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O'Shea CJ, Brooks AG, Middeldorp ME, Harper C, Hendriks JM, Russo AM, Freeman JV, Gopinathannair R, Varma N, Deering TF, Campbell K, Sanders P. Device-detected atrial fibrillation in a large remote-monitored cohort: implications for anticoagulation and need for new pathways of service delivery. J Interv Card Electrophysiol 2023; 66:1659-1668. [PMID: 36735111 PMCID: PMC10547627 DOI: 10.1007/s10840-023-01481-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/14/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Remote monitoring (RM) can facilitate early detection of subclinical and symptomatic atrial fibrillation (AF), providing an opportunity to evaluate the need for stroke prevention therapies. We aimed to characterize the burden of RM AF alerts and its impact on anticoagulation of patients with device-detected AF. METHODS Consecutive patients with a cardiac implantable electronic device, at least one AF episode, undergoing RM were included and assigned an estimated minimum CHA2DS2-VASc score based on age and device type. RM was provided via automated software system, providing rapid alert processing by device specialists and systematic, recurrent prompts for anticoagulation. RESULTS From 7651 individual, 389,188 AF episodes were identified, 3120 (40.8%) permanent pacemakers, 2260 (29.5%) implantable loop recorders (ILRs), 987 (12.9%) implantable cardioverter defibrillators, 968 (12.7%) cardiac resynchronization therapy (CRT) defibrillators, and 316 (4.1%) CRT pacemakers. ILRs transmitted 48.8% of all AF episodes. At twelve-months, 3404 (44.5%) AF < 6 min, 1367 (17.9%) 6 min-6 h, 1206 (15.8%) 6-24 h, and 1674 (21.9%) ≥ 24 h. A minimum CHA2DS2-VASc score of 2 was assigned to 1704 (63.1%) of the patients with an AF episode of ≥ 6 h, 531 (31.2%) who were not anticoagulated at 12-months, and 1031 (61.6%) patients with an AF episode duration of ≥ 24 h, 290 (28.1%) were not anticoagulated. CONCLUSIONS Despite being intensively managed via RM software system incorporating cues for anticoagulation, a substantial proportion of patients with increased stroke risk remained unanticoagulated after a device-detected AF episode of significant duration. These data highlight the need for improved clinical response pathways and an integrated care approach to RM. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry: ACTRN12620001232921.
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Affiliation(s)
- Catherine J O'Shea
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Anthony G Brooks
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
| | - Melissa E Middeldorp
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | | | - Jeroen M Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - James V Freeman
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | | | | | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia.
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia.
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Roberts H, Matheson K, Sapp J, Gardner M, Gray C, AbdelWahab A, Lee D, MacIntyre C, Parkash R. Prevalence and management of electrical lead abnormalities in cardiac implantable electronic device leads. Heart Rhythm O2 2023; 4:417-426. [PMID: 37520017 PMCID: PMC10373148 DOI: 10.1016/j.hroo.2023.05.002] [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: 08/01/2023] Open
Abstract
Background Electrical lead abnormalities (ELAs) can result in device malfunction, leading to significant morbidity in patients with cardiac implantable electronic devices (CIEDs). Objective We sought to determine the prevalence and management of ELAs in patients with CIEDs. Methods This was a retrospective cohort study of patients implanted with a CIED between 2012 and 2019 at a tertiary care center. The primary outcome was ELA defined as increased capture threshold (≥2× implantation value), decreased sensing (≤0.5 implantation value), change in impedance (>50% over 3 months), or nonphysiologic potentials. A secondary outcome of device clinic utilization was also collected. Results There were 2996 unique patients (35% female) included with 4600 leads (57% Abbott, 43% Medtronic). ELAs were observed in 135 (3%) leads, including 124 (92%) Abbott and 10 (7%) Medtronic leads (hazard ratio 9.25, P < .001). Mean follow-up was 4.5 ± 2.2 years. ELAs were associated smaller lead French size, atrial location, and Abbott leads. Lead revision was required in 28% of cases. Patients with lead abnormalities had 38% more in-clinic visits per patient year of follow-up compared with those without (P < .001). Conclusion ELAs were more frequent in certain models, which increased rates of revision and follow-up. Identification of factors that mitigate these abnormalities to improve lead performance are required to improve care for these devices and provide efficient healthcare.
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Affiliation(s)
- Hilary Roberts
- Department of Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Kara Matheson
- Research Methods Unit, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - John Sapp
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Martin Gardner
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Chris Gray
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Amir AbdelWahab
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - David Lee
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | - Ratika Parkash
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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Rocha MEQA, Lima NDA, Pinho LGB, Gondim DSP, Miná CPC, Rocha EAQA, Rocha MCT, Nobre JS, Pereira FTM, Prakash P, Maia FPA, Rocha EA. Remote monitoring of pacemakers and defibrillators: Effective and safe in Brazil? Heart Rhythm O2 2022; 3:736-742. [PMID: 36589013 PMCID: PMC9795284 DOI: 10.1016/j.hroo.2022.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background The remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has become a common method of in-home monitoring and follow-up in high-income countries given its effectiveness, safety, convenience, and the possibility of early intervention. However, in Brazil, RM is still underutilized. Objectives This observational study aims to demonstrate our experience of using RM in Brazil and the predictive factors of RM of CIED follow-up in Brazil. Methods This was a prospective cohort study of patients with a CIED. Event rates are reported and clinical responses to those findings and outcomes based on the detection of RM. A logistic regression model was performed to identify predictors of more events, with P < .05 for statistical significance. Results This study evaluated consecutive 119 patients: 30.2% with pacemakers, 42.8% with implantable cardioverter-defibrillator, 22.7% with cardiac resynchronization therapy (CRT) with defibrillator, and 3.3% with CRT with pacemaker. Events were detected in 63.9% of the cases in 29.5 ± 23 months of follow-up. The outcomes found were that 44.5% needed elective evaluation in medical treatment and 23.5% needed immediate evaluation in therapy. Logistic regression analysis showed that the groups with CRT or CRT with defibrillator (75.0%), reduced ejection fraction (76.5%), and New York Heart Association functional class ≥II (75.0%) had the highest RM event rates. Conclusions RM proved to be effective and safe in the follow-up of patients with CIEDs in Brazil, allowing early interventions and facilitating therapeutic management.
