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Scacciavillani R, Koliastasis L, Doundoulakis I, Chiotis S, Kordalis A, Narducci ML, Kotoulas S, Pinnacchio G, Bencardino G, Perna F, Comerci G, Gatzoulis KA, Tsiachris D, Pelargonio G. Remote Monitoring of Cardiac Implantable Electronic Devices in Very Elderly Patients: Advantages and Specific Problems. J Cardiovasc Dev Dis 2024; 11:209. [PMID: 39057629 PMCID: PMC11277150 DOI: 10.3390/jcdd11070209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Cardiac implantable electronic devices (CIEDs) offer the benefit of remote monitoring and decision making and find particular applications in special populations such as the elderly. Less transportation, reduced costs, prompt diagnosis, a sense of security, and continuous real-time monitoring are the main advantages. On the other hand, less physician-patient interactions and the technology barrier in the elderly pose specific problems in remote monitoring. CIEDs nowadays are abundant and are mostly represented by rhythm control/monitoring devices, whereas hemodynamic remote monitoring devices are gaining popularity and are evolving and becoming refined. Future directions include the involvement of artificial intelligence, yet disparities of availability, lack of follow-up data, and insufficient patient education are still areas to be improved. This review aims to describe the role of CIED in the very elderly and highlight the merits and possible drawbacks.
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Affiliation(s)
- Roberto Scacciavillani
- Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy; (R.S.); (G.P.)
| | - Leonidas Koliastasis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (L.K.); (S.C.); (A.K.); (S.K.); (K.A.G.); (D.T.)
| | - Ioannis Doundoulakis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (L.K.); (S.C.); (A.K.); (S.K.); (K.A.G.); (D.T.)
| | - Sotirios Chiotis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (L.K.); (S.C.); (A.K.); (S.K.); (K.A.G.); (D.T.)
| | - Athanasios Kordalis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (L.K.); (S.C.); (A.K.); (S.K.); (K.A.G.); (D.T.)
| | - Maria Lucia Narducci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (G.P.); (G.B.); (F.P.); (G.C.)
- Cardiology Unit, Cardiothoracic Department, Azienda Ospedaliera Universitaria Santa Maria della Misericordia, 33100 Udine, Italy
| | - Sotiris Kotoulas
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (L.K.); (S.C.); (A.K.); (S.K.); (K.A.G.); (D.T.)
| | - Gaetano Pinnacchio
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (G.P.); (G.B.); (F.P.); (G.C.)
| | - Gianluigi Bencardino
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (G.P.); (G.B.); (F.P.); (G.C.)
| | - Francesco Perna
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (G.P.); (G.B.); (F.P.); (G.C.)
| | - Gianluca Comerci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (G.P.); (G.B.); (F.P.); (G.C.)
| | - Konstantinos A. Gatzoulis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (L.K.); (S.C.); (A.K.); (S.K.); (K.A.G.); (D.T.)
| | - Dimitris Tsiachris
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (L.K.); (S.C.); (A.K.); (S.K.); (K.A.G.); (D.T.)
| | - Gemma Pelargonio
- Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy; (R.S.); (G.P.)
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (G.P.); (G.B.); (F.P.); (G.C.)
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Ferrick AM, Raj SR, Deneke T, Kojodjojo P, Lopez-Cabanillas N, Abe H, Boveda S, Chew DS, Choi JI, Dagres N, Dalal AS, Dechert BE, Frazier-Mills CG, Gilbert O, Han JK, Hewit S, Kneeland C, DeEllen Mirza S, Mittal S, Ricci RP, Runte M, Sinclair S, Alkmim-Teixeira R, Vandenberk B, Varma N. 2023 HRS/EHRA/APHRS/LAHRS expert consensus statement on practical management of the remote device clinic. Heart Rhythm 2023; 20:e92-e144. [PMID: 37211145 DOI: 10.1016/j.hrthm.2023.03.1525] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 05/23/2023]
Abstract
Remote monitoring is beneficial for the management of patients with cardiovascular implantable electronic devices by impacting morbidity and mortality. With increasing numbers of patients using remote monitoring, keeping up with higher volume of remote monitoring transmissions creates challenges for device clinic staff. This international multidisciplinary document is intended to guide cardiac electrophysiologists, allied professionals, and hospital administrators in managing remote monitoring clinics. This includes guidance for remote monitoring clinic staffing, appropriate clinic workflows, patient education, and alert management. This expert consensus statement also addresses other topics such as communication of transmission results, use of third-party resources, manufacturer responsibilities, and programming concerns. The goal is to provide evidence-based recommendations impacting all aspects of remote monitoring services. Gaps in current knowledge and guidance for future research directions are also identified.
