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D'Onofrio A, Solimene F, Bulava A, Shoda M, Klein C, Gargaro A, Timmel T, Giacopelli D, Botto G. A multiparametric heart failure score at baseline is associated with long-term outcome in patients with remotely monitored implantable cardioverter-defibrillators: A pooled analysis of nine clinical trials. Heart Rhythm 2024:S1547-5271(24)03418-0. [PMID: 39383980 DOI: 10.1016/j.hrthm.2024.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 09/17/2024] [Accepted: 10/01/2024] [Indexed: 10/11/2024]
Abstract
BACKGROUND To predict worsening heart failure hospitalizations (WHFHs), the HeartInsight multiparametric algorithm calculates a Heart Failure (HF) Score based on temporal trends of physiologic parameters obtained through automatic daily remote monitoring of implantable cardioverter-defibrillators (ICDs). OBJECTIVE We studied the association of the baseline HF Score (BHFScore), determined at algorithm activation, with long-term patient outcomes. METHODS Data from nine clinical trials were pooled, including 1,841 ICD patients with a pre-implant ejection fraction ≤35%, NYHA class II/III, and no long-standing atrial fibrillation. Primary endpoint was a composite of death or WHFH. RESULTS After a median follow-up of 631 days (interquartile range, 385-865), there were 243 WHFHs in 173 patients (9.4%) and 122 deaths (6.6%), 52 of which (42.6%) were cardiovascular. Primary endpoint occurred in 265 patients (14.4%). A multivariable time-to-first event analysis showed that a high BHFScore (>23, as determined by a time-dependent receiver operating characteristics curve analysis) was significantly associated with the occurrence of primary endpoint (adjusted hazard ratio [HR], 2.05; 95%-confidence interval [CI], 1.54-2.71; p<0.0001), all-cause death (HR, 2.37; CI, 1.56-3.58; p<0.0001), cardiovascular death (HR, 2.19; CI, 1.14-4.22; p=0.019), and WHFH (HR, 1.91; CI, 1.35-2.71; p=0.0003). In a hierarchical event analysis of all-cause death as the outcome with highest priority and WHFHs as repeated-event outcomes, the win-ratio was 2.47 (CI, 1.89-3.24; p<0.0001). CONCLUSIONS Based on a retrospective analysis of clinical trial data with adjudicated events, baseline HF Score derived from device-monitored variables was able to stratify patients at higher long-term risk of death or WHFH.
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Affiliation(s)
- Antonio D'Onofrio
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi Hospital, Naples, Italy.
| | | | - Alan Bulava
- Ceske Budejovice Hospital, Faculty of Health and Social Sciences, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Morio Shoda
- Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Cedric Klein
- University of Lille, CHU Lille, Lille University Hospital Center, Lille, Hauts-de-France, France
| | - Alessio Gargaro
- Clinical Unit, Biotronik Italia S.p.a., Cologno Monzese (MI), Italy
| | - Tobias Timmel
- Center for Clinical Research, Biotronik SE & Co. KG, Berlin, Germany
| | | | - Gianluca Botto
- U.O. Electrophysiology, ASST Rhodense, Garbagnate Milanese (MI), Italy
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Molina-Lerma M, Cózar-León R, García-Fernández FJ, Calvo D. Spanish pacemaker registry. 21st official report of Heart Rhythm Association of the Spanish Society of Cardiology (2023). REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00267-6. [PMID: 39251130 DOI: 10.1016/j.rec.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 07/17/2024] [Indexed: 09/11/2024]
Abstract
INTRODUCTION Data on implants of cardiac pacing systems in Spain in 2023 are presented. METHODS The registry is based on the information provided by centers to the recording platform of the Heart Rhythm Association after device implantations, through Cardiodispositivos, the online platform of the National Registry. Other information sources include: a) data transfers from the manufacturing and marketing industry; b) the European pacemaker patient card; and c) local databases submitted by the implanting centers. RESULTS In 2023, 112 hospitals participated in the registry (30 more than in 2022). A total of 24 343 device implantations were reported (48.1% more than in 2022) compared with 45 120 reported by Eucomed (European Confederation of Medical Suppliers Associations). Of these, 1646 were cardiac resynchronization therapy pacemakers. The devices showing the largest increases were leadless pacemakers, with 963 devices implanted, representing an 18.1% increase over 2022. The most frequent indication was atrioventricular block followed, for the first time, by atrial tachyarrhythmia with slow ventricular response. The number of devices included in remote monitoring also increased (cardiac resynchronization therapy defibrillators, 71%; cardiac resynchronization therapy pacemakers, 63%; and conventional pacemakers, 28%), although more moderately. CONCLUSIONS In 2023, there was an increase in the number of institutions participating in the registry. The reporting of device implantations rose by 48.1%, and the implantation of leadless pacemakers grew by 18.1%. Remote monitoring also experienced modest growth compared with previous years.