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Affiliation(s)
| | - Neiberg de Alcantara Lima
- Division of Cardiology, Department of Internal Medicine, Wayne State University, Detroit, Michigan,Address reprint requests and correspondence: Dr Neiberg de Alcantara Lima, Division of Cardiology, Department of Internal Medicine, Wayne State University, 3990 John R. Street, 4 Hudson, Detroit, MI 48021.
| | | | | | | | | | | | - Juvêncio Santos Nobre
- Department of Statistics and Applied Mathematics, Federal University of Ceara, Fortaleza, Brazil
| | | | - Preeya Prakash
- Division of Cardiology, Department of Internal Medicine, Wayne State University, Detroit, Michigan
| | | | - Eduardo Arrais Rocha
- Postgraduate Program in Cardiovascular Sciences, Federal University of Ceara, Fortaleza, Brazil
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4
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Leitch J, Asakai H, Dawson L, Medi C, Norman M, Stevenson I, Toal E, Turnbull S, Young G. Cardiac Society of Australia and New Zealand (CSANZ) Position Statement on the Follow-Up of Cardiovascular Implantable Electronic Devices 2022. Heart Lung Circ 2022; 31:1054-1063. [PMID: 35760743 DOI: 10.1016/j.hlc.2022.05.001] [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: 04/19/2022] [Accepted: 05/05/2022] [Indexed: 11/15/2022]
Abstract
Recognising the need for a national approach for the recommended best practice for the follow-up of implanted cardiac rhythm devices to ensure patient safety, this document has been produced by the Cardiac Society of Australia and New Zealand (CSANZ). It draws on accepted practice standards and guidelines of international electrophysiology bodies. It lays out methodology, frequency, and content of follow-up, including remote monitoring; personnel, including physician, allied health, nursing and industry; paediatric and adult congenital heart patients; and special considerations including magnetic resonance imaging scanning, perioperative management, and hazard alerts.
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Affiliation(s)
| | - James Leitch
- John Hunter Hospital, Newcastle, NSW, Australia.
| | - Hiroko Asakai
- The Children's Hospital at Westmead, Heart Centre for Children, Sydney, NSW, Australia
| | | | - Caroline Medi
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | | | - Edward Toal
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Samual Turnbull
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Glenn Young
- Royal Adelaide Hospital, Adelaide, SA, Australia
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Kotalczyk A, Imberti JF, Lip GYH, Wright DJ. Telemedical Monitoring Based on Implantable Devices-the Evolution Beyond the CardioMEMS™ Technology. Curr Heart Fail Rep 2022; 19:7-14. [PMID: 35174451 PMCID: PMC8853059 DOI: 10.1007/s11897-021-00537-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 12/11/2022]
Abstract
Purpose of the Review We aimed to provide an overview of telemedical monitoring and its impact on outcomes among heart failure (HF) patients. Recent Findings Most HF readmissions may be prevented if clinical parameters are strictly controlled via telemedical monitoring. Predictive algorithms for patients with cardiovascular implantable electronic devices (e.g., Triage-HF Plus by Medtronic or HeartLogic by Boston Scientific) were developed to identify patients at significantly increased risk of HF events. However, randomized control trial-based data are heterogeneous regarding the advantages of telemedical monitoring in HF patients. The likelihood of adverse clinical outcomes increases when pulmonary artery pressure (PAP) rises, usually days to weeks before clinical manifestations of HF. A wireless monitoring system (CardioMEMS™) detecting changes in PAP was proposed for HF patients. CardioMEMS™ transmits data to the healthcare provider and allows to institute timely intensification of HF therapies. CardioMEMS™-guided pharmacotherapy reduced a risk of HF-related hospitalization (hazard ratio [HR]: 0.72; 95% confidence interval (CI) 0.60–0–0.85; p < 0.01). Summary Relevant developments and innovations of telemedical care may improve clinical outcomes among HF patients. The use of CardioMEMS™ was found to be safe and cost-effective by reducing the rates of HF hospitalizations.
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Affiliation(s)
- Agnieszka Kotalczyk
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Jacopo F Imberti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - David Justin Wright
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK. .,Liverpool Heart & Chest Hospital, Liverpool, UK.
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6
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Buyting R, Melville S, Chatur H, White CW, Légaré JF, Lutchmedial S, Brunt KR. Virtual Care With Digital Technologies for Rural Canadians Living With Cardiovascular Disease. CJC Open 2022; 4:133-147. [PMID: 35198931 PMCID: PMC8843960 DOI: 10.1016/j.cjco.2021.09.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/26/2021] [Indexed: 01/14/2023] Open
Abstract
Canada is a wealthy nation with a geographically diverse population, seeking health innovations to better serve patients in accordance with the Canada Health Act. In this country, population and geography converge with social determinants, policy, procurement regulations, and technological advances with the goal to achieve equity in the management and distribution of health care. Rural and remote patients are a vulnerable population; when managing chronic conditions like cardiovascular disease, there is currently inequity to accessing specialist physicians at the recommended frequency-increasing the likelihood of poor health outcomes. Ensuring equitable care for this population is an unrealized priority of several provincial and federal government mandates. Virtual care technology might provide practical, economical, and innovative solutions to remedy this discrepancy. We conducted a scoping review of the literature pertaining to the use of virtual care technologies to monitor patients living in rural areas of Canada with cardiovascular disease. A search strategy was developed to identify the literature specific to this context across 3 bibliographic databases. Two hundred thirty-two unique citations were ultimately assessed for eligibility, of which 37 met the inclusion criteria. In our assessment of these articles, we provide a summary of the interventions studied, their reported effectiveness in reducing adverse events and mortality, the challenges to implementation, and the receptivity of these technologies among patients, providers, and policy-makers. Furthermore, we glean insight into the barriers and opportunities to ensure equitable care for rural patients and conclude that there is an ongoing need for clinical trials on virtual care technologies in this context.
