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Sciarra L, Romano S, Paparella G, Scarà A. Editorial: Pharmacological therapy in patients with arrhythmias. Front Pharmacol 2024; 15:1465539. [PMID: 39119612 PMCID: PMC11306869 DOI: 10.3389/fphar.2024.1465539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 08/10/2024] Open
Affiliation(s)
- L. Sciarra
- Cardiovascular Disease Department, University of Study L’Aquila, L’Aquila, Italy
| | - S. Romano
- Cardiovascular Disease Department, University of Study L’Aquila, L’Aquila, Italy
| | | | - A. Scarà
- Cardiovascular Disease Department, University of Study L’Aquila, L’Aquila, Italy
- San Carlo di Nancy-GVM Hospital, Rome, Italy
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2
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Shelke S, Veerubhotla K, Lee Y, Lee CH. Telehealth of cardiac devices for CVD treatment. Biotechnol Bioeng 2024; 121:823-834. [PMID: 38151894 DOI: 10.1002/bit.28637] [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: 10/03/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/29/2023]
Abstract
This review covers currently available cardiac implantable electronic devices (CIEDs) as well as updated progress in real-time monitoring techniques for CIEDs. A variety of implantable and wearable devices that can diagnose and monitor patients with cardiovascular diseases are summarized, and various working mechanisms and principles of monitoring techniques for Telehealth and mHealth are discussed. In addition, future research directions are presented based on the rapidly evolving research landscape including Artificial Intelligence (AI).
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Affiliation(s)
- Sushil Shelke
- Division of Pharmacology and Pharmaceutics Sciences, School of Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Krishna Veerubhotla
- Division of Pharmacology and Pharmaceutics Sciences, School of Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Yugyung Lee
- Division of Computer Science, School of Science and Engineering, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Chi H Lee
- Division of Pharmacology and Pharmaceutics Sciences, School of Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri, USA
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3
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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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4
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Ferrick AM, Raj SR, Deneke T, Kojodjojo P, Lopez‐Cabanillas N, Abe H, Boveda S, Chew DS, Choi J, 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 J, 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. J Arrhythm 2023; 39:250-302. [PMID: 37324757 PMCID: PMC10264760 DOI: 10.1002/joa3.12851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] 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 HospitalJapan
| | | | | | | | - Nikolaos Dagres
- Heart Center Leipzig at the University of LeipzigLeipzigGermany
| | | | | | | | | | - Janet K. Han
- VA Greater Los Angeles Healthcare SystemLos AngelesCalifornia
| | | | | | | | | | | | - Mary Runte
- University of LethbridgeLethbridgeAlbertaCanada
| | | | | | - Bert Vandenberk
- University of CalgaryCalgaryAlbertaCanada
- Department of Cardiovascular SciencesLeuvenBelgium
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5
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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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6
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Calò L, Martino A, Bollettino M, Scialla L, Cicogna F, Tota C, Ponziani B, Oliviero G, Panuccio M, Fagagnini A, Toto F, Fanisio F, De Ruvo E. Heart failure and telemedicine: where are we and where are we going? Opportunities and critical issues. Eur Heart J Suppl 2023; 25:C326-C330. [PMID: 37125315 PMCID: PMC10132621 DOI: 10.1093/eurheartjsupp/suad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Heart failure (HF) is one of the main causes of morbidity in the world and is responsible for an enormous amount of health costs, mostly due to hospitalizations. The remote control techniques of vital signs and health status have the potential to help prevent factors leading to HF instability by stimulating early therapeutic interventions. The goal of telemedicine is to change the intervention strategy from a 'reactive' type, in which therapy is optimized in response to the worsening of symptoms, to a 'pro-active' type, in which therapeutic changes are undertaken based on changes in the monitored parameters during the sub-clinical phase. This article is aimed at exploring the major results obtained by telemedicine application in HF patients with and without cardiac electronic devices or in those with haemodynamic sensors and to analyse the critical issues and the opportunities of its use.
