing number of patients with implantable cardioverter-defibrillators (ICD) places a large burden on follow-up providers. This study investigated the possibility of longer in-office follow-up intervals in primary prevention ICD patients under remote monitoring with automatic daily data transmissions from the implant memory. Methods and results Conducted in 155 ICD recipients with MADIT II indications, the study compared the burden of scheduled and unscheduled ICD follow-up visits, quality of life (SF-36), and clinical outcomes in patients randomized to either 3- or 12-month follow-up intervals in the period between 3 and 27 months after implantation. Remote monitoring (Biotronik Home Monitoring) was used equally in all patients. In contrast to previous clinical studies, no calendar-based remote data checks were performed between scheduled in-office visits. Compared with the 3-month follow-up interval, the 12-month interval resulted in a minor increase in the number of unscheduled follow-ups (0.64 vs. 0.27 per patient-year; P = 0.03) and in a major reduction in the total number of in-office ICD follow-ups (1.60 vs. 3.85 per patient-year; P < 0.001). No significant difference was found in mortality, hospitalization rate, or hospitalization length during the 2-year observation period, but more patients were lost to follow-up in the 12-month group (10 vs. 3; P = 0.04). The SF-36 scores favoured the 12-month intervals in the domains ‘social functioning’ and ‘mental health’. Conclusion In prophylactic ICD recipients under automatic daily remote monitoring, the extension of the 3-month in-office follow-up interval to 12 months appeared to safely reduce the ICD follow-up burden during 27 months after implantation. ClinicalTrials.gov Identifier NCT00401466 (http://www.clinicaltrials.gov/ct2/show/NCT00401466).
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Affiliation(s)
- Gerhard Hindricks
- Internal Medicine and Cardiology Division, University of Leipzig Heart Center, Strümpellstrasse 39, Leipzig D-04289, Germany
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Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, Cleland J, Deharo JC, Delgado V, Elliott PM, Gorenek B, Israel CW, Leclercq C, Linde C, Mont L, Padeletti L, Sutton R, Vardas PE. 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Europace 2013; 15:1070-118. [PMID: 23801827 DOI: 10.1093/europace/eut206] [Citation(s) in RCA: 751] [Impact Index Per Article: 68.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
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- Department of Cardiology, Ospedali del Tigullio, Via Don Bobbio 25, IT-16033 Lavagna, (GE) Italy
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Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, Cleland J, Deharo JC, Delgado V, Elliott PM, Gorenek B, Israel CW, Leclercq C, Linde C, Mont L, Padeletti L, Sutton R, Vardas PE, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Kirchhof P, Blomstrom-Lundqvist C, Badano LP, Aliyev F, Bänsch D, Baumgartner H, Bsata W, Buser P, Charron P, Daubert JC, Dobreanu D, Faerestrand S, Hasdai D, Hoes AW, Le Heuzey JY, Mavrakis H, McDonagh T, Merino JL, Nawar MM, Nielsen JC, Pieske B, Poposka L, Ruschitzka F, Tendera M, Van Gelder IC, Wilson CM. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J 2013; 34:2281-329. [PMID: 23801822 DOI: 10.1093/eurheartj/eht150] [Citation(s) in RCA: 1444] [Impact Index Per Article: 131.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Michele Brignole
- Department of Cardiology, Ospedali del Tigullio, Via Don Bobbio 25, IT-16033 Lavagna, (GE) Italy.