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Affiliation(s)
- Ryan Buyting
- Department of Pharmacology, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
- Division of Cardiac Surgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada
- Division of Cardiology, Saint John Regional Hospital, Saint John, New Brunswick, Canada
- Horizon Health Network, CardioVascular Research New Brunswick (CVR-NB), Saint John, New Brunswick, Canada
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
- IMPART Investigator Team Canada, Saint John, New Brunswick, Canada
| | - Sarah Melville
- Division of Cardiology, Saint John Regional Hospital, Saint John, New Brunswick, Canada
- Horizon Health Network, CardioVascular Research New Brunswick (CVR-NB), Saint John, New Brunswick, Canada
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
- IMPART Investigator Team Canada, Saint John, New Brunswick, Canada
| | - Hanif Chatur
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
- IMPART Investigator Team Canada, Saint John, New Brunswick, Canada
| | - Christopher W. White
- Division of Cardiac Surgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada
- Horizon Health Network, CardioVascular Research New Brunswick (CVR-NB), Saint John, New Brunswick, Canada
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
| | - Jean-François Légaré
- Division of Cardiac Surgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada
- Horizon Health Network, CardioVascular Research New Brunswick (CVR-NB), Saint John, New Brunswick, Canada
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
- IMPART Investigator Team Canada, Saint John, New Brunswick, Canada
| | - Sohrab Lutchmedial
- Division of Cardiology, Saint John Regional Hospital, Saint John, New Brunswick, Canada
- Horizon Health Network, CardioVascular Research New Brunswick (CVR-NB), Saint John, New Brunswick, Canada
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
- IMPART Investigator Team Canada, Saint John, New Brunswick, Canada
| | - Keith R. Brunt
- Department of Pharmacology, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
- IMPART Investigator Team Canada, Saint John, New Brunswick, Canada
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Patients with Cardiovascular Implantable Electronic Devices in the Era of COVID-19 and Their Response to Telemedical Solutions. Medicina (B Aires) 2022; 58:medicina58020160. [PMID: 35208484 PMCID: PMC8877859 DOI: 10.3390/medicina58020160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background and objectives: The COVID-19 pandemic has transformed the healthcare system, leading to the rapid implementation of telemedical solutions, especially in cardiology. The aim of this survey was to evaluate the patients (pts) with cardiac implantable electronic devices (CIED) perspectives on the telemedicine elements such as teleconsultation, telemonitoring, and e-prescription. Materials and methods: An anonymous questionnaire was created and delivered to CIED pts who came to the ambulatory outpatient clinic. In this survey, we evaluated teleconsultation, home monitoring systems, and e-prescription in the 17 single-choice and multiple-choice questions and a rating on a scale of 0 to 10. Results: During the four-month period, 226 pts (58% male) completed the questionnaire. Regular visits were most frequent in pts living in the urban area where the clinic was located, and least frequent in those living in rural areas (p = 0.0158). Moreover, 89 pts (39%) had teleconsultation before CIED interrogation, and satisfaction was 99%; 24 pts (11%) had home-monitoring control and 135 pts (60%) would have liked to have this opportunity; 88 pts (34.5%) would be able to pay additional costs for home-monitoring, with a mean amount of 65 PLN (±68.24). The e-prescription system was used by 203 pts (90%), and it was evaluated with 8.6 points (±2) on a scale from 0 to 10 points. Conclusions: The COVID-19 pandemic disrupted the previous functioning of the health system, and telemedicine became an alternative to traditional ambulatory visits and proved to be essential in the continuity of patient care. There is a substantial need for further development of telemedicine solutions in the healthcare system.
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Chew DS, Zarrabi M, You I, Morton J, Low A, Reyes L, Yuen B, Sumner GL, Raj SR, Exner DV, Wilton SB. Clinical and Economic Outcomes Associated with Remote Monitoring for Cardiac Implantable Electronic Devices: A Population-Based Analysis. Can J Cardiol 2022; 38:736-744. [DOI: 10.1016/j.cjca.2022.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 01/07/2022] [Accepted: 01/21/2022] [Indexed: 11/28/2022] Open
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Sapp JA, Gillis AM, AbdelWahab A, Nault I, Nery PB, Healey JS, Raj SR, Lockwood E, Sterns LD, Sears SF, Wells GA, Yee R, Philippon F, Tang A, Parkash R. Remote-only monitoring for patients with cardiac implantable electronic devices: a before-and-after pilot study. CMAJ Open 2021; 9:E53-E61. [PMID: 33495385 PMCID: PMC7843075 DOI: 10.9778/cmajo.20200041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Outcomes for patients with cardiac implantable electronic devices are better when follow-up incorporates remote monitoring technology in addition to in-clinic visits. For patients with implantable devices, we sought to determine the feasibility, safety and associated health care utilization of remote-only follow-up, along with its effects on patients' quality of life and costs. METHODS This multicentre before-and-after pilot study involved patients with new or existing pacemakers or implantable cardioverter defibrillators. The "before" phase of the study spanned the period October 2015 to February 2017; the "after" phase spanned the period October 2016 to February 2018. The exposure was remote-only follow-up in combination with Remote View, a service that facilitates access to device data, allowing device settings to be viewed remotely to facilitate remote programming. Outcomes at 12 months were feasibility (adherence to remote monitoring), safety (rate of adverse events) and health care utilization (remote and in-clinic appointments). We also assessed quality of life, using 3 validated scales, and costs, taking into account both health care system and patient costs. RESULTS A total of 176 patients were enrolled. Adherence (defined as at least 1 successful remote transmission during follow-up) was 87% over a mean follow-up of 11.7 (standard deviation 2.2) months. There was a reduction in in-clinic visits at specialized sites among patients with both implantable defibrillators (26 v. 5, p < 0.001, n = 48) and pacemakers (42 v. 10, p < 0.001, n = 51). There was no significant change in visits to community sites for patients with defibrillators (13 v. 17, p = 0.3, n = 48). The composite rate of death, stroke, cardiovascular hospitalization and device-related hospitalization was 7% (n = 164). No adverse events were linked to the intervention. There was no change in quality-of-life scales between baseline and 12 months. Health care costs were reduced by 31% for patients with defibrillators and by 44% for those with pacemakers. INTERPRETATION This pilot study showed the feasibility of remote-only follow-up, with no increase in adverse clinical outcomes and no effect on quality of life, but with reductions in costs and health care utilization. These results support progression to a larger-scale study of whether superior effectiveness and reduced cost can be achieved, with preservation of safety, through use of remote-only follow-up. TRIAL REGISTRATION ClinicalTrials.gov, no. NCT02585817.
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Affiliation(s)
- John A Sapp
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Anne M Gillis
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Amir AbdelWahab
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Isabelle Nault
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Pablo B Nery
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Jeff S Healey
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Satish R Raj
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Evan Lockwood
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Laurence D Sterns
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Samuel F Sears
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - George A Wells
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Raymond Yee
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - François Philippon
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Anthony Tang
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Ratika Parkash
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont.