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Affiliation(s)
- Leonardo Calò
- Division of Cardiology, Policlinic Casilino, Via Casilina 1049, Rome 00139, Italy
| | - Annamaria Martino
- Division of Cardiology, Policlinic Casilino, Via Casilina 1049, Rome 00139, Italy
| | - Michela Bollettino
- Division of Cardiology, Policlinic Casilino, Via Casilina 1049, Rome 00139, Italy
| | - Ludovica Scialla
- Division of Cardiology, Policlinic Casilino, Via Casilina 1049, Rome 00139, Italy
| | - Francesco Cicogna
- Division of Cardiology, Policlinic Casilino, Via Casilina 1049, Rome 00139, Italy
| | - Claudia Tota
- Division of Cardiology, Policlinic Casilino, Via Casilina 1049, Rome 00139, Italy
| | - Beatrice Ponziani
- Division of Cardiology, Policlinic Casilino, Via Casilina 1049, Rome 00139, Italy
| | - Giada Oliviero
- Division of Cardiology, Policlinic Casilino, Via Casilina 1049, Rome 00139, Italy
| | - Marco Panuccio
- Division of Cardiology, Policlinic Casilino, Via Casilina 1049, Rome 00139, Italy
| | - Alessandro Fagagnini
- Division of Cardiology, Policlinic Casilino, Via Casilina 1049, Rome 00139, Italy
| | - Federica Toto
- Division of Cardiology, Policlinic Casilino, Via Casilina 1049, Rome 00139, Italy
| | - Francesca Fanisio
- Division of Cardiology, Policlinic Casilino, Via Casilina 1049, Rome 00139, Italy
| | - Ermenegildo De Ruvo
- Division of Cardiology, Policlinic Casilino, Via Casilina 1049, Rome 00139, Italy
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7
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De Lange L, Van Steenkiste G, Vernemmen I, Vera L, Cromheeke KMC, Walser U, Meert H, Decloedt A, van Loon G. Successful application of closed loop stimulation pacemakers with remote monitoring in 3 miniature donkeys with syncope. J Vet Intern Med 2021; 35:2920-2925. [PMID: 34741540 PMCID: PMC8692216 DOI: 10.1111/jvim.16305] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/16/2021] [Accepted: 10/19/2021] [Indexed: 11/28/2022] Open
Abstract
Rate‐adaptive single chamber pacemakers with accelerometer, closed loop stimulation (CLS), and remote monitoring functionality (Eluna 8 SR‐T, Biotronik, SE & Co, Germany) were implanted in 3 miniature donkeys with third‐degree atrioventricular block and syncope. After recovery, different pacemaker programming modes were tested at rest, during stress without physical exercise and during physical exercise. Pacing rates were compared to actual atrial rates and showed that CLS functionality allowed physiological heart rate adaptation. A transmitter installed in the stable provided wireless connection of the pacemaker to the internet. Home monitoring was activated which performed daily wireless transmission of pacemaker functional measurements to an online server allowing diagnosis of pathological arrhythmias and pacemaker malfunction from a distance. Closed loop stimulation and remote monitoring functionality resulted in nearly physiological rate adaptation and allowed remote “from‐the‐stable” patient follow‐up.
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Affiliation(s)
- Lisa De Lange
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Merelbeke, Belgium
| | - Glenn Van Steenkiste
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Merelbeke, Belgium
| | - Ingrid Vernemmen
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Merelbeke, Belgium
| | - Lisse Vera
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Merelbeke, Belgium
| | | | - Ulla Walser
- Biotronik Belgium, Vilvoorde, Belgium.,Biotronik SE & Co. KG, Berlin, Germany
| | - Hans Meert
- Biotronik Belgium, Vilvoorde, Belgium.,Biotronik SE & Co. KG, Berlin, Germany
| | - Annelies Decloedt
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Merelbeke, Belgium
| | - Gunther van Loon
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Merelbeke, Belgium
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8
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Daley C, Toscos T, Allmandinger T, Ahmed R, Wagner S, Mirro M. Organizational Models for Cardiac Implantable Electronic Device Remote Monitoring: Current and Future Directions. Card Electrophysiol Clin 2021; 13:483-497. [PMID: 34330375 DOI: 10.1016/j.ccep.2021.04.008] [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] [Indexed: 11/19/2022]
Abstract
This review provides an overview of the literature on the organization, staffing, and structure of remote monitoring (RM) clinics, primarily from countries in Western Europe and United States, as well as the challenges, considerations, and future directions for RM clinic models of care. Using a current case example of an RM clinic in the Midwestern United States, this document provides key information from the viewpoint of a clinic undergoing a shift in workflow. Finally, this review distills key considerations for RM management for electrophysiology clinics, vendors and industry, and policy makers.
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Affiliation(s)
- Carly Daley
- Health Services and Informatics Research Department, Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Dr., Fort Wayne, IN 46845, USA; Department of BioHealth Informatics, IUPUI School of Informatics and Computing, 535 W. Michigan St., Indianapolis, IN 46202, USA.