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Varma N, Brugada P. Automatic remote monitoring: milestones reached, paths to pave. Europace 2013; 15 Suppl 1:i69-i71. [DOI: 10.1093/europace/eut118] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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232
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Lau CP, Zhang S. Remote monitoring of cardiac implantable devices in the Asia-Pacific. Europace 2013; 15 Suppl 1:i65-i68. [DOI: 10.1093/europace/eut081] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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233
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Guédon-Moreau L, Mabo P, Kacet S. Current clinical evidence for remote patient management. ACTA ACUST UNITED AC 2013; 15 Suppl 1:i6-i10. [DOI: 10.1093/europace/eut119] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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234
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Zanaboni P, Landolina M, Marzegalli M, Lunati M, Perego GB, Guenzati G, Curnis A, Valsecchi S, Borghetti F, Borghi G, Masella C. Cost-utility analysis of the EVOLVO study on remote monitoring for heart failure patients with implantable defibrillators: randomized controlled trial. J Med Internet Res 2013; 15:e106. [PMID: 23722666 PMCID: PMC3670725 DOI: 10.2196/jmir.2587] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/25/2013] [Accepted: 05/09/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Heart failure patients with implantable defibrillators place a significant burden on health care systems. Remote monitoring allows assessment of device function and heart failure parameters, and may represent a safe, effective, and cost-saving method compared to conventional in-office follow-up. OBJECTIVE We hypothesized that remote device monitoring represents a cost-effective approach. This paper summarizes the economic evaluation of the Evolution of Management Strategies of Heart Failure Patients With Implantable Defibrillators (EVOLVO) study, a multicenter clinical trial aimed at measuring the benefits of remote monitoring for heart failure patients with implantable defibrillators. METHODS Two hundred patients implanted with a wireless transmission-enabled implantable defibrillator were randomized to receive either remote monitoring or the conventional method of in-person evaluations. Patients were followed for 16 months with a protocol of scheduled in-office and remote follow-ups. The economic evaluation of the intervention was conducted from the perspectives of the health care system and the patient. A cost-utility analysis was performed to measure whether the intervention was cost-effective in terms of cost per quality-adjusted life year (QALY) gained. RESULTS Overall, remote monitoring did not show significant annual cost savings for the health care system (€1962.78 versus €2130.01; P=.80). There was a significant reduction of the annual cost for the patients in the remote arm in comparison to the standard arm (€291.36 versus €381.34; P=.01). Cost-utility analysis was performed for 180 patients for whom QALYs were available. The patients in the remote arm gained 0.065 QALYs more than those in the standard arm over 16 months, with a cost savings of €888.10 per patient. Results from the cost-utility analysis of the EVOLVO study show that remote monitoring is a cost-effective and dominant solution. CONCLUSIONS Remote management of heart failure patients with implantable defibrillators appears to be cost-effective compared to the conventional method of in-person evaluations. TRIAL REGISTRATION ClinicalTrials.gov NCT00873899; http://clinicaltrials.gov/show/NCT00873899 (Archived by WebCite at http://www.webcitation.org/6H0BOA29f).
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Affiliation(s)
- Paolo Zanaboni
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway.
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235
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"We as Human Beings Get Farther and Farther Apart": the experiences of patients with remote monitoring systems. Heart Lung 2013; 42:313-9. [PMID: 23582212 DOI: 10.1016/j.hrtlng.2013.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/28/2013] [Accepted: 03/01/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To explore the experiences of patients living with an implantable cardioverter-defibrillator (ICD) who had received remote monitoring (RM). BACKGROUND Anecdotal evidence suggests that not all patients with RM use the technology. METHODS Focus groups of patients with an ICD who received an RM system. Transcripts reviewed using thematic analysis. RESULTS Nine patients (3 women and 6 men; median [range] age, 73 [58-91] years) received an RM system. Patients were assigned to a group in regard to RM system use (nonusers, n = 5; users, n = 4). Few nonusers recalled having prior conversations about the system. Users described it as "simple" and "easy" to use. Nonusers often were unsure whether their system was correctly transmitting information. System benefits perceived by users included convenience and security. Nonusers expressed mistrust. Recommendations included early education and help lines. CONCLUSIONS Patient adherence to RM systems can be improved by explaining perceived benefits and addressing barriers to use.