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10
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O'Shea CJ, Middeldorp ME, Hendriks JM, Brooks AG, Lau DH, Emami M, Mishima R, Thiyagarajah A, Feigofsky S, Gopinathannair R, Varma N, Campbell K, Sanders P. Remote Monitoring Alert Burden: An Analysis of Transmission in >26,000 Patients. JACC Clin Electrophysiol 2020; 7:226-234. [PMID: 33602404 DOI: 10.1016/j.jacep.2020.08.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/14/2020] [Accepted: 08/16/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study sought to determine the remote monitoring (RM) alert burden in a multicenter cohort of patients with a cardiac implantable electronic device (CIED). BACKGROUND RM of CIEDs allows timely recognition of patient and device events requiring intervention. Most RM involves burdensome manual workflow occurring exclusively on weekdays during office hours. Automated software may reduce such a burden, streamlining real-time alert responses. METHODS We retrospectively analyzed 26,713 consecutive patients with a CIED undergoing managed RM utilizing PaceMate software between November 2018 and November 2019. Alerts were analyzed according to type, acuity (red indicates urgent, and yellow indicates nonurgent) and CIED category. RESULTS In total, 12,473 (46.7%) patients had a permanent pacemaker (PPM), 9,208 (34.5%) had an implantable cardioverter-defibrillator (ICD), and 5,032 (18.8%) had an implantable loop recorder (ILR). Overall, 82,797 of the 205,804 RM transmissions were alerts, with the remainder being scheduled transmissions. A total of 14,638 (54.8%) patients transmitted at least 1 alert. Permanent pacemakers were responsible for 25,700 (31.0%) alerts, ICDs for 15,643 (18.9%) alerts, and ILRs for 41,454 (50.1%) alerts, with 3,935 (4.8%) red alerts and 78,862 (95.2%) yellow alerts. ICDs transmitted 2,073 (52.7%) red alerts; 5,024 (32.1%) ICD alerts were for ventricular tachyarrhythmias and antitachycardia pacing/shock delivery. CONCLUSIONS In an RM cohort of 26,713 patients with CIEDs, 54.8% of patients transmitted at least 1 alert during a 12-month period, totaling over 82,000 alerts. ILRs were overrepresented, and ICDs were underrepresented, in these alerts. The enormity of the number of transmissions and the growing ILR alert burden highlight the need for new management pathways for RM.
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Affiliation(s)
- Catherine J O'Shea
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Melissa E Middeldorp
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Jeroen M Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia; College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Anthony G Brooks
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Mehrdad Emami
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Ricardo Mishima
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Anand Thiyagarajah
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Niraj Varma
- Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kevin Campbell
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA; Pacemate, Bradenton, Florida, USA
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia.
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11
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Abstract
PURPOSE OF REVIEW Despite the promise of remote patient monitoring (RPM), this technology remained underutilized secondary to a lack of data transparency and systems issues until the COVID-19 pandemic ushered in a new era of telehealth and virtual solutions out of necessity. This review will explore the data supporting the use of RPM via both implantable and wearable devices in the field of cardiology and the role of home monitoring using RPM in the era of COVID-19. RECENT FINDINGS RPM using implantable cardiac devices is a safe alternative to in-person only visits which leads to enhanced patient satisfaction and improved clinical outcomes. Consumer-grade wearable sensors have drastically expanded RPM capabilities from just the sickest cardiac patients to the entire population aiding in early diagnosis and real-time disease management. Home monitoring enabled by automated alert systems tailored specifically to the needs of the patient by the provider will be the cornerstone of a more continuous, patent-centric healthcare model.
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Affiliation(s)
- Jennifer C. Miller
- University of Southern California’s Center for Body Computing, 12015 E Waterfront Dr, Los Angeles, CA 90094 USA
| | - Devin Skoll
- University of Southern California’s Center for Body Computing, 12015 E Waterfront Dr, Los Angeles, CA 90094 USA
| | - Leslie A. Saxon
- University of Southern California’s Center for Body Computing, 12015 E Waterfront Dr, Los Angeles, CA 90094 USA
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12
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Remote Monitoring of Cardiovascular Implantable Electronic Devices in Canada: Survey of Patients and Device Health Care Professionals. CJC Open 2020; 3:391-399. [PMID: 34027341 PMCID: PMC8129436 DOI: 10.1016/j.cjco.2020.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/14/2020] [Indexed: 11/26/2022] Open
Abstract
Background Remote monitoring is used to supplement in-clinic follow-up for patients with cardiac implantable electronic devices (CIEDs) every 6-12 months. There is a need to optimize remote management for CIEDs because of the consistent increases in CIED implants over the past decade. The objective of this study was to investigate real and perceived barriers to the use of remote patient management strategies in Canada and to better understand how remote models of care can be optimized. Methods We surveyed 512 CIED patients and practitioners in 22 device clinics in Canada. Results Device clinic surveys highlighted significant variation and inconsistency in follow-up care for in-clinic and remote visits across and within clinics. This survey showed that funding policies and management of additional workflow are barriers to optimal use and uptake. Despite this, device clinics perceive remote follow-up as a valuable resource and an efficient way to manage patient follow-up. Patients were broadly satisfied with their CIED follow-up care but identified barriers related to coordination of care, visit logistics, and information needs. Views varied as a function of clinical or sociodemographic characteristics. Most patients (n = 228; 91%) expressed a desire to receive a phone call from their device clinic after a remote transmission has been received. Conclusions Lack of a unified, guideline-supported approach to follow-up after CIED implant, and discrepant funding policies across jurisdictions, are significant barriers to the use of remote patient management strategies in Canada. Efforts to increase or expand use of remote follow-up must recognize these barriers and the needs of specific subgroups of patients.
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13
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Kotalczyk A, Kalarus Z, Wright DJ, Boriani G, Lip GYH. Cardiac Electronic Devices: Future Directions and Challenges. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2020; 13:325-338. [PMID: 33061681 PMCID: PMC7526741 DOI: 10.2147/mder.s245625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/02/2020] [Indexed: 12/26/2022] Open
Abstract
Cardiovascular implantable electronic devices (CIEDs) are essential management options for patients with brady- and tachyarrhythmias or heart failure with concomitant optimal pharmacotherapy. Despite increasing technological advances, there are still gaps in the management of CIED patients, eg, the growing number of lead- and pocket-related long-term complications, including cardiac device–related infective endocarditis, requires the greatest care. Likewise, patients with CIEDs should be monitored remotely as a part of a comprehensive, holistic management approach. In addition, novel technologies used in smartwatches may be a convenient tool for long-term atrial fibrillation (AF) screening, especially in high-risk populations. Early detection of AF may reduce the risk of stroke and other AF-related complications. The objective of this review article was to provide an overview of novel technologies in cardiac rhythm–management devices and future challenges related to CIEDs.