| | - Tammy Toscos
- Health Services and Informatics Research Department, Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Dr., Fort Wayne, IN 46845, USA; Department of BioHealth Informatics, IUPUI School of Informatics and Computing, 535 W. Michigan St., Indianapolis, IN 46202, USA
| | - Tina Allmandinger
- Arrhythmia Diagnostic Center, Parkview Physicians Group, 11108 Parkview Circle, Fort Wayne, IN 46845, USA
| | - Ryan Ahmed
- Health Services and Informatics Research Department, Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Dr., Fort Wayne, IN 46845, USA
| | - Shauna Wagner
- Health Services and Informatics Research Department, Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Dr., Fort Wayne, IN 46845, USA
| | - Michael Mirro
- Health Services and Informatics Research Department, Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Dr., Fort Wayne, IN 46845, USA; Department of BioHealth Informatics, IUPUI School of Informatics and Computing, 535 W. Michigan St., Indianapolis, IN 46202, USA; Department of Medicine, Indiana University School of Medicine, 340 West 10th St., Indianapolis, IN 46202, USA
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9
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Varma N, Love CJ, Michalski J, Epstein AE. Alert-Based ICD Follow-Up: A Model of Digitally Driven Remote Patient Monitoring. JACC Clin Electrophysiol 2021; 7:976-987. [PMID: 33640345 DOI: 10.1016/j.jacep.2021.01.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/04/2021] [Accepted: 01/09/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The goal of this study was to test whether continuous automatic remote patient monitoring (RPM) linked to centralized analytics reduces nonactionable in-person patient evaluation (IPE) but maintains detection of at-risk patients and provides actionable notifications. BACKGROUND Conventional ambulatory care requires frequent IPEs. Many encounters are nonactionable, and additional unscheduled IPEs occur. METHODS Patients receiving implantable cardioverter-defibrillators for Class I/IIa indications were randomized (2:1) to RPM or conventional follow-up, and they were followed up for 15 months. IPEs were conducted every 3 months in the conventional care group but at 3 and 15 months with RPM. Groups were compared for patient retention, nonactionable IPEs, and discovery of at-risk patients during 1 year of exclusive RPM. Frequency and value of RPM alerts were assessed. RESULTS Patients enrolled (mean age 63.5 ± 12.8 years; male 71.9%; left ventricular ejection fraction 29.0 ± 10.7%; primary prevention 72.3%; n = 1450) were similar between groups (977 RPM vs. 473 conventional care). Mean follow-up durations were 407 ± 103 days for the RPM group versus 399 ± 111 days for the conventional care group (p = 0.165). Patient attrition to follow-up was 42% greater with conventional care (20.1% [87 of 431]) versus RPM (14.2% [129 of 908]; p = 0.007). Nonactionable IPEs were reduced 81% by RPM (0.7 per patient year) compared with conventional care (3.6 per patient year; p < 0.001) but event discoveries remained similar (2.9 per patient year). In RPM, alert rate was median 1 per patient (interquartile range: 0 to 3) with >50% actionability, indicating low volume but high clinical value. Unscheduled IPE was the basis for discovery of 100% of intercurrent problems in RPM and also 75% in conventional care, indicating limited value of appointment-based follow-up for problem discovery. The number of IPEs needed to discover an actionable event was 8.2 in Conventional, 4.9 in RPM, and 2.1 when alert driven (p < 0.001). CONCLUSIONS RPM transformed ambulatory care to IPE directed to those patients with clinically actionable events when required. Filtering patient information by digitally driven remote monitoring expends fewer clinic resources while providing a greater yield of actionable interventions. (Lumos-T Safely Reduces Routine Office Device Follow-up [TRUST]; NCT00336284).
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Affiliation(s)
- Niraj Varma
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Charles J Love
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Andrew E Epstein
- Department of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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10
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Calò L, de Ruvo E, Martino AM, Prenner G, Manninger M, Scherr D. Trends beyond the new normal: from remote monitoring to digital connectivity. Eur Heart J Suppl 2021; 22:P8-P12. [PMID: 33390863 PMCID: PMC7757717 DOI: 10.1093/eurheartj/suaa170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
COVID pandemic emergency has forced changes from traditional in-person visits to application of telemedicine in order to overcome the barriers and to deliver care. COVID-19 has accelerated adoption of digital health. During this time, the distance is itself a prevention tool and the use of technology to deliver healthcare services and information has driven the discovery of mobile and connected health services. Health services should to be prepared to integrate the old model of remote monitoring of CIEDs and adopt new digital tools such as mobile Apps and connected sensors.
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Affiliation(s)
- Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Ermenegildo de Ruvo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Anna Maria Martino
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Günther Prenner
- Clinical Department of Cardiology, University of Graz, Graz, Austria
| | - Martin Manninger
- Clinical Department of Cardiology, University of Graz, Graz, Austria
| | - Daniel Scherr
- Clinical Department of Cardiology, University of Graz, Graz, Austria
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11
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Braunschweig F, Anker SD, Proff J, Varma N. Remote monitoring of implantable cardioverter-defibrillators and resynchronization devices to improve patient outcomes: dead end or way ahead? Europace 2020; 21:846-855. [PMID: 30903152 PMCID: PMC6545502 DOI: 10.1093/europace/euz011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/24/2019] [Indexed: 12/11/2022] Open
Abstract
Remote monitoring (RM) has become a new standard of care in the follow-up of patients with implantable pacemakers and defibrillators. While it has been consistently shown that RM enables earlier detection of clinically actionable events compared with traditional in-patient evaluation, this advantage did not translate into improved patient outcomes in clinical trials of RM except one study using daily multiparameter telemonitoring in heart failure (HF) patients. Therefore, this review, focusing on RM studies of implantable cardioverter-defibrillators and cardiac resynchronization therapy defibrillators in patients with HF, discusses possible explanations for the differences in trial outcomes. Patient selection may play an important role as more severe HF and concomitant atrial fibrillation have been associated with improved outcomes by RM. Furthermore, the technical set-up of RM may have an important impact as a higher level of connectivity with more frequent data transmission can be linked to better outcomes. Finally, there is growing evidence as to the need of effective algorithms ensuring a fast and well-structured clinical response to the events detected by RM. These factors re-emphasize the potential of remote management of device patients with HF and call for continued clinical research and technical development in the field.