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Calò L, Gargaro A, De Ruvo E, Palozzi G, Sciarra L, Rebecchi M, Guarracini F, Fagagnini A, Piroli E, Lioy E, Chirico A. Economic impact of remote monitoring on ordinary follow-up of implantable cardioverter defibrillators as compared with conventional in-hospital visits. A single-center prospective and randomized study. J Interv Card Electrophysiol 2013; 37:69-78. [PMID: 23515883 DOI: 10.1007/s10840-013-9783-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 01/13/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Few data are available on actual follow-up costs of remote monitoring (RM) of implantable defibrillators (ICD). Our study aimed at assessing current direct costs of 1-year ICD follow-up based on RM compared with conventional quarterly in-hospital follow-ups. METHODS AND RESULTS Patients (N = 233) with indications for ICD were consecutively recruited and randomized at implant to be followed up for 1 year with standard quarterly in-hospital visits or by RM with one in-hospital visit at 12 months, unless additional in-hospital visits were required due to specific patient conditions or RM alarms. Costs were calculated distinguishing between provider and patient costs, excluding RM device and service cost. The frequency of scheduled in-hospital visits was lower in the RM group than in the control arm. Follow-up required 47 min per patient/year in the RM arm versus 86 min in the control arm (p = 0.03) for involved physicians, generating cost estimates for the provider of USD 45 and USD 83 per patient/year, respectively. Costs for nurses were comparable. Overall, the costs associated with RM and standard follow-up were USD 103 ± 27 and 154 ± 21 per patient/year, respectively (p = 0.01). RM was cost-saving for the patients: USD 97 ± 121 per patient/year in the RM group versus 287 ± 160 per patient/year (p = 0.0001). CONCLUSION The time spent by the hospital staff was significantly reduced in the RM group. If the costs for the device and service are not charged to patients or the provider, patients could save about USD 190 per patient/year while the hospital could save USD 51 per patient/year.
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Affiliation(s)
- Leonardo Calò
- Division of Cardiology, Policlinico Casilino, ASL Roma B, Via Casilina, 1049, 00169, Rome, Italy.
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Stellbrink C, Andresen D, Böcker D, Lewalter T. [Implantable cardioverter defibrillator]. Herzschrittmacherther Elektrophysiol 2013; 24:75-78. [PMID: 23608953 DOI: 10.1007/s00399-013-0265-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This article aims to give an overview over important articles in the field of implantable cardioverter defibrillator (ICD) therapy in 2012. Important publications concern analyses on therapy efficacy and safety of the subcutaneous ICD, gender-specific differences in the complication rate and prognosis after ICD implantation, the necessity of intraoperative testing of the defibrillation threshold and the impact of preventive measures to reduce ICD therapies on prognosis after device implantation. The relevance of the study findings for daily clinical practice is briefly discussed.
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Affiliation(s)
- C Stellbrink
- Klinik für Kardiologie und Internistische Intensivmedizin, Klinikum Bielefeld, Teutoburger Strasse 50, Bielefeld, Germany.
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Moya À, Sancho-Tello MJ, Arenal Á, Fidalgo ML, Brugada R, Martínez Ferrer J, Merino JL, Ruíz Mateas F, Mont JL. Innovations in heart rhythm disturbances: cardiac electrophysiology, arrhythmias, and cardiac pacing. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2013; 66:116-23. [PMID: 24775385 DOI: 10.1016/j.rec.2012.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 10/03/2012] [Indexed: 11/24/2022]
Abstract
This article reviews the most relevant articles published in 2012 in the field of arrhythmias, on subjects that include clinical arrhythmology, ablation, cardiac pacing, and the genetics of sudden cardiac death.
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Affiliation(s)
- Àngel Moya
- Unidad de Arritmias, Servicio de Cardiología, Universidad Autónoma de Barcelona, Hospital General Universitario Vall d'Hebron, Barcelona, Spain.
| | - María José Sancho-Tello
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ángel Arenal
- Unidad de Arritmias, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Ramon Brugada
- Centre de Genètica Cardiovascular IDIBGI y Facultad de Medicina, Universidad de Girona, Girona, Spain
| | - José Martínez Ferrer
- Unidad de Arritmias, Servicio de Cardiología, Hospital General de Araba, Vitoria, Álava, Spain
| | - José Luis Merino
- Unidad de Electrofisiología Cardiaca Robotizada, Servicio de Cardiología, Hospital La Paz, Madrid, Spain
| | - Francisco Ruíz Mateas
- Unidad de Estimulación Cardiaca, Servicio de Cardiología, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Josep Lluis Mont
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínic, Barcelona, Spain