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Affiliation(s)
- Agnieszka Kotalczyk
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - David Justin Wright
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
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14
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Kelly SE, Clifford TJ, Coyle D, Martin J, Welch V, Skidmore B, Birnie D, Parkash R, Tang ASL, Wells GA. Virtual follow-up and care for patients with cardiac electronic implantable devices: protocol for a systematic review. Syst Rev 2020; 9:153. [PMID: 32593307 PMCID: PMC7321546 DOI: 10.1186/s13643-020-01406-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 06/07/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Capacity to deliver outpatient care for patients with cardiac implantable electronic devices (CIEDs) may soon be outweighed by need. This systematic review aims to investigate the comparative effectiveness, safety, and cost for virtual or remote clinic interventions for patients with CIEDs and explores how outcomes may be influenced by patient or system factors in-depth. METHODS We will perform a systematic literature search in MEDLINE, Embase, PsycINFO, CINAHL, Proquest Dissertations & Theses, other EBM Reviews, and trial registry databases. Two authors will independently screen titles and abstracts for eligibility. We will include randomized and non-randomized controlled trials, quasi-randomized and experimental studies, cohort, and case-control studies. Study populations of interest are individuals with a CIED (pacemaker, ICD, CRT). Eligibility will be restricted to virtual or remote follow-up or care interventions compared to any other approach. The co-primary outcomes of interest are mortality and patient satisfaction. Secondary outcomes include clinical effectiveness (e.g., ICD shock, time-to-detection of medical event, hospitalizations), safety (e.g., serious or device-related adverse events), device efficacy (e.g., transmissions, malfunctions), costs, workflow (e.g., resources, process outcomes, time-saved), and patient reported (e.g., burden, quality of life). Data will be extracted by one author and checked by a second using a standardized template. We will use published frameworks to capture data relevant to intervention effects that may be influenced by intervention definition or complexity, context and setting, or in socially disadvantaged populations. Detailed descriptive results will be presented for all included studies and outcomes, and where feasible, synthesized using meta-analysis. Risk of bias will be assessed by two review authors independently using Cochrane Risk of Bias tools. Certainty of evidence will be assessed using the GRADE approach. DISCUSSION Increases in number of CIEDs implanted, combined with an aging population and finite health resource allocations at the system-level may lead to increased reliance on virtual follow-up or care models in the future. These models must prioritize consistent, equitable, and timely care as a priority. Results from this systematic review will provide important insight into the potential contextual factors which moderate or mediate the effectiveness, safety, and cost of virtual follow-up or care models for patients. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42020145210.
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Affiliation(s)
- Shannon E Kelly
- School of Epidemiology and Public Health, University of Ottawa, 101 - 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
| | - Tammy J Clifford
- School of Epidemiology and Public Health, University of Ottawa, 101 - 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, 101 - 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Janet Martin
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Vivian Welch
- School of Epidemiology and Public Health, University of Ottawa, 101 - 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - David Birnie
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ratika Parkash
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anthony S L Tang
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, 101 - 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
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15
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Kelly SE, Clifford TJ, Skidmore B, Birnie D, Parkash R, Wells GA. Patient and healthcare provider reported barriers and enablers to virtual or remote-only follow-up models for cardiovascular implantable electronic devices: protocol for a qualitative framework synthesis. Syst Rev 2020; 9:151. [PMID: 32580756 PMCID: PMC7315548 DOI: 10.1186/s13643-020-01410-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Virtual care models are used to follow-up patients with cardiovascular implantable electronic devices (CIED), including pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization therapy. There is increasing interest in the expansion of virtual, or even remote-only, CIED care models to alleviate resource and economic burden to both patients and specialty device clinics and to maintain or improve equity and access to high-quality cardiovascular care. This qualitative framework synthesis aims to identify barriers and enablers to virtual care models from both the perspective of the patient and device clinics. How setting, context, equity factors or other aspects influence these factors, or satisfaction with care, will also be investigated. METHODS We will perform a systematic literature search in MEDLINE, Embase, PsycINFO, CINAHL, Proquest Dissertations & Theses, other EBM Reviews, and trial registry databases. Screening will be completed by two independent review authors. Original research articles having a qualitative component (i.e., qualitative, mixed-, or multi-method) are eligible. Study populations of interest are (a) individuals with a CIED or (b) healthcare providers involved in any aspect of virtual or remote follow-up of patients with CIEDs. Eligibility will be restricted to studies published after January 1, 2000 in English or French. Data will be captured using standardized templates based on the domains and constructs of the Theoretical Domains Framework and the Warwick Patient Experiences Framework. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research will be applied to all included studies. The GRADE-CERQual approach will be applied to assess and summarize confidence in key findings. Reporting will follow the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) statement. Detailed descriptive results will be presented, and summary of qualitative findings tables will be produced. DISCUSSION While a number of trials have captured the clinical effectiveness and safety of virtual follow-up for CIEDs, there has been less attention given to factors affecting use and implementation of remote care by patients and healthcare providers or satisfaction with care. Results from this qualitative framework synthesis will provide important lived experience data from both patients and healthcare providers which will be essential to incorporate in clinical guidelines. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020160533.