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Affiliation(s)
| | - Stefan D Anker
- Department of Cardiology and Pneumology, Innovative Clinical Trials, University Medical Centre Göttingen, Göttingen, Germany
| | | | - Niraj Varma
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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12
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Toscos T, Daley C, Wagner S, Coupe A, Ahmed R, Holden RJ, Flanagan ME, Pfafman R, Ghahari RR, Mirro M. Patient responses to daily cardiac resynchronization therapy device data: A pilot trial assessing a novel patient-centered digital dashboard in everyday life. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2020; 1:97-106. [PMID: 35265880 PMCID: PMC8890068 DOI: 10.1016/j.cvdhj.2020.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Heart failure (HF) is a growing public health problem in the United States. Implantable cardiac resynchronization therapy (CRT) devices reduce mortality and morbidity, and remote monitoring (RM) of these devices improves outcomes. However, patient RM adherence is low, due in part to lack of access to their RM data. Providing these data to patients may increase engagement, but they must be appropriately tailored to ensure understanding. Objective The purpose of this study was to examine patients’ experiences interacting with their RM data through a novel digital dashboard as part of daily life. Methods In this mixed-methods pilot study, 10 patients with implantable CRT defibrillators were given access to a patient-centered RM data dashboard, updated daily for 6–12 months. Pre- and post-health literacy, engagement, electronic portal (MyChart, Epic Systems Corporation) logins, and RM adherence were measured; system usability scores were collected at exit; and dashboard views were tracked. Exit interviews were conducted to elucidate patients’ experiences. Results Participants (100% white; 60% male; age 34–80 years [mean ± SD: 62.0 ± 13.4]) had adequate health literacy, increased MyChart logins (P = .0463), and nonsignificant increase in RM adherence. Participants viewed their dashboards 0–42 times (mean 14.9 ± 12.5). Interviews revealed participants generally appreciated access to their data, understood it, and responded to changes; however, questions and concerns remained regarding data interpretation and visualization. Conclusion Preliminary findings support potential future integration of a CRT RM data dashboard in the daily care of HF patients. With appropriate informational support and personalization, sharing RM data with patients in a tailored dashboard may improve health engagement.
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13
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Watanabe E, Yamazaki F, Goto T, Asai T, Yamamoto T, Hirooka K, Sato T, Kasai A, Ueda M, Yamakawa T, Ueda Y, Yamamoto K, Tokunaga T, Sugai Y, Tanaka K, Hiramatsu S, Arakawa T, Schrader J, Varma N, Ando K. Remote Management of Pacemaker Patients With Biennial In-Clinic Evaluation: Continuous Home Monitoring in the Japanese At-Home Study: A Randomized Clinical Trial. Circ Arrhythm Electrophysiol 2020; 13:e007734. [PMID: 32342703 PMCID: PMC7237026 DOI: 10.1161/circep.119.007734] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Current expert consensus recommends remote monitoring for cardiac implantable electronic devices, with at least annual in-office follow-up. We studied safety and resource consumption of exclusive remote follow-up (RFU) in pacemaker patients for 2 years. Methods: In Japan, consecutive pacemaker patients committed to remote monitoring were randomized to either RFU or conventional in-office follow-up (conventional follow-up) at twice yearly intervals. RFU patients were only seen if indicated by remote monitoring. All returned to hospital after 2 years. The primary end point was a composite of death, stroke, or cardiovascular events requiring surgery, and the primary hypothesis was noninferiority with 5% margin. Results: Of 1274 randomized patients (50.4% female, age 77±10 years), 558 (RFU) and 550 (Conventional follow-up) patients reached either the primary end point or 24 months follow-up. The primary end point occurred in 10.9% and 11.8%, respectively (P=0.0012 for noninferiority). The median (interquartile range) number of in-office follow-ups was 0.50 (0.50–0.63) in RFU and 2.01 (1.93–2.05) in conventional follow-up per patient-year (P<0.001). Insurance claims for follow-ups and directly related diagnostic procedures were 18 800 Yen (16 500–20 700 Yen) in RFU and 21 400 Yen (16 700–25 900 Yen) in conventional follow-up (P<0.001). Only 1.4% of remote follow-ups triggered an unscheduled in-office follow-up, and only 1.5% of scheduled in-office follow-ups were considered actionable. Conclusions: Replacing periodic in-office follow-ups with remote follow-ups for 2 years in pacemaker patients committed to remote monitoring does not increase the occurrence of major cardiovascular events and reduces resource consumption. Registration: URL: https://clinicaltrials.gov; Unique identifier: NCT01523704.