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Affiliation(s)
- Manuel Molina-Lerma
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | - Rocío Cózar-León
- Servicio de Cardiología, Hospital Universitario Virgen Macarena, Seville, Spain; Facultad de Medicina, Universidad de Sevilla, Seville, Spain
| | | | - David Calvo
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Vandenberk B, Ferrick N, Wan EY, Narayan SM, Ferrick AM, Raj SR. Determinants of global cardiac implantable electrical device remote monitoring utilization - Results from an international survey. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2024; 5:141-148. [PMID: 38989041 PMCID: PMC11232424 DOI: 10.1016/j.cvdhj.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Abstract
Background Despite near-global availability of remote monitoring (RM) in patients with cardiac implantable electronic devices (CIED), there is a high geographical variability in the uptake and use of RM. The underlying reasons for this geographic disparity remain largely unknown. Objectives To study the determinants of worldwide RM utilization and identify locoregional barriers of RM uptake. Methods An international survey was administered to all CIED clinic personnel using the Heart Rhythm Society global network collecting demographic information, as well as information on the use of RM, the organization of the CIED clinic, and details on local reimbursement and clinic funding. The most complete response from each center was included in the current analysis. Stepwise forward multivariate linear regression was performed to identify determinants of the percentage of patients with a CIED on RM. Results A total of 302 responses from 47 different countries were included, 61.3% by physicians and 62.3% from hospital-based CIED clinics. The median percentage of CIED patients on RM was 80% (interquartile range, 40-90). Predictors of RM use were gross national income per capita (0.76% per US$1000, 95% CI 0.72-1.00, P < .001), office-based clinics (7.48%, 95% CI 1.53-13.44, P = .014), and presence of clinic funding (per-patient payment model 7.90% [95% CI 0.63-15.17, P = .033); global budget 3.56% (95% CI -6.14 to 13.25, P = .471]). Conclusion The high variability in RM utilization can partly be explained by economic and structural barriers that may warrant specific efforts by all stakeholders to increase RM utilization.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Neal Ferrick
- Department of Cardiology, Montefiore Medical Center, New York, New York
| | - Elaine Y. Wan
- Division of Cardiology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Sanjiv M. Narayan
- Cardiology Division, Cardiovascular Institute, Stanford University, Stanford, California
| | - Aileen M. Ferrick
- Cardiac Electrophysiology, White Plains Hospital, White Plains, New York, New York
| | - Satish R. Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Tan VH, See Tow HX, Fong KY, Wang Y, Yeo C, Ching CK, Lim TW. Remote monitoring of cardiac implantable electronic devices using smart device interface versus radiofrequency-based interface: A systematic review. J Arrhythm 2024; 40:596-604. [PMID: 38939794 PMCID: PMC11199811 DOI: 10.1002/joa3.13054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 06/29/2024] Open
Abstract
Background Guidelines recommended remote monitoring (RM) in managing patients with Cardiac Implantable Electronic Devices. In recent years, smart device (phone or tablet) monitoring-based RM (SM-RM) was introduced. This study aims to systematically review SM-RM versus bedside monitor RM (BM-RM) using radiofrequency in terms of compliance, connectivity, and episode transmission time. Methods We conducted a systematic review, searching three international databases from inception until July 2023 for studies comparing SM-RM (intervention group) versus BM-RM (control group). Results Two matched studies (21 978 patients) were retrieved (SM-RM arm: 9642 patients, BM-RM arm: 12 336 patients). There is significantly higher compliance among SM-RM patients compared with BM-RM patients in both pacemaker and defibrillator patients. Manyam et al. found that more SM-RM patients than BM-RM patients transmitted at least once (98.1% vs. 94.3%, p < .001), and Tarakji et al. showed that SM-RM patients have higher success rates of scheduled transmissions than traditional BM-RM methods (SM-RM: 94.6%, pacemaker manual: 56.3%, pacemaker wireless: 77.0%, defibrillator wireless: 87.1%). There were higher enrolment rates, completed scheduled and patient-initiated transmissions, shorter episode transmission time, and higher connectivity among SM-RM patients compared to BM-RM patients. Younger patients (aged <75) had more patient-initiated transmissions, and a higher proportion had ≥10 transmissions compared with older patients (aged ≥75) in both SM-RM and BM-RM groups. Conclusion SM-RM is a step in the right direction, with good compliance, connectivity, and shorter episode transmission time, empowering patients to be in control of their health. Further research on cost-effectiveness and long-term clinical outcomes can be carried out.