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Affiliation(s)
- Shannon E Kelly
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada. .,University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Tammy J Clifford
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - David Birnie
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ratika Parkash
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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16
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Beca B, Sapp JL, Gardner MJ, Gray C, AbdelWahab A, MacIntyre C, Doucette S, Parkash R. Mortality and Heart Failure After Upgrade to Cardiac Resynchronization Therapy. CJC Open 2020; 1:93-99. [PMID: 32159089 PMCID: PMC7063653 DOI: 10.1016/j.cjco.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 02/13/2019] [Indexed: 11/03/2022] Open
Abstract
Background Cardiac resynchronization therapy (CRT) is effective in treating advanced heart failure (HF), but data describing benefits and long-term outcomes for upgrades from a preexisting device are limited. This study sought to compare long-term outcomes in de novo CRT implants with those eligible for CRT with a prior device. Methods This is a retrospective cohort study using data from a provincial registry (2002-2015). Patients were included if they had mild-moderate HF, left ventricular ejection fraction ≤ 35%, and QRS duration ≥ 130 ms. Patients were classified as de novo CRT or upgraded to CRT from a prior device. Outcomes were mortality and composite mortality and HF hospitalization. Results There were 342 patients included in the study. In a multivariate model, patients in the upgraded cohort (n = 233) had a higher 5-year mortality rate (adjusted hazard ratio, 2.86; 95% confidence interval, 1.59-5.15; P = 0.0005) compared with the de novo cohort (n = 109) and higher composite mortality and HF hospitalization (adjusted hazard ratio, 2.60; 95% confidence interval, 1.54-4.37; P = 0.0003). Conclusions Implantation of de novo CRTs was associated with lower mortality and HF hospitalization compared with upgraded CRTs from preexisting devices. It is unknown whether these differences are due to the timing of CRT implementation or other clinical factors. Further work in this area may be helpful to determine how to improve outcomes for these patients.
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Affiliation(s)
- Bogdan Beca
- Division of Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John L Sapp
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Centre, Halifax, Nova Scotia, Canada
| | - Martin J Gardner
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Centre, Halifax, Nova Scotia, Canada
| | - Christopher Gray
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Centre, Halifax, Nova Scotia, Canada
| | - Amir AbdelWahab
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Centre, Halifax, Nova Scotia, Canada
| | - Ciorsti MacIntyre
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Centre, Halifax, Nova Scotia, Canada
| | - Steve Doucette
- Research Methods Unit, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ratika Parkash
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Centre, Halifax, Nova Scotia, Canada
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17
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Abstract
The population of patients with heart failure continues to grow, which introduced significant challenges in clinical practice related to the management of cardiac arrhythmia and advanced heart failure syndromes. Device therapy has increasingly become essential in the management of life-threatening arrhythmia and clinical heart failure in this population. This review will discuss the use of cardiac implantable electronic devices in heart failure with primary focus on sudden cardiac death prevention and cardiac resynchronization, including published evidence and evolving technologies.
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Affiliation(s)
- Ayman A Hussein
- From the Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, OH
| | - Bruce L Wilkoff
- From the Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, OH
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18
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MacIntyre CJ, Sapp JL, Abdelwahab A, Al-Harbi M, Doucette S, Gray C, Gardner MJ, Parkash R. The Effect of Shock Burden on Heart Failure and Mortality. CJC Open 2019; 1:161-167. [PMID: 32159102 PMCID: PMC7063602 DOI: 10.1016/j.cjco.2019.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/17/2019] [Indexed: 12/12/2022] Open
Abstract
Background Prior studies have demonstrated an association between appropriate implantable cardioverter defibrillator (ICD) shocks and mortality in clinical trials. The effect of shock burden on heart failure and mortality has not been previously studied in a large population-based cohort. Methods The cohort was derived using a comprehensive prospective ICD registry in the province of Nova Scotia with a mean follow-up of 4 ± 2.3 years. With the use of time-varying analysis, the relationship among shock burden, mortality, and heart failure hospitalization was determined. Results A total of 776 patients (mean age of 64.8 years) were included in the study, of whom 37% received appropriate therapy during follow-up. A single ICD shock did not confer an increased mortality risk compared with no therapy (hazard ratio [HR], 1.23; 95% confidence interval [CI], 0.84-1.79; P = 0.3), but mortality risk was significantly increased with ≥ 2 shocks (HR, 3.23; 95% CI, 2.04-5.09; P < 0.0001). There was a significant increase in heart failure hospitalization associated with receiving 1 ICD shock (HR, 2.05; 95% CI, 1.46-2.89; P < 0.0001) or more than 1 ICD shock (HR, 4.36; CI, 2.53-7.52; P < 0.0001) compared with patients receiving no ICD therapy. Patients who received antitachycardia pacing alone showed no difference in heart failure hospitalization (HR, 0.93; CI, 0.67-1.29; P = 0.7) and improved survival (HR, 0.69; CI, 0.5-0.96; P = 0.03) compared with those receiving no ICD therapy. Conclusion Ventricular arrhythmia treated with appropriate ICD shocks is associated with an increased risk of heart failure hospitalization, whereas recurrent episodes of ventricular arrhythmia requiring shocks are associated with both higher mortality and higher heart failure hospitalization rates.
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Affiliation(s)
- Ciorsti J MacIntyre
- Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - John L Sapp
- Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Amir Abdelwahab
- Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Mousa Al-Harbi
- Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Steve Doucette
- Research Methods Unit, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Chris Gray
- Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Martin J Gardner
- Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Ratika Parkash
- Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
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19
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Abstract
PURPOSE OF REVIEW Recent evidence has demonstrated substantial benefits associated with remote monitoring of cardiac implantable electronic devices (CIEDs), and treatment guidelines have endorsed the use of remote monitoring. Familiarity with the features of remote monitoring systems and the data supporting its use are vital for physicians' care for patients with CEIDs. RECENT FINDINGS Remote monitoring remains underutilized, but its use is expanding including in new practice settings including emergency departments. Patient experience and outcomes are positive, with earlier detection of clinical events such as atrial fibrillation, reductions in inappropriate implantable cardioverter-defibrillator (ICD) shocks and potentially a decrease in mortality with frequent remote monitoring utilizaiton. Rates of hospitalization are reduced among remote monitoring users, and the replacement of outpatient follow-up visits with remote monitoring transmissions has been shown to be well tolerated. In addition, health resource utilization is lower and remote monitoring has been associated with considerable cost savings. A dose relationship exists between use of remote monitoring and patient outcomes, and those with early and high transmission rates have superior outcomes. SUMMARY Remote monitoring provides clinicians with the ability to provide comprehensive follow-up care for patients with CIEDs. Patient outcomes are improved, and resource utilization is decreased with appropriate use of remote monitoring. Future efforts must focus on improving the utilization and efficiency of remote monitoring.