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Affiliation(s)
- Eiichi Watanabe
- Department of Cardiology, Fujita Health University School of Medicine, Aichi (E.W.)
| | - Fumio Yamazaki
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital (F.Y.)
| | - Toshihiko Goto
- Department of Cardiology, Nagoya City University Hospital (T.G.), Aichi, Japan
| | - Toru Asai
- Department of Cardiology, Ichinomiya Municipal Hospital (T. Asai), Aichi, Japan
| | - Toshihiko Yamamoto
- Department of Cardiology, Handa City Hospital (T. Yamamoto), Aichi, Japan
| | - Keiji Hirooka
- Department of Cardiology, National Hospital Organization Osaka National Hospital (K.H.), Tokyo, Japan
| | - Toshiaki Sato
- Department of Cardiology, Kyorin University Hospital (T.S.), Tokyo, Japan
| | - Atsunobu Kasai
- Department of Cardiology, Japanese Red Cross Ise Hospital, Mie (A.K.)
| | - Marehiko Ueda
- Department of Cardiology, Chiba University Hospital (M.U.), Tokyo, Japan
| | - Takeshi Yamakawa
- Department of Cardiology, Teikyo University Hospital (T. Yamakawa), Tokyo, Japan
| | - Yasunori Ueda
- Department of Cardiology, Osaka Police Hospital, Japan (Y.U.)
| | | | - Takeshi Tokunaga
- Department of Cardiology, JA Toride Medical Ctr, Ibaraki, Japan (T.T.)
| | - Yoshinao Sugai
- Department of Cardiology, Hiraka General Hospital, Akita, Japan (Y.S.)
| | - Kazuhiko Tanaka
- Department of Cardiology, Kasukabe Chuo General Hospital, Saitama, Japan (K.T.)
| | - Shigeki Hiramatsu
- Department of Cardiology, Fukuyama Cardiovascular Hospital, Hiroshima, Japan (S.H.)
| | - Tomoharu Arakawa
- Department of Cardiology, Daido Hospital, Aichi, Japan (T. Arakawa)
| | | | - Niraj Varma
- Cleveland Clinic, Heart & Vascular Institute, OH (N.V.)
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan (K.A.)
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Mian Qaisar S, Fawad Hussain S. Arrhythmia Diagnosis by Using Level-Crossing ECG Sampling and Sub-Bands Features Extraction for Mobile Healthcare. SENSORS 2020; 20:s20082252. [PMID: 32316133 PMCID: PMC7218877 DOI: 10.3390/s20082252] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/24/2020] [Accepted: 04/01/2020] [Indexed: 11/16/2022]
Abstract
Mobile healthcare is an emerging technique for clinical applications. It is usually based on cloud-connected biomedical implants. In this context, a novel solution is presented for the detection of arrhythmia by using electrocardiogram (ECG) signals. The aim is to achieve an effective solution by using real-time compression, efficient signal processing, and data transmission. The system utilizes level-crossing-based ECG signal sampling, adaptive-rate denoising, and wavelet-based sub-band decomposition. Statistical features are extracted from the sub-bands and used for automated arrhythmia classification. The performance of the system was studied by using five classes of arrhythmia, obtained from the MIT-BIH dataset. Experimental results showed a three-fold decrease in the number of collected samples compared to conventional counterparts. This resulted in a significant reduction of the computational cost of the post denoising, features extraction, and classification. Moreover, a seven-fold reduction was achieved in the amount of data that needed to be transmitted to the cloud. This resulted in a notable reduction in the transmitter power consumption, bandwidth usage, and cloud application processing load. Finally, the performance of the system was also assessed in terms of the arrhythmia classification, achieving an accuracy of 97%.