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Affiliation(s)
- Vern Hsen Tan
- Department of CardiologyChangi General HospitalSingaporeSingapore
| | - Hui Xin See Tow
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Khi Yung Fong
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Yue Wang
- Department of CardiologyChangi General HospitalSingaporeSingapore
| | - Colin Yeo
- Department of CardiologyChangi General HospitalSingaporeSingapore
| | - Chi Keong Ching
- Department of CardiologyNational Heart Centre SingaporeSingaporeSingapore
| | - Toon Wei Lim
- Department of CardiologyNational University Heart Centre SingaporeSingaporeSingapore
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Preda A, Falco R, Tognola C, Carbonaro M, Vargiu S, Gallazzi M, Baroni M, Gigli L, Varrenti M, Colombo G, Zanotto G, Giannattasio C, Mazzone P, Guarracini F. Contemporary Advances in Cardiac Remote Monitoring: A Comprehensive, Updated Mini-Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:819. [PMID: 38793002 PMCID: PMC11122881 DOI: 10.3390/medicina60050819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024]
Abstract
Over the past decade, remote monitoring (RM) has become an increasingly popular way to improve healthcare and health outcomes. Modern cardiac implantable electronic devices (CIEDs) are capable of recording an increasing amount of data related to CIED function, arrhythmias, physiological status and hemodynamic parameters, providing in-depth and updated information on patient cardiovascular function. The extensive use of RM for patients with CIED allows for early diagnosis and rapid assessment of relevant issues, both clinical and technical, as well as replacing outpatient follow-up improving overall management without compromise safety. This approach is recommended by current guidelines for all eligible patients affected by different chronic cardiac conditions including either brady- and tachy-arrhythmias and heart failure. Beyond to clinical advantages, RM has demonstrated cost-effectiveness and is associated with elevated levels of patient satisfaction. Future perspectives include improving security, interoperability and diagnostic power as well as to engage patients with digital health technology. This review aims to update existing data concerning clinical outcomes in patients managed with RM in the wide spectrum of cardiac arrhythmias and Hear Failure (HF), disclosing also about safety, effectiveness, patient satisfaction and cost-saving.
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Affiliation(s)
- Alberto Preda
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Raffaele Falco
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Chiara Tognola
- Clinical Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
| | - Marco Carbonaro
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Sara Vargiu
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Michela Gallazzi
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Matteo Baroni
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Lorenzo Gigli
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Marisa Varrenti
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Giulia Colombo
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Gabriele Zanotto
- Department of Cardiology, Ospedale Magalini di Villafranca, 37069 Villafranca di Verona, Italy
| | - Cristina Giannattasio
- Clinical Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Patrizio Mazzone
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Fabrizio Guarracini
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
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Kratka A, Rotering TL, Raitt MH, Whooley MA, Dhruva SS. Informational letters or postcards to initiate remote monitoring among veterans with pacemakers and implantable cardioverter-defibrillators: A randomized, controlled trial. Pacing Clin Electrophysiol 2024; 47:642-649. [PMID: 38556540 DOI: 10.1111/pace.14912] [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: 10/25/2023] [Revised: 12/04/2023] [Accepted: 12/10/2023] [Indexed: 04/02/2024]
Abstract
BACKGROUND Remote monitoring (RM) of pacemakers and implantable cardioverter-defibrillators (ICDs) is a Class 1, Level of Evidence A recommendation because of its multitude of clinical benefits. However, RM adherence rates are suboptimal, precluding patients from achieving these benefits. There is a need for direct-to-patient efforts to improve adherence. METHODS In this national randomized, controlled trial conducted in the Veterans Health Administration (VHA), 2120 patients with a pacemaker or ICD who had not sent an RM transmission for ≥1 year (and usually ≥3 years) while under VHA care for their device were randomly assigned to be mailed a postcard (n = 1076) or a detailed letter (n = 1044). The postcard described what RM does and its key benefits (reduced mortality and fewer in-person visits). The letter provided a similar message but included more details about RM benefits and the process. The primary outcome was an RM transmission sent within 90 days of mailing, and a secondary outcome was an RM transmission sent within 365 days. RESULTS The primary outcome was achieved in 121 (11.3%) in the postcard and 96 patients (9.2%) in the letter group (p = .12). The secondary outcome was achieved in 266 (24.7%) and 239 (22.9%), respectively (p = .32). CONCLUSIONS This randomized trial showed no significant difference in the proportion of chronically non-adherent patients who sent an RM transmission after receiving a low-cost postcard or a detailed, higher-cost letter encouraging their participation in RM. However, as only a minority of patients responded to either, further work is needed to engage patients in the life-saving benefits of RM.