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Affiliation(s)
| | | | | | | | | | - Haruhiko Abe
- University of Occupational and Environmental Health Hospital, Kitakyushu, Japan
| | | | | | | | - Nikolaos Dagres
- Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Aarti S Dalal
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Olivia Gilbert
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Janet K Han
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | | | | | | | | | | | - Mary Runte
- University of Lethbridge, Lethbridge, Alberta, Canada
| | | | | | - Bert Vandenberk
- University of Calgary, Calgary, Alberta, Canada; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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Ferrick AM, Raj SR, Deneke T, Kojodjojo P, Lopez-Cabanillas N, Abe H, Boveda S, Chew DS, Choi JI, Dagres N, Dalal AS, Dechert BE, Frazier-Mills CG, Gilbert O, Han JK, Hewit S, Kneeland C, Mirza SD, Mittal S, Ricci RP, Runte M, Sinclair S, Alkmim-Teixeira R, Vandenberk B, Varma N, Davenport E, Freedenberg V, Glotzer TV, Huang JL, Ikeda T, Kramer DB, Lin D, Rojel-Martínez U, Stühlinger M, Varosy PD. 2023 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Practical Management of the Remote Device Clinic. Europace 2023; 25:euad123. [PMID: 37208301 PMCID: PMC10199172 DOI: 10.1093/europace/euad123] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
Remote monitoring is beneficial for the management of patients with cardiovascular implantable electronic devices by impacting morbidity and mortality. With increasing numbers of patients using remote monitoring, keeping up with higher volume of remote monitoring transmissions creates challenges for device clinic staff. This international multidisciplinary document is intended to guide cardiac electrophysiologists, allied professionals, and hospital administrators in managing remote monitoring clinics. This includes guidance for remote monitoring clinic staffing, appropriate clinic workflows, patient education, and alert management. This expert consensus statement also addresses other topics such as communication of transmission results, use of third-party resources, manufacturer responsibilities, and programming concerns. The goal is to provide evidence-based recommendations impacting all aspects of remote monitoring services. Gaps in current knowledge and guidance for future research directions are also identified.
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Affiliation(s)
| | | | | | | | | | - Haruhiko Abe
- University of Occupational and Environmental Health Hospital, Kitakyushu, Japan
| | | | | | | | - Nikolaos Dagres
- Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Aarti S Dalal
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Olivia Gilbert
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Janet K Han
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | | | | | | | | | | | - Mary Runte
- University of Lethbridge, Lethbridge, Alberta, Canada
| | | | | | - Bert Vandenberk
- University of Calgary, Calgary, Alberta, Canada
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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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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Demand for weekend outpatient chemotherapy among patients with cancer in Japan. Support Care Cancer 2020; 29:1287-1291. [PMID: 32621265 PMCID: PMC7843541 DOI: 10.1007/s00520-020-05575-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/11/2020] [Indexed: 10/28/2022]
Abstract
BACKGROUND Advanced cancer therapeutics have improved patient survival, leading to an increase in the number of patients who require long-term outpatient chemotherapy. However, the available schedule options for chemotherapy are generally limited to traditional business hours. METHOD In 2017, we surveyed 721 patients with cancer in Okayama, Japan, regarding their preferences for evening and weekend (Friday evening, Saturday, and Sunday) chemotherapy appointments. RESULTS A preference for evening and weekend appointment options was indicated by 37% of the respondents. Patients who requested weekend chemotherapy were younger, female, with no spouse or partner, living alone, employed, and currently receiving treatment. Among these factors, age and employment status were significantly associated with a preference for weekend chemotherapy, according to multivariate analysis. CONCLUSION Our findings reveal a demand for evening and weekend outpatient chemotherapy, especially among young, employed patients.