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Parkash R, Thibault B, Philippon F, Yee R, Stephenson E, Healey J, Krahn A, Exner D, Simpson C, Crystal E, Nery P, Essebag V, Sterns L, Tang A, Wells G. Canadian Registry of Implantable Electronic Device Outcomes: Surveillance of High-Voltage Leads. Can J Cardiol 2018; 34:808-811. [PMID: 29801745 DOI: 10.1016/j.cjca.2018.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/12/2018] [Accepted: 02/12/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cardiac implantable electrical devices (CIEDs) are subject to advisories and complications that can result in morbidity and mortality for patients; there is currently no system in Canada to track these. METHODS This was a multicenter, prospective cohort study conducted at 5 centers to determine feasibility. Patients with a de novo high-voltage (HV) lead implantation were included and followed for a minimum of 1 year. RESULTS There were 611 leads enrolled into the registry over 18 months. The mean age was 62.4 ± 12.8 years; 144 (23.6%) women were enrolled. The indication for lead implantation was for primary prevention in 65.5%. There were 497 (82.1%) de novo devices (single chamber: 54.5%, dual chamber: 20.5%, cardiac resynchronization therapy [CRT] 25.0%); the remainder of the procedures was a system revision for either upgrade (8.1%) or lead revision (9.8%). The lead revision rate at 1 year was 3.4%, with the primary reason being lead dislodgements. Mortality rate was 3.8% at 1 year. The rate of any device-related complication was 2.0% at 30 days, with the highest rate in CRT implants (4.9%, P = 0.0105). At 1 year, the complication rate was 4.5%, with no significant difference among device types. CONCLUSIONS This study demonstrates that device surveillance is feasible and highlights (1) the need for CIED surveillance to track device-related complications, (2) the scope of this should be larger, and (3) mandatory participation should be considered. This system could predict CIEDs that may be susceptible to higher than usual rates of failure, mitigating adverse outcomes in patients.
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Affiliation(s)
- Ratika Parkash
- Department of Medicine, Division of Cardiology, QEII Health Sciences Center, Halifax, Nova Scotia, Canada.
| | - Bernard Thibault
- Division of Cardiology, Montréal Heart Institute, Montréal, Québec, Canada
| | - Francois Philippon
- Division of Cardiology, Université de Laval, Québec City, Québec, Canada
| | - Raymond Yee
- Division of Cardiology, London Health Sciences Center, London, Ontario, Canada
| | | | - Jeff Healey
- Division of Cardiology, Hamilton Health Sciences Center, Hamilton, Ontario, Canada
| | - Andrew Krahn
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Derek Exner
- Division of Cardiology, Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Christopher Simpson
- Division of Cardiology, Kingston General Hospital, Kingston, Ontario, Canada
| | - Eugene Crystal
- Division of Cardiology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Pablo Nery
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Vidal Essebag
- Divisions of Cardiology, McGill University and Hôpital de Sacre Coeur, Montréal, Québec, Canada
| | - Laurence Sterns
- Division of Cardiology, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Anthony Tang
- Division of Cardiology, London Health Sciences Center, London, Ontario, Canada
| | - George Wells
- Cardiovascular Research Methods Center, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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21
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Cheung CC, Deyell MW. Remote Monitoring of Cardiac Implantable Electronic Devices. Can J Cardiol 2018; 34:941-944. [PMID: 29691097 DOI: 10.1016/j.cjca.2018.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/28/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022] Open
Abstract
Over the past decade, technological advancements have transformed the delivery of care for arrhythmia patients. From early transtelephonic monitoring to new devices capable of wireless and cellular transmission, remote monitoring has revolutionized device care. In this article, we review the current evolution and evidence for remote monitoring in patients with cardiac implantable electronic devices. From passive transmission of device diagnostics, to active transmission of patient- and device-triggered alerts, remote monitoring can shorten the time to diagnosis and treatment. Studies have shown that remote monitoring can reduce hospitalization and emergency room visits, and improve survival. Remote monitoring can also reduce the health care costs, while providing increased access to patients living in rural or marginalized communities. Unfortunately, as many as two-thirds of patients with remote monitoring-capable devices do not use, or are not offered, this feature. Current guidelines recommend remote monitoring and interrogation, combined with annual in-person evaluation in all cardiac device patients. Remote monitoring should be considered in all eligible device patients and should be considered standard of care.
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Affiliation(s)
- Christopher C Cheung
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marc W Deyell
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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22
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Weng W, Sapp J, Doucette S, MacIntyre C, Gray C, Gardner M, Abdelwahab A, Parkash R. Benefit of Implantable Cardioverter-Defibrillator Generator Replacement in a Primary Prevention Population-Based Cohort. JACC Clin Electrophysiol 2017; 3:1180-1189. [DOI: 10.1016/j.jacep.2017.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/15/2017] [Accepted: 03/13/2017] [Indexed: 11/25/2022]
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23
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Czosek RJ, Brown J, Proctor D, Koch P, Martin M, Rust M, Anderson JB. Improvement in patient and physician notification of cardiac rhythm device report transmissions. BMJ Open Qual 2017; 6:e000155. [PMID: 29450294 PMCID: PMC5699127 DOI: 10.1136/bmjoq-2017-000155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 12/02/2022] Open
Abstract
Background Cardiac rhythm devices (CRD) require complex management to identify potential device or patient issues. While easy to obtain, report processing is complex and time consuming. In our population, a majority of reports were performed outside of institutional protocols and no method for electrophysiology (EP) notification for unscheduled reports existed. These process breakdowns led to potential issues with safety and associated loss of work efficiency. Objective Our aim was to decrease the percentage of reports without EP notification from 30% to 10% over a 9-month time period. Methods We created a detailed process map of in-office and home device reporting. Failure mode and effects analysis (FMEA)/Pareto charts were used to determine the mechanistic underpinnings of notification failures and identify areas for process improvement. Multiple interventions were implemented using the Plan-Do-Study-Act (PDSA) technique. Process run charts and control charts were used to evaluate ongoing changes. Results Our FMEA identified failures related to (1) lack of physician understanding of the device reporting system, (2) lack of an easy to use method of EP notification and (3) lack of patient understanding of report notification. Pareto charts identified the most frequent failures to be associated with specific cardiology subspecialties as well as reports sent from home. We performed multiple interventions including(1) creation of an easy to use method of EP notification used by patients and medical staff, (2) physician education and (3) patient education. Compared with baseline reporting, there was a decrease from 30% to <10% of device reports obtained without EP notification. This process improvement additionally resulted in a 34% reduction in time required for device processing. Conclusions Development of a unified EP reporting system and quality improvement methodology resulted in improved CRD report notification and improved efficiency for staff. These process changes resulted in improvement across differing cardiac subspecialty providers and patients.
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Affiliation(s)
- Richard J Czosek
- Department of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James Brown
- Department of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Diane Proctor
- Department of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Paula Koch
- Department of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Michelle Martin
- Department of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Mary Rust
- Department of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jeffrey B Anderson
- Department of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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24
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Styles K, Sapp J, Gardner M, Gray C, Abdelwahab A, MacIntyre C, Gao D, Al-Harbi M, Doucette S, Theriault C, Parkash R. The influence of sex and age on ventricular arrhythmia in a population-based registry. Int J Cardiol 2017. [DOI: 10.1016/j.ijcard.2017.06.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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25
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2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm 2017; 14:e503-e551. [PMID: 28919379 DOI: 10.1016/j.hrthm.2017.09.001] [Citation(s) in RCA: 718] [Impact Index Per Article: 102.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Indexed: 02/06/2023]
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26
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Philippon F, Sterns LD, Nery PB, Parkash R, Birnie D, Rinne C, Mondesert B, Exner D, Bennett M. Management of Implantable Cardioverter Defibrillator Recipients: Care Beyond Guidelines. Can J Cardiol 2017; 33:977-990. [DOI: 10.1016/j.cjca.2017.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 05/07/2017] [Accepted: 05/08/2017] [Indexed: 01/19/2023] Open
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O'Shea CJ, McGavigan AD, Clark RA, Chew DPB, Ganesan A. Mobile health: an emerging technology with implications for global internal medicine. Intern Med J 2017; 47:616-619. [DOI: 10.1111/imj.13440] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/09/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Catherine J. O'Shea
- Flinders University; Adelaide South Australia Australia
- Department of Cardiovascular Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network; Flinders University; Adelaide South Australia Australia
| | - Andrew D. McGavigan
- Flinders University; Adelaide South Australia Australia
- Department of Cardiovascular Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network; Flinders University; Adelaide South Australia Australia
| | - Robyn A. Clark
- School of Nursing and Midwifery; Flinders University; Adelaide South Australia Australia
| | - Derek P. B. Chew
- Flinders University; Adelaide South Australia Australia
- Department of Cardiovascular Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network; Flinders University; Adelaide South Australia Australia
| | - Anand Ganesan
- Flinders University; Adelaide South Australia Australia
- Department of Cardiovascular Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network; Flinders University; Adelaide South Australia Australia
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28
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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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29
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Parthiban N, Esterman A, Mahajan R, Twomey DJ, Pathak RK, Lau DH, Roberts-Thomson KC, Young GD, Sanders P, Ganesan AN. Remote Monitoring of Implantable Cardioverter-Defibrillators. J Am Coll Cardiol 2015; 65:2591-2600. [DOI: 10.1016/j.jacc.2015.04.029] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
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30
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Boyer SL, Silka MJ, Bar-Cohen Y. Current practices in the monitoring of cardiac rhythm devices in pediatrics and congenital heart disease. Pediatr Cardiol 2015; 36:821-6. [PMID: 25527229 DOI: 10.1007/s00246-014-1090-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 12/11/2014] [Indexed: 11/24/2022]
Abstract
Although guidelines for routine follow-up of pacemakers and implantable cardioverter defibrillators (ICDs) are available for adults, minimal data supports their appropriateness in pediatrics and congenital heart disease. This study aimed to define current practices of cardiac rhythm device (CRD) follow-up among pediatric electrophysiologists. Pediatric and Congenital EP Society (PACES) members were surveyed regarding frequency of CRD in-person follow-up as well as transtelephonic monitoring (TTM) and remote monitoring (RM) practices. If home monitoring was used, the effect on in-person follow-up was also evaluated. A total of 106 PACES members responded to the survey. Uncomplicated pacemaker and ICD patients were both followed in-person at a median interval of 6 months (range 1-12 months). TTM was utilized by 67 % of responders (median interval 3 months; range 1-6 months), while RM was used by 87 % for pacemakers (median interval 3 months; range 1-6 months) and 92 % for ICDs (median interval 3 months; range 2 weeks-6 months). When TTM was used, 21 % of responders reduced their frequency of pacemaker clinic visits. In comparison, RM reduced the frequency of clinic visits for pacemakers and ICDs in 32 and 31 % of responders, respectively. Patient age was an independent factor in determining CRD follow-up for 49 % of responders. While CRD follow-up by pediatric electrophysiologists in general follows adult guidelines, individual practices widely vary. In contrast to published recommendations in adults, TTM and RM utilization does not reduce the frequency of in-person visits for the majority of pediatric electrophysiologists.
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Affiliation(s)
- Stacey L Boyer
- Division of Cardiology, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Mail Stop #34, Los Angeles, CA, 90027, USA
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31
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Nair GM, Nair V, Healey JS, Morillo CA. Automatic Implantable Cardioverter Defibrillator Lead Dislodgement Resulting in Sudden Cardiac Death: A Case Report. Can J Cardiol 2014; 30:1460.e7-9. [DOI: 10.1016/j.cjca.2014.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 07/04/2014] [Accepted: 07/06/2014] [Indexed: 11/26/2022] Open
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32
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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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Parkash R, Philippon F, Shanks M, Thibault B, Cox J, Low A, Essebag V, Bashir J, Moe G, Birnie DH, Larose E, Yee R, Swiggum E, Kaul P, Redfearn D, Tang AS, Exner DV. Canadian Cardiovascular Society guidelines on the use of cardiac resynchronization therapy: implementation. Can J Cardiol 2014; 29:1346-60. [PMID: 24182753 DOI: 10.1016/j.cjca.2013.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 09/12/2013] [Accepted: 09/13/2013] [Indexed: 01/11/2023] Open
Abstract
Recent studies have provided the impetus to update the recommendations for cardiac resynchronization therapy (CRT). This article provides guidance on the implementation of CRT and is intended to serve as a framework for the implementation of CRT within the Canadian health care system and beyond. These guidelines were developed through a critical evaluation of the existing literature, and expert consensus. The panel unanimously adopted each recommendation. The 9 recommendations relate to patient selection in the presence of comorbidities, delivery and optimization of CRT, and resources required to deliver this therapy. The strength of evidence was weighed, taking full consideration of any risk of bias, and any imprecision, inconsistency, and indirectness of the available data. The strength of each recommendation and the quality of evidence were adjudicated. Trade-offs between desirable and undesirable consequences of alternative management strategies were considered, as were values, preferences, and resource availability. These guidelines were externally reviewed by experts, modified based on those reviews, and will be updated as new knowledge is acquired.
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Affiliation(s)
- Ratika Parkash
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
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