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Affiliation(s)
- Allison Kratka
- Section of Cardiology, Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Thomas L Rotering
- Section of Cardiology, Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco School of Medicine, San Francisco, United States
| | - Merritt H Raitt
- Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Knight Cardiovascular Institute, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Mary A Whooley
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco School of Medicine, San Francisco, United States
- Section of General Internal Medicine, Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Sanket S Dhruva
- Section of Cardiology, Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco School of Medicine, San Francisco, United States
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García-Fernández FJ, Calvo Simal S, Cano Pérez Ó, Calvo Cuervo D, Pombo Jiménez M, Fernández Lozano I, Villagraz Tercedor L, Fernández Palacios G, Martín González J. Impact of the COVID-19 pandemic on implantation of cardiac implantable electronic devices and remote monitoring activations. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:243-253. [PMID: 37516312 DOI: 10.1016/j.rec.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/07/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION AND OBJECTIVES Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is considered more reliable, efficient, and safer than conventional in-person follow-up. However, the implementation of RM is still suboptimal. This study aimed to analyze the impact of the COVID-19 pandemic on the rates of CIED implants and RM activations in Spain. METHODS The COVID-19 RM Spain Registry was used to analyze the monthly number of all CIED implantations and RM activations from January 2018 to December 2021. A descriptive analysis was performed using aggregated data from the five major CIED manufacturers. RESULTS A total of 205 345 CIEDs were recorded. The number of implants decreased sharply (48.2%) during the pandemic lockdown (March-June 2020) but gradually increased thereafter, compensating for the previous reduction. However, pacemakers and implantable cardiac defibrillators (ICD) showed an aggregate loss of 7% and 3%, respectively, from the annual average during 2020-2021. In contrast, cardiac resynchronization therapy defibrillators (CRT-D) increased by 17%, and pacemakers (CRT-P) by 4.5% over the 2-year period. The percentage of RM activations increased from 24.5% in 2018 to 49.0% in 2021, with a sharp increase during the lockdown. The RM activation rates consistently increased during the lockdown for all devices: pacemakers (14.4% vs 37.2%; P <.001); ICD (75.6% vs 94.2%; P <.001); CRT-D/CRT-P (68.6-44.2% vs 81.6-61%; P <.001), and implantable loop recorders (50.2% vs 68.7%; P <.001). CONCLUSIONS The significant decline in implants during the lockdown gradually recovered, except for pacemakers and ICD. However, the COVID-19 pandemic boosted RM for all CIEDs in Spain.
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Affiliation(s)
- F J García-Fernández
- Unidad de Arritmias, Servicio de Cardiología., Hospital Universitario de Burgos, Burgos, Spain.
| | - Sara Calvo Simal
- Unidad de Investigación, Fundación Burgos por las Ciencias de la Salud, Universidad de Burgos, Burgos, Spain
| | - Óscar Cano Pérez
- Unidad de Arritmias, área de Enfermedades Cardiovasculares, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - David Calvo Cuervo
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - Marta Pombo Jiménez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Ignacio Fernández Lozano
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Lola Villagraz Tercedor
- Unidad de Arritmias, Servicio de Cardiología., Hospital Universitario de Burgos, Burgos, Spain
| | | | - Javier Martín González
- Unidad de Arritmias, Servicio de Cardiología., Hospital Universitario de Burgos, Burgos, Spain
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Seo J, Alhuarrat MAD, Krishnan S, Saralidze T, Lim H, Chen B, Flomenbaum D, Naser A, Kharawala A, Apple SJ, Ferrick N, Chudow J, Di Biase L, Fisher JD, Krumerman A, Ferrick KJ. Utilization of the remote monitoring of cardiac implantable electronic devices in a diverse demographic cohort: Insights from a single-center observation. Pacing Clin Electrophysiol 2024; 47:185-194. [PMID: 38010836 DOI: 10.1111/pace.14883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/29/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Despite its clinical benefits, patient compliance to remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) varies and remains under-studied in diverse populations. OBJECTIVE We sought to evaluate RM compliance, clinical outcomes, and identify demographic and socioeconomic factors affecting RM in a diverse urban population in New York. METHODS This retrospective cohort study included patients enrolled in CIED RM at Montefiore Medical Center between December 2017 and May 2022. RM compliance was defined as the percentage of days compliant to RM transmission divided by the total prescribed days of RM. Patients were censored when they were lost to follow-up or at the time of death. The cohorts were categorized into low (≤30%), intermediate (31-69%), and high (≥70%) RM compliance groups. Statistical analyses were conducted accordingly. RESULTS Among 853 patients, median RM compliance was 55%. Age inversely affected compliance (p < .001), and high compliance was associated with guideline-directed medical therapy (GDMT) usage and implantable cardioverter defibrillator (ICD)/cardiac resynchronization defibrillator (CRTD) devices. The low-compliance group had a higher mortality rate and fewer regular clinic visits (p < .001) than high-compliance group. Socioeconomic factors did not significantly impact compliance, while Asians showed higher compliance compared with Whites (OR 3.67; 95% CI 1.08-12.43; p = .04). Technical issues were the main reason for non-compliance. CONCLUSION We observed suboptimal compliance to RM, which occurred most frequently in older patients. Clinic visit compliance, optimal medical therapy, and lower mortality were associated with higher compliance, whereas insufficient understanding of RM usage was the chief barrier to compliance.