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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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Lopez-Villegas A, Catalan-Matamoros D, Robles-Musso E, Bautista-Mesa R, Peiro S. Cost-utility analysis on telemonitoring of users with pacemakers: The PONIENTE study. J Telemed Telecare 2018; 25:204-212. [PMID: 29621908 DOI: 10.1177/1357633x18767184] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Few studies have confirmed the cost-saving of telemonitoring of users with pacemakers (PMs). The purpose of this controlled, non-randomised, non-masked clinical trial was to perform an economic assessment of telemonitoring (TM) of users with PMs and check whether TM offers a cost-utility alternative to conventional follow-up in hospital. METHODS Eighty-two patients implanted with an internet-based transmission PM were selected to receive either conventional follow-up in hospital ( n = 52) or TM ( n = 30) from their homes. The data were collected during 12 months while patients were being monitored. The economic assessment of the PONIENTE study was performed as per the perspectives of National Health Service (NHS) and patients. A cost-utility analysis was conducted to measure whether the TM of patients with PMs is cost-effective in terms of costs per gained quality-adjusted life years (QALYs). RESULTS There was a significant cost-saving for participants in the TM group in comparison with the participants in the conventional follow-up group. From the NHS's perspective, the patients in the TM group gained 0.09 QALYs more than the patients in the conventional follow-up group over 12 months, with a cost saving of 57.64% (€46.51 versus €109.79, respectively; p < 0.001) per participant per year. In-office visits were reduced by 52.49% in the TM group. The costs related to the patient perspective were lower in the TM group than in the conventional follow-up group (€31.82 versus €73.48, respectively; p < 0.005). The costs per QALY were 61.68% higher in the in-office monitoring group. DISCUSSION The cost-utility analysis performed in the PONIENTE study showed that the TM of users with PMs appears to be a significant cost-effective alternative to conventional follow-up in hospital.
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Affiliation(s)
- Antonio Lopez-Villegas
- 1 Social Involvement of Critical and Emergency Medicine, CTS-609 Research Group, Hospital de Poniente, Almeria, Spain.,2 Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø. Norway
| | - Daniel Catalan-Matamoros
- 3 Department of Journalism and Communication, University Carlos III of Madrid, Madrid, Spain.,4 Health Sciences CTS-451 Research Group, University of Almeria, Almería, Spain
| | | | | | - Salvador Peiro
- 7 Health Services Research Unit, FISABIO-PUBLIC HEALTH, Valencia, Spain
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Wilsmore B, Leitch J. Remote monitoring of medical devices in Australia. Med J Aust 2017; 206:62-63. [PMID: 28152348 DOI: 10.5694/mja16.00730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/16/2016] [Indexed: 11/17/2022]
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Facchin D, Baccillieri M, Gasparini G, Zoppo F, Allocca G, Brieda M, Verlato R, Proclemer A. Findings of an observational investigation of pure remote follow-up of pacemaker patients: is the in-clinic device check still needed? Int J Cardiol 2016; 220:781-6. [DOI: 10.1016/j.ijcard.2016.06.162] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/24/2016] [Indexed: 12/18/2022]
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Use of remote monitoring in the management of ICD end-of-life: Data from the DECODE registry. Int J Cardiol 2016; 221:430-2. [DOI: 10.1016/j.ijcard.2016.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/03/2016] [Indexed: 12/29/2022]
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Marcantoni L, Toselli T, Urso G, Pratola C, Ceconi C, Bertini M. Impact of remote monitoring on the management of arrhythmias in patients with implantable cardioverter-defibrillator. J Cardiovasc Med (Hagerstown) 2016; 16:775-81. [PMID: 25032715 DOI: 10.2459/jcm.0000000000000148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND In the last decade, there has been an exponential increase in cardioverter-defibrillator (ICD) implants. Remote monitoring systems, allow daily follow-ups of patients with ICD. OBJECTIVE To evaluate the impact of remote monitoring on the management of cardiovascular events associated with supraventricular and ventricular arrhythmias during long-term follow-up. METHODS A total of 207 patients undergoing ICD implantation/replacement were enrolled: 79 patients received remote monitoring systems and were followed up every 12 months, and 128 patients were followed up conventionally every 6 months. All patients were followed up and monitored for the occurrence of supraventricular and ventricular arrhythmia-related cardiovascular events (ICD shocks and/or hospitalizations). RESULTS During a median follow-up of 842 days (interquartile range 476-1288 days), 32 (15.5%) patients experienced supraventricular arrhythmia-related events and 51 (24.6%) patients experienced ventricular arrhythmia-related events. Remote monitoring had a significant role in the reduction of supraventricular arrhythmia-related events, but it had no effect on ventricular arrhythmia-related events. In multivariable analysis, remote monitoring remained as an independent protective factor, reducing the risk of supraventricular arrhythmia-related events of 67% [hazard ratio, 0.33; 95% confidence interval (CI), 0.13-0.82; P = 0.017]. CONCLUSION Remote monitoring systems improved outcomes in patients with supraventricular arrhythmias by reducing the risk of cardiovascular events, but no benefits were observed in patients with ventricular arrhythmias.