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Novedades en alteraciones del ritmo cardiaco: electrofisiología cardiaca, arritmias y estimulación cardiaca. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Ricci RP, Morichelli L, D'Onofrio A, Calò L, Vaccari D, Zanotto G, Curnis A, Buja G, Rovai N, Gargaro A. Effectiveness of remote monitoring of CIEDs in detection and treatment of clinical and device-related cardiovascular events in daily practice: the HomeGuide Registry. Europace 2013; 15:970-7. [PMID: 23362021 PMCID: PMC3689436 DOI: 10.1093/europace/eus440] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aims The HomeGuide Registry was a prospective study (NCT01459874), implementing a model for remote monitoring of cardiac implantable electronic devices (CIEDs) in daily clinical practice, to estimate effectiveness in major cardiovascular event detection and management. Methods and results The workflow for remote monitoring [Biotronik Home Monitoring (HM)] was based on primary nursing: each patient was assigned to an expert nurse for management and to a responsible physician for medical decisions. In-person visits were scheduled once a year. Seventy-five Italian sites enrolled 1650 patients [27% pacemakers, 27% single-chamber implantable cardioverter defibrillators (ICDs), 22% dual-chamber ICDs, 24% ICDs with cardiac resynchronization therapy]. Population resembled the expected characteristics of CIED patients. During a 20 ± 13 month follow-up, 2471 independently adjudicated events were collected in 838 patients (51%): 2033 (82%) were detected during HM sessions; 438 (18%) during in-person visits. Sixty were classified as false-positive, with generalized estimating equation-adjusted sensitivity and positive predictive value of 84.3% [confidence interval (CI), 82.5–86.0%] and 97.4% (CI, 96.5–98.2%), respectively. Overall, 95% of asymptomatic and 73% of actionable events were detected during HM sessions. Median reaction time was 3 days [interquartile range (IQR), 1–14 days]. Generalized estimating equation-adjusted incremental utility, calculated according to four properties of major clinical interest, was in favour of the HM sessions: +0.56 (CI, 0.53–0.58%), P < 0.0001. Resource consumption: 3364 HM sessions performed (76% by nurses), median committed monthly manpower of 55.5 (IQR, 22.0–107.0) min × health personnel/100 patients. Conclusion Home Monitoring was highly effective in detecting and managing clinical events in CIED patients in daily practice with remarkably low manpower and resource consumption.
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Affiliation(s)
- Renato Pietro Ricci
- Department of Cardiology, San Filippo Neri Hospital, via Martinotti 20, Rome, Italy.
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Kamakura S. Necessity of Face-to-Face Encounters With Recipients of Cardiovascular Implantable Electronic Devices With Remote Monitoring. Circ J 2013; 77:2691-3. [DOI: 10.1253/circj.cj-13-1110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shiro Kamakura
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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Zabel M, Vollmann D, Lüthje L, Seegers J, Sohns C, Zenker D, Hasenfuss G. Randomized Clinical evaluatiON of wireless fluid monitoriNg and rEmote ICD managemenT using OptiVol alert-based predefined management to reduce cardiac decompensation and health care utilization: the CONNECT-OptiVol study. Contemp Clin Trials 2012; 34:109-16. [PMID: 23073567 DOI: 10.1016/j.cct.2012.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 10/08/2012] [Accepted: 10/08/2012] [Indexed: 10/27/2022]
Abstract
AIMS The CONNECT-OptiVol study is designed to investigate whether wireless fluid monitoring using OptiVol alerts as well as implantable cardioverter-defibrillator (ICD) remote monitoring (RM) reduces cardiac decompensations and health care utilization in ICD patients, as compared to standard clinical care. METHODS Patients undergoing implantation of wireless telemetry-enabled dual chamber (ICD-DR) or cardiac resynchronization therapy/defibrillator (CRT-D) devices with the OptiVol feature are eligible for the study. In a randomized fashion, OptiVol function, its audible alert as well as its remote alert, and other ICD RM alerts are switched ON or OFF. The primary study objective is to estimate an improvement of heart failure status. The primary endpoint is measured as a prolongation of the time to first hospitalization due to worsened heart failure. The secondary objectives are to estimate: a reduction of the time from event to clinical decision, a reduction of the rate of health care utilization, and improved quality of life (QoL) measures (secondary endpoints). The study is designed as a single center pilot study with 180 patients randomized 1:1 to the two study arms. CONCLUSION The CONNECT-OptiVol study aims to answer whether wireless fluid monitoring integrated into RM may reduce cardiac decompensations and health care utilization in ICD patients. The results can be used to adequately power future studies evaluating the benefit of these features. Study enrollment has been completed, and follow-up is expected to be finished in September 2012.
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Affiliation(s)
- Markus Zabel
- Dept. of Cardiology and Pneumology, Heart Research Center, University Medical Center, Göttingen, Germany.
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