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Affiliation(s)
- Jiyoung Seo
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Suraj Krishnan
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Tinatin Saralidze
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Hyomin Lim
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Brett Chen
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David Flomenbaum
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ahmad Naser
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amrin Kharawala
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Samuel J Apple
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Neal Ferrick
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jay Chudow
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - John D Fisher
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrew Krumerman
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kevin J Ferrick
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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9
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Rosman L, Mazzella AJ, Gu X, Vives CA, Lanctin D, Natera AC, Gehi A, Lampert R. A Patient-Centered Intervention Reduces Disparities in Remote Monitoring in Patients With Implanted Cardiac Devices. JACC Clin Electrophysiol 2024; 10:316-330. [PMID: 37999668 DOI: 10.1016/j.jacep.2023.10.001] [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: 01/20/2023] [Revised: 09/21/2023] [Accepted: 10/01/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Remote monitoring (RM) is recommended for patients with cardiovascular implantable electronic devices, yet many individuals, especially those living in underserved communities, fail to receive this guideline-directed care. Multilevel interventions that target patient and clinic-level barriers to RM care may be beneficial. OBJECTIVES This study sought to evaluate a remotely delivered, patient-centered intervention to improve RM activation and adherence and reduce disparities in RM care. METHODS The intervention provides home delivery of remote monitor, phone-based education, monitor setup, and facilitation of first transmission. A retrospective cohort analysis was performed using RM data from 190,643 patients (71.6 ± 12.7 years of age, 40.5% female) implanted with a pacemaker or defibrillator at 4,195 U.S. clinics between October 2015 and October 2019. Outcomes included RM activation (12 weeks and 1-year postimplantation) and adherence to clinic-scheduled transmissions. Patients receiving a cardiovascular implantable electronic deviceimplant 0 to 730 days before (control group, n = 95,861) and after (intervention group, n = 94,782) intervention launch were compared using logistic regression and generalized estimating equations. Multivariable models included patient, clinic, and neighborhood socioeconomic characteristics. RESULTS The odds of achieving guideline-recommended activation were significantly higher in the intervention group at 12 weeks (OR: 2.99; 76.7% vs 60.9%; P < 0.001) and 1 year (OR: 3.05; 88.2% vs 79.3%; P < 0.001). Adherence to scheduled transmissions was also higher in the intervention group compared with the control group (OR: 2.18; 89.1% vs 81.9%; P < 0.001). Preintervention disparities in RM activation and adherence were reduced in underserved groups following the intervention. CONCLUSIONS A remotely delivered patient-centered intervention was associated with earlier activation and improved adherence to RM while reducing disparities in RM care.
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Affiliation(s)
- Lindsey Rosman
- Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
| | - Anthony J Mazzella
- Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | | | | | - Anil Gehi
- Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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10
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McLaughlin MM, Raitt MH, Tarasovsky G, Whooley MA, Dhruva SS. Informational Postcards Increase Engagement with Remote Monitoring Among Veterans with Pacemakers and Implantable Cardioverter-Defibrillators: a Stepped-Wedge Randomized Controlled Trial. J Gen Intern Med 2024; 39:87-96. [PMID: 38252247 PMCID: PMC10937872 DOI: 10.1007/s11606-023-08478-9] [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: 04/09/2023] [Accepted: 10/12/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Remote monitoring (RM) of pacemakers and implantable cardioverter-defibrillators (ICDs) reduces morbidity and mortality. However, many patients are not adherent to RM. OBJECTIVE To test the effect of informational postcards on RM adherence. DESIGN/PATIENTS Stepped-wedge randomized controlled trial among Veterans with pacemakers and ICDs. INTERVENTION In wave 1, Veterans who had sent at least 1 transmission within the past 2 years but had become non-adherent were randomly assigned to receive a postcard or no postcard. Those receiving postcards were randomized to 1 of 2 messages: (1) a"warning" postcard describing risks of non-adherence or (2) an "encouraging" postcard describing benefits of adherence. In wave 2, Veterans who had either not received a postcard in wave 1 or had since become non-adherent were mailed a postcard (again, randomized to 1 of 2 messages). Patients who did not send an RM transmission within 1 month were mailed a second, identical postcard. MAIN MEASURES Transmission within 70 days. KEY RESULTS Overall, 6351 Veterans were included. In waves 1 and 2, postcards were mailed to 5657 Veterans (2821 "warning" messages and 2836 "encouraging" messages). Wave 1 included 2178 Veterans as controls (i.e., not mailed a postcard), some of whom received a postcard in wave 2 if they remained non-adherent. In wave 2, 3473 postcards were sent. Of the 5657 patients mailed a postcard, 2756 (48.7%) sent an RM transmission within 70 days, compared to 530 (24.3%) of 2178 controls (absolute difference 24.4%, 95% confidence interval [CI] 22.2%, 26.6%). Of those who sent a transmission, 71.8% did so after the first postcard. Transmission rates at 70 days did not significantly differ between "warning" and "encouraging" messages (odds ratio 1.04, 95% CI 0.92, 1.18). CONCLUSIONS Informational postcards led to a 24.4% absolute increase in adherence at 70 days among Veterans with pacemakers and ICDs who were non-adherent to RM.