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Affiliation(s)
- Lina Marcantoni
- Department of Cardiology, S. Anna Hospital, University of Ferrara, Cona, Ferrara, Italy
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Digital monitoring and care: Virtual medicine. Trends Cardiovasc Med 2016; 26:722-730. [PMID: 27373351 DOI: 10.1016/j.tcm.2016.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 05/13/2016] [Accepted: 05/19/2016] [Indexed: 01/29/2023]
Abstract
Remote digital health monitoring technologies can be synergistically organized to create a virtual medical system providing more continuous care centered on the patient rather than the bricks and mortar medical complex. Utilization of the digitalized patient health monitoring can facilitate diagnosis, treatment plans, physician-patient interaction, and accelerate the progress of medical research, education, and training. The field of cardiac electrophysiology has been an early adopter of this shift in care and serves as a paradigm applicable to all areas of medicine. The overall impact of this remote virtual care model on the quality of medical care and patient experience requires greater study, as well as vigilance as to the differences between technology and care in order to preserve the intangible and immeasurable factors that bring humanity to the art and science of medicine.
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de Ruvo E, Sciarra L, Martino AM, Rebecchi M, Iulianella RV, Sebastiani F, Fagagnini A, Borrelli A, Scarà A, Grieco D, Tota C, Stirpe F, Calò L. A prospective comparison of remote monitoring systems in implantable cardiac defibrillators: potential effects of frequency of transmissions. J Interv Card Electrophysiol 2015; 45:81-90. [DOI: 10.1007/s10840-015-0067-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
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Abstract
Recent technological advances in the management of patients with cardiovascular implantable electronic devices (CIEDs) have expanded clinicians’ ability to remotely monitor patients with CIEDs. Remote monitoring, in addition to periodic in-person device evaluation, provides many advantages to patients and clinicians. Aside from the therapeutic and diagnostic benefits of pacemakers, implantable cardioverter-defibrillators, cardiac resynchronization therapy devices, and implantable loop recorders, improvement in clinical outcomes, clinical efficiencies, and patient experience can be realized with the adoption of remote CIED monitoring. These advantages create significant value to both patients and CIED follow-up centers.
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Affiliation(s)
- Robin A. Leahy
- Robin A. Leahy is Director of Electrophysiology Services, Sanger Heart & Vascular Institute–Carolinas HealthCare System, 1001 Blythe Blvd, Ste 300, Charlotte, NC 28203 (robin. ). Elizabeth E. Davenport is Nurse Manager, Cardiac Rhythm Device Clinics, Sanger Heart & Vascular Institute–Carolinas HealthCare System, Charlotte, North Carolina
| | - Elizabeth E. Davenport
- Robin A. Leahy is Director of Electrophysiology Services, Sanger Heart & Vascular Institute–Carolinas HealthCare System, 1001 Blythe Blvd, Ste 300, Charlotte, NC 28203 (robin. ). Elizabeth E. Davenport is Nurse Manager, Cardiac Rhythm Device Clinics, Sanger Heart & Vascular Institute–Carolinas HealthCare System, Charlotte, North Carolina
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HRS Expert Consensus Statement on remote interrogation and monitoring for cardiovascular implantable electronic devices. Heart Rhythm 2015; 12:e69-100. [PMID: 25981148 DOI: 10.1016/j.hrthm.2015.05.008] [Citation(s) in RCA: 366] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Indexed: 11/23/2022]
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Telemedicine for cardiovascular disease continuum: A position paper from the Italian Society of Cardiology Working Group on Telecardiology and Informatics. Int J Cardiol 2015; 184:452-458. [PMID: 25755064 DOI: 10.1016/j.ijcard.2015.02.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 02/02/2015] [Accepted: 02/21/2015] [Indexed: 11/20/2022]
Abstract
Telemedicine is the provision of health care services, through the use of information and communication technology, in situations where the health care professional and the patient, or 2 health care professionals, are not in the same location. It involves the secure transmission of medical data and information, through text, sound, images, or other forms needed for the prevention, diagnosis, treatment, and follow-up of a patient. First data on implementation of telemedicine for the diagnosis and treatment of acute myocardial infarction date from more than 10 years ago. Telemedicine has a potential broad application to the cardiovascular disease continuum and in many branches of cardiology, at least including heart failure, ischemic heart disease and arrhythmias. Telemedicine might have an important role as part of a strategy for the delivery of effective health care for patients with cardiovascular disease. In this document the Working Group on Telecardiology and Informatics of the Italian Society of Cardiology intends to remark some key-points regarding potential benefit achievable with the implementation of telemedicine support in the continuum of cardiovascular disease.
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Implantable cardioverter defibrillator remote monitoring is well accepted and easy to use during long-term follow-up. J Interv Card Electrophysiol 2014; 41:203-9. [DOI: 10.1007/s10840-014-9935-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/01/2014] [Indexed: 12/11/2022]
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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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