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Affiliation(s)
- Saeed Mian Qaisar
- College of Engineering, Effat University, Jeddah 22332, Saudi Arabia
- Correspondence: ; Tel.: +966-1221-37849
| | - Syed Fawad Hussain
- Machine Learning and Data Science Lab, Ghulam Ishaq Khan Institute of Engineering Sciences and Technology, Topi 23460, Pakistan;
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15
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Cloud-based ECG monitoring using event-driven ECG acquisition and machine learning techniques. Phys Eng Sci Med 2020; 43:623-634. [PMID: 32524444 DOI: 10.1007/s13246-020-00863-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
Abstract
An approach is proposed for the detection of chronic heart disorders from the electrocardiogram (ECG) signals. It utilizes an intelligent event-driven ECG signal acquisition system to achieve a real-time compression and effective signal processing and transmission. The experimental results show that grace of event-driven nature an overall 2.6 times compression and bandwidth utilization gain is attained by the suggested solution compared to the counter classical methods. It results in a significant reduction in the complexity and execution time of the post denoising, features extraction and classification processes. The overall system precision is studied in terms of the classification accuracy, the F-measure, the area under the ROC curve (AUC) and the Kappa statistics. The best classification accuracy of 94.07% is attained. It confirms that the designed event-driven solution realizes a computationally efficient automatic diagnosis of the cardiac arrhythmia while achieving a high precision decision support for cloud-based mobile health monitoring.
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Morimoto Y, Nishii N, Tsukuda S, Kawada S, Miyamoto M, Miyoshi A, Nakagawa K, Watanabe A, Nakamura K, Morita H, Ito H. A Low Critical Event Rate Despite a High Abnormal Event Rate in Patients with Cardiac Implantable Electric Devices Followed Up by Remote Monitoring. Intern Med 2019; 58:2333-2340. [PMID: 31118368 PMCID: PMC6746648 DOI: 10.2169/internalmedicine.1905-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective Remote monitoring (RM) of cardiac implantable electric devices (CIEDs) has been advocated as a healthcare standard. However, expert consensus statements suggest that all patients require annual face-to-face follow-up consultations at outpatient clinics even if RM reveals no episodes. The objective of this study was to determine the critical event rate after CIED implantation through RM. Methods This multicenter, retrospective, cohort study evaluated patients with pacemakers (PMs), implantable cardioverter defibrillators (ICDs), or cardiac resynchronization therapy defibrillator (CRT-Ds) and analyzed whether or not the data drawn from RM included abnormal or critical events. Patients A total of 1,849 CIED patients in 12 hospitals who were followed up by the RM center in Okayama University Hospital were included in this study. Results During the mean follow-up period of 774.9 days, 16,560 transmissions were analyzed, of which 11,040 (66.7%) were abnormal events and only 676 (4.1%) were critical events. The critical event rate in the PM group was significantly lower than that in the ICD or CRT-D groups (0.9% vs. 5.0% or 5.9%, p<0.001). A multivariate analysis revealed that ICD, CRT-D, and a low ejection fraction were independently associated with critical events. In patients with ICD, the independent risk factors for a critical event were old age, low ejection fraction, Brugada syndrome, dilated phase hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy. Conclusion Although abnormal events were observed in two-thirds of the transmitted RM data, the critical event rate was <1% in patients with a PM, which was lower in comparison to the rates in patients with ICDs or CRT-Ds. A low ejection fraction was an independent predictor of critical events.
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Affiliation(s)
- Yoshimasa Morimoto
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Nobuhiro Nishii
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Saori Tsukuda
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Satoshi Kawada
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Masakazu Miyamoto
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Akihito Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Atsuyuki Watanabe
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
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17
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Li KHC, White FA, Tipoe T, Liu T, Wong MC, Jesuthasan A, Baranchuk A, Tse G, Yan BP. The Current State of Mobile Phone Apps for Monitoring Heart Rate, Heart Rate Variability, and Atrial Fibrillation: Narrative Review. JMIR Mhealth Uhealth 2019; 7:e11606. [PMID: 30767904 PMCID: PMC6396075 DOI: 10.2196/11606] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/06/2018] [Accepted: 11/25/2018] [Indexed: 12/19/2022] Open
Abstract
Background Mobile phone apps capable of monitoring arrhythmias and heart rate (HR) are increasingly used for screening, diagnosis, and monitoring of HR and rhythm disorders such as atrial fibrillation (AF). These apps involve either the use of (1) photoplethysmographic recording or (2) a handheld external electrocardiographic recording device attached to the mobile phone or wristband. Objective This review seeks to explore the current state of mobile phone apps in cardiac rhythmology while highlighting shortcomings for further research. Methods We conducted a narrative review of the use of mobile phone devices by searching PubMed and EMBASE from their inception to October 2018. Potentially relevant papers were then compared against a checklist for relevance and reviewed independently for inclusion, with focus on 4 allocated topics of (1) mobile phone monitoring, (2) AF, (3) HR, and (4) HR variability (HRV). Results The findings of this narrative review suggest that there is a role for mobile phone apps in the diagnosis, monitoring, and screening for arrhythmias and HR. Photoplethysmography and handheld electrocardiograph recorders are the 2 main techniques adopted in monitoring HR, HRV, and AF. Conclusions A number of studies have demonstrated high accuracy of a number of different mobile devices for the detection of AF. However, further studies are warranted to validate their use for large scale AF screening.