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Affiliation(s)
- Megan M McLaughlin
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Merritt H Raitt
- Portland Veterans Affairs Health Care System, Portland, OR, USA
| | - Gary Tarasovsky
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Mary A Whooley
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Sanket S Dhruva
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA.
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11
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Howard TS, Vinocur JM. Translation of Tools and Techniques from the Adult Electrophysiology World to Pediatric Cardiac Implantable Electronic Devices. Card Electrophysiol Clin 2023; 15:515-525. [PMID: 37865524 DOI: 10.1016/j.ccep.2023.06.004] [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: 10/23/2023]
Abstract
This article reviews various opportunities to translate established and novel tools and techniques used in adult electrophysiology to pediatrics and the adult congenital heart disease population. There is a specific focus on preoperative management of special population, implantation techniques, and postoperative programming of devices.
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Affiliation(s)
- Taylor S Howard
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, E1920, Houston, TX 77030, USA.
| | - Jeffrey M Vinocur
- Department of Pediatrics, Division of Pediatric Cardiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
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12
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Rotering TL, Hysong SJ, Williams KE, Raitt MH, Whooley MA, Dhruva SS. Strategies to enhance remote monitoring adherence among patients with cardiovascular implantable electronic devices. Heart Rhythm O2 2023; 4:794-804. [PMID: 38204458 PMCID: PMC10774668 DOI: 10.1016/j.hroo.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
Background Remote monitoring (RM) of patients with cardiovascular implantable electronic devices (CIEDs) (pacemakers and implantable cardioverter-defibrillators) has a Class 1, Level of Evidence A Heart Rhythm Society recommendation. Yet RM adherence varies widely across settings, and factors associated with variation are not understood. Objective The purpose of this study was to identify strategies for supporting RM across Veterans Health Administration (VHA) facilities. Methods In a national evaluation, we surveyed and interviewed 27 nurses, medical instrument technicians, and advanced practice providers across 26 VHA facilities (following approximately 15,000 CIED patients). Participants were selected based on overall patient adherence by facility, which ranged from 46%-96%. Questions covered RM adherence strategies, manufacturer resources, organizational characteristics, and workflows for optimizing adherence. Results All clinicians reported that RM adherence was extremely important (53.8%), very important (34.6%), or important (11.5%) for improving patient outcomes. High performing facilities prioritized consistent patient education about RM and evaluated nonadherence using dashboards and manufacturer web sites. High performing facilities instituted clear standard operating procedures that defined staff responsibilities and facilitated efficient contact with nonadherent patients and then family members by phone and then mail. Clinicians based at high performing facilities spent twice as many hours per week (9.1) on average managing RM adherence compared to other facilities (4.5). Effective communication (internally and with non-VHA care partners) and use of CIED manufacturer resources were essential. Facilities that were not high performing rarely used these strategies. Conclusion Clinicians can support high RM adherence by emphasizing patient education, regularly assessing and addressing nonadherence using staff protocols, and engaging CIED manufacturers.
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Affiliation(s)
- Thomas L. Rotering
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Section of Cardiology, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California
| | - Sylvia J. Hysong
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Katherine E. Williams
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Merritt H. Raitt
- Portland Veterans Affairs Health Care System, Portland, Oregon
- Knight Cardiovascular Institute, Oregon Health and Sciences University, Portland, Oregon
| | - Mary A. Whooley
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Sanket S. Dhruva
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Section of Cardiology, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California
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13
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Dhruva SS, Raitt MH, Munson S, Moore HJ, Steele P, Rosman L, Whooley MA. Barriers and Facilitators Associated With Remote Monitoring Adherence Among Veterans With Pacemakers and Implantable Cardioverter-Defibrillators: Qualitative Cross-Sectional Study. JMIR Cardio 2023; 7:e50973. [PMID: 37988153 DOI: 10.2196/50973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/07/2023] [Accepted: 10/12/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The Heart Rhythm Society strongly recommends remote monitoring (RM) of cardiovascular implantable electronic devices (CIEDs) because of the clinical outcome benefits to patients. However, many patients do not adhere to RM and, thus, do not achieve these benefits. There has been limited study of patient-level barriers and facilitators to RM adherence; understanding patient perspectives is essential to developing solutions to improve adherence. OBJECTIVE We sought to identify barriers and facilitators associated with adherence to RM among veterans with CIEDs followed by the Veterans Health Administration. METHODS We interviewed 40 veterans with CIEDs regarding their experiences with RM. Veterans were stratified into 3 groups based on their adherence to scheduled RM transmissions over the past 2 years: 6 fully adherent (≥95%), 25 partially adherent (≥65% but <95%), and 9 nonadherent (<65%). As the focus was to understand challenges with RM adherence, partially adherent and nonadherent veterans were preferentially weighted for selection. Veterans were mailed a letter stating they would be called to understand their experiences and perspectives of RM and possible barriers, and then contacted beginning 1 week after the letter was mailed. Interviews were structured (some questions allowing for open-ended responses to dive deeper into themes) and focused on 4 predetermined domains: knowledge of RM, satisfaction with RM, reasons for nonadherence, and preferences for health care engagement. RESULTS Of the 44 veterans contacted, 40 (91%) agreed to participate. The mean veteran age was 75.3 (SD 7.6) years, and 98% (39/40) were men. Veterans had been implanted with their current CIED for an average of 4.4 (SD 2.8) years. A total of 58% (23/40) of veterans recalled a discussion of home monitoring, and 45% (18/40) reported a good understanding of RM; however, when asked to describe RM, their understanding was sometimes incomplete or not correct. Among the 31 fully or partially adherent veterans, nearly all were satisfied with RM. Approximately one-third recalled ever being told the results of a remote transmission. Among partially or nonadherent veterans, only one-fourth reported being contacted by a Department of Veterans Affairs health care professional regarding not having sent a remote transmission; among those who had troubleshooted to ensure they could send remote transmissions, they often relied on the CIED manufacturer for help (this experience was nearly always positive). Most nonadherent veterans felt more comfortable engaging in RM if they received more information or education. Most veterans were interested in being notified of a successful remote transmission and learning the results of their remote transmissions. CONCLUSIONS Veterans with CIEDs often had limited knowledge about RM and did not recall being contacted about nonadherence. When they were contacted and troubleshooted, the experience was positive. These findings provide opportunities to optimize strategies for educating and engaging patients in RM.
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Affiliation(s)
- Sanket S Dhruva
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Merritt H Raitt
- Division of Cardiology, Department of Specialty Care, Portland Veterans Affairs Health Care System, Portland, OR, United States
| | - Scott Munson
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Hans J Moore
- Cardiology Section, Medical Service, Washington DC Veterans Affairs Medical Center, Washington, DC, United States
| | - Pamela Steele
- Cardiology Section, Medical Service, Washington DC Veterans Affairs Medical Center, Washington, DC, United States
| | - Lindsey Rosman
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mary A Whooley
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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14
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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: 25] [Impact Index Per Article: 25.0] [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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15
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Varma N. Highlights from the 2023 HRS/EHRA/APHRS/LAHRS expert consensus statement on practical management of the remote device clinic. Heart Rhythm O2 2023; 4:526-527. [PMID: 37744939 PMCID: PMC10513915 DOI: 10.1016/j.hroo.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Affiliation(s)
- Niraj Varma
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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16
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Svennberg E, Caiani EG, Bruining N, Desteghe L, Han JK, Narayan SM, Rademakers FE, Sanders P, Duncker D. The digital journey: 25 years of digital development in electrophysiology from an Europace perspective. Europace 2023; 25:euad176. [PMID: 37622574 PMCID: PMC10450797 DOI: 10.1093/europace/euad176] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 08/26/2023] Open
Abstract
AIMS Over the past 25 years there has been a substantial development in the field of digital electrophysiology (EP) and in parallel a substantial increase in publications on digital cardiology.In this celebratory paper, we provide an overview of the digital field by highlighting publications from the field focusing on the EP Europace journal. RESULTS In this journey across the past quarter of a century we follow the development of digital tools commonly used in the clinic spanning from the initiation of digital clinics through the early days of telemonitoring, to wearables, mobile applications, and the use of fully virtual clinics. We then provide a chronicle of the field of artificial intelligence, a regulatory perspective, and at the end of our journey provide a future outlook for digital EP. CONCLUSION Over the past 25 years Europace has published a substantial number of papers on digital EP, with a marked expansion in digital publications in recent years.