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Affiliation(s)
- Ka Hou Christien Li
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong).,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong).,Faculty of Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Timothy Tipoe
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong).,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Martin Cs Wong
- Division of Family Medicine and Primary Health Care, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Aaron Jesuthasan
- Faculty of Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Adrian Baranchuk
- Division of Cardiology, Kingston General Hospital, Queen's University, Kington, ON, Canada
| | - Gary Tse
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong).,Division of Cardiology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Bryan P Yan
- Division of Cardiology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong).,Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China (Hong Kong).,Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
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18
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Chokesuwattanaskul R, Safadi AR, Ip R, Waraich HK, Hudson OM, Ip JH. Data Transmission Delay in Medtronic Reveal LINQ<sup>TM</sup> Implantable Cardiac Monitor: Clinical Experience in 520 Patients. ACTA ACUST UNITED AC 2019. [DOI: 10.4236/jbise.2019.128030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Zanotto G, D'Onofrio A, Della Bella P, Solimene F, Pisanò EC, Iacopino S, Dondina C, Giacopelli D, Gargaro A, Ricci RP. Organizational model and reactions to alerts in remote monitoring of cardiac implantable electronic devices: A survey from the Home Monitoring Expert Alliance project. Clin Cardiol 2018; 42:76-83. [PMID: 30421438 DOI: 10.1002/clc.23108] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/22/2018] [Accepted: 10/25/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND This survey aimed to describe the organizational workflow of cardiac implantable electronic devices (CIEDs) remote monitoring (RM) service in ordinary practice. METHODS A questionnaire was designed for our purpose and completed by 49 sites participating to the Italian Home Monitoring Expert Alliance. RESULTS A dedicated organizational model for RM was set up for 86% of centers. The median RM team consisted of 2 (Interquartile range [IQR]: 1-3) physicians and 1 (IQR: 0-2) nurse. RM service was available in working hours and the median percentage of patients included was 100% (IQR: 10%-100%) for implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) recipients and 5% (IQR:0%-30%) for pacemakers. In-office follow-up was performed every 12 and 6 months for pacemaker and ICD/CRT recipients, respectively. More than 90% of sites used to activate all technical alerts, with a prompt reaction in case of an out-of-range parameter. The threshold for atrial fibrillation (AF) daily burden notification in most cases ranged from 2.4 to 7.2 hours. All ventricular arrhythmias alerts were usually switched on: an inappropriate therapy or more than one appropriate episode triggered an urgent in-hospital visit. Concerning heart failure, low CRT percentage pacing alert was always used, while the other available notifications were less frequently switched on. CONCLUSIONS This survey showed that RM service was usually set up with a primary nursing model including on average two responsible physicians and one nurse and mainly offered to ICD/CRT patients. Technical, AF and ventricular arrhythmia alerts triggered prompt reactions, while heart failure related indexes were generally less applied.
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20
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Söth-Hansen M, Witt CT, Rasmussen M, Kristensen J, Gerdes C, Nielsen JC. Time until diagnosis of clinical events with different remote monitoring systems in implantable cardioverter-defibrillator patients. Heart Rhythm 2018; 15:1648-1654. [DOI: 10.1016/j.hrthm.2018.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Indexed: 12/13/2022]
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21
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Ono M, Varma N. Remote Monitoring for Chronic Disease Management: Atrial Fibrillation and Heart Failure. Card Electrophysiol Clin 2018; 10:43-58. [PMID: 29428141 DOI: 10.1016/j.ccep.2017.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This review aims to cover the latest evidence of remote monitoring of cardiac implantable electronic devices for the management of atrial fibrillation and heart failure. Remote monitoring is useful for early detection for device-detected atrial fibrillation, which increases the risk of thromboembolic events. Early anticoagulation based on remote monitoring potentially reduces the risk of stroke, but optimal alert setting needs to be clarified. Multiparameter monitoring with automatic transmission is useful for heart failure management. Improved adherence to remote monitoring and an optimal algorithm for transmitted alerts and their management are warranted in the management of heart failure.
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Affiliation(s)
- Maki Ono
- Department of Cardiology, Kameda General Hospital, 929 Higashi-cho, Kamogawa City, Chiba 296-8602, Japan; Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, J2-2, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Niraj Varma
- Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, J2-2, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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22
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Nishii N, Miyoshi A, Kubo M, Miyamoto M, Morimoto Y, Kawada S, Nakagawa K, Watanabe A, Nakamura K, Morita H, Ito H. Analysis of arrhythmic events is useful to detect lead failure earlier in patients followed by remote monitoring. J Cardiovasc Electrophysiol 2017; 29:463-470. [DOI: 10.1111/jce.13399] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/27/2017] [Accepted: 11/29/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Nobuhiro Nishii
- Department of Cardiovascular Therapeutics; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Akihito Miyoshi
- Department of Cardiovascular Medicine; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Motoki Kubo
- Department of Cardiovascular Medicine; Fukuyama City Hospital; Fukuyama Japan
| | - Masakazu Miyamoto
- Department of Cardiovascular Medicine; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Yoshimasa Morimoto
- Department of Cardiovascular Medicine; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Satoshi Kawada
- Department of Cardiovascular Medicine; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Atsuyuki Watanabe
- Department of Cardiovascular Medicine; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
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23
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Hidefjäll P. Drivers and barriers for implementing remote monitoring of patients with cardiac implantable electronic devices in Sweden – a mixed methods study. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2017. [DOI: 10.1080/20479700.2017.1397907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Patrik Hidefjäll
- LIME – Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Varma N, Love CJ, Schweikert R, Moll P, Michalski J, Epstein AE. Automatic remote monitoring utilizing daily transmissions: transmission reliability and implantable cardioverter defibrillator battery longevity in the TRUST trial. Europace 2017; 20:622-628. [DOI: 10.1093/europace/eux059] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/14/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Niraj Varma
- Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Charles J Love
- Department of Cardiology, New York University Langone Medical Center, New York, NY, USA
| | | | - Philip Moll
- Clinical Studies, Biotronik, Lake Oswego, OR, USA
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Ono M, Varma N. Remote monitoring to Improve long-term prognosis in heart failure patients with implantable cardioverter-defibrillators. Expert Rev Med Devices 2017; 14:335-342. [PMID: 28299956 DOI: 10.1080/17434440.2017.1306438] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Strong evidence exists for the utility of remote monitoring in cardiac implantable electronic devices for early detection of arrhythmias and evaluation of system performance. The application of remote monitoring for the management of chronic disease such as heart failure has been an active area of research. Areas covered: This review aims to cover the latest evidence of remote monitoring of implantable cardiac defibrillators in terms of heart failure prognosis. This article also updates the current technology relating to the method and discusses key factors to be addressed in order to better use the approach. PubMed and internet searches were conducted to acquire most recent data and technology information. Expert commentary: Multiparameter monitoring with automatic transmission is useful for heart failure management. Improved adherence to remote monitoring and an optimal algorithm for transmitted alerts and their management are warranted in the management of heart failure.
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Affiliation(s)
- Maki Ono
- a Department of Cardiology , Kameda General Hospital , Chiba , Japan
| | - Niraj Varma
- b Heart and Vascular Institute, J2-2 Cardiac Pacing and Electrophysiology, Cleveland Clinic , Cleveland , OH , USA
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Abstract
Mobile electrocardiographs consist of three components: a mobile device (e.g. a smartphone), an electrocardiographic device or accessory, and a mobile application. Mobile platforms are small computers with sufficient computational power, good quality display, suitable data storage, and several possibilities of data transmission. Electrocardiographic electrodes and sensors for mobile use utilize unconventional materials, e.g. rubber, e-textile, and inkjet-printed nanoparticle electrodes. Mobile devices can be handheld, worn as vests or T-shirts, or attached to patient's skin as biopatches. Mobile electrocardiographic devices and accessories may additionally record other signals including respiratory rate, activity level, and geolocation. Large-scale clinical studies that utilize electrocardiography are easier to conduct using mobile technologies and the collected data are suitable for "big data" processing. This is expected to reveal phenomena so far inaccessible by standard electrocardiographic techniques.
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Affiliation(s)
| | - Marek Malik
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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27
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Remote monitoring of cardiac implantable electronic devices (CIED). Trends Cardiovasc Med 2016; 26:568-77. [PMID: 27134007 DOI: 10.1016/j.tcm.2016.03.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/07/2016] [Accepted: 03/24/2016] [Indexed: 11/20/2022]
Abstract
With increasing indications and access to cardiac implantable electronic devices (CIEDs) worldwide, the number of patients needing CIED follow-up continues to rise. In parallel, the technology available for managing these devices has advanced considerably. In this setting, remote monitoring (RM) has emerged as a complement to routine in-office care. Rigorous studies, randomized and otherwise, have demonstrated advantages to patient with CIED management systems, which incorporates RM resulting in authoritative guidelines from relevant professional societies recommending RM for all eligible patients. In addition to clinical benefits, CIED management programs that include RM have been shown to be cost effective and associated with high patient satisfaction. Finally, RM programs hold promise for the future of CIED research in light of the massive data collected through RM databases converging with unprecedented computational capability. This review outlines the available data associated with clinical outcomes in patients managed with RM with an emphasis on randomized trials; the impact of RM on patient satisfaction, cost-effectiveness, and healthcare utilization; and possible future directions for the use of RM in clinical practice and research.
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