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Affiliation(s)
- Emma Svennberg
- Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden
| | - Enrico G Caiani
- Politecnico di Milano, Electronic, Information and Biomedical Engineering Department, Milan, Italy
- Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Nico Bruining
- Department of Clinical and Experimental Information processing (Digital Cardiology), Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Lien Desteghe
- Research Group Cardiovascular Diseases, University of Antwerp, 2000 Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, 2056 Edegem, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium
| | - Janet K Han
- Division of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Cardiac Arrhythmia Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Sanjiv M Narayan
- Cardiology Division, Cardiovascular Institute and Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 5005 Adelaide, Australia
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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17
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Melissano D, Gualtieri MR, Greco A, Muscella A, Marzo A, Perrone C. Creation of pacemaker remote monitoring networks between hospital and pharmacies during Covid-19 outbreak. Indian Pacing Electrophysiol J 2023; 23:116-119. [PMID: 37245641 PMCID: PMC10214741 DOI: 10.1016/j.ipej.2023.05.003] [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: 11/21/2022] [Revised: 03/22/2023] [Accepted: 05/26/2023] [Indexed: 05/30/2023] Open
Abstract
INTRODUCTION Remote Monitoring (RM) of Cardiac Implantable Electronic Devices (CIEDs) is proven to be safe and efficient. It has been adopted in our center since years. At the time of the recent Covid-19 outbreak, we introduced and tested a collaborative organizational model, through a new RM device (Totem), creating a network with the surrounding territory and limiting CIED patients' presence in hospital. METHODS We involved 4 neighbor pharmacies where Totem devices were installed; we called and informed 64 patients with Totem compatible pacemaker (PM) about the possibility to perform their PM follow-up (FU) in-pharmacy; 58 gave their consent and their data were inserted into our RM database. RESULTS During an 18-month FU period, a total of 70 RM transmissions have been received: one alert of high atrial burden triggering a pharmacological optimization, one alert of high ventricular impedance leading to a new ventricular lead implantation and four alerts of elective replacement indicator. Fulfilled questionnaires revealed complete patient satisfaction. CONCLUSIONS A collaborative network between our hospital and the surrounding territory to perform RM FUs of CIEDs during Covid-19 pandemic was feasible, leading to patient compliance and satisfaction and revealing important technical and clinical alerts.
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Affiliation(s)
- Donato Melissano
- Presidio Ospedaliero "Francesco Ferrari", Dipartimento Cardiovascolare, U.O.S.V.D, Cardiologia, Viale Francesco Ferrari, 1, 73042, Casarano, Lecce, Italy.
| | - Maria Rosaria Gualtieri
- Presidio Ospedaliero "Francesco Ferrari", Dipartimento Cardiovascolare, U.O.S.V.D, Cardiologia, Viale Francesco Ferrari, 1, 73042, Casarano, Lecce, Italy
| | - Assunta Greco
- Presidio Ospedaliero "Francesco Ferrari", Dipartimento Cardiovascolare, U.O.S.V.D, Cardiologia, Viale Francesco Ferrari, 1, 73042, Casarano, Lecce, Italy
| | - Antonella Muscella
- Presidio Ospedaliero "Francesco Ferrari", Dipartimento Cardiovascolare, U.O.S.V.D, Cardiologia, Viale Francesco Ferrari, 1, 73042, Casarano, Lecce, Italy
| | - Antonio Marzo
- Presidio Ospedaliero "Francesco Ferrari", Dipartimento Cardiovascolare, U.O.S.V.D, Cardiologia, Viale Francesco Ferrari, 1, 73042, Casarano, Lecce, Italy
| | - Claudio Perrone
- Presidio Ospedaliero "Francesco Ferrari", Dipartimento Cardiovascolare, U.O.S.V.D, Cardiologia, Viale Francesco Ferrari, 1, 73042, Casarano, Lecce, Italy
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18
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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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19
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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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20
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Shurlock J, Brown S, Dayer M, Furniss G. Rapid Roll Out of a Pacemaker Home Monitoring Programme: A Patient Perspective. Heart Lung Circ 2023:S1443-9506(23)00151-8. [PMID: 37150706 DOI: 10.1016/j.hlc.2023.03.015] [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: 09/27/2022] [Revised: 03/17/2023] [Accepted: 03/27/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To assess the safety, efficacy, and patient acceptability of a pacemaker home monitoring (HM) service. METHODS All patients receiving a new Biotronik (Biotronik, Berlin, Germany) pacemaker between March 2020 and February 2021 were contacted for participation. Participants were surveyed on their experience of pacemaker HM. HM alerts and remote wound monitoring rates were also assessed. RESULTS Of the patients contacted, 77% responded, with a mean age of 80.6±9.9 years. Of these, 95.8% agreed that the home monitoring (HM) has been beneficial. Two thirds preferred HM to face-to-face follow-up and two thirds felt safe with HM. Three themes were identified from the comments: reassurance, technology and data security. Forty-one percent (41%) of respondents would like more reassurance that their HM is working, 18% mentioned technology with mixed responses, and 4.7% cited cybersecurity or the use of their personal data as a concern. The average one-way patient journey saved was 24.3±16.7 km (15.1±10.4 miles). One in three HM alerts required action but only 3.4% were urgent. Remote wound review was successful in 59%. CONCLUSIONS The majority of patients prefer HM and almost all think it has been beneficial. It saves significant travel time and provides actionable alerts. The patient experience could be improved by reassuring patients that their device is being monitored.
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Affiliation(s)
| | - Stewart Brown
- Cardiology department, Musgrove Park Hospital, Taunton, UK
| | - Mark Dayer
- Cardiology department, Musgrove Park Hospital, Taunton, UK
| | - Guy Furniss
- Cardiology department, Musgrove Park Hospital, Taunton, UK
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21
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Vandenberk B, Raj SR. Remote Patient Monitoring: What Have We Learned and Where Are We Going? CURRENT CARDIOVASCULAR RISK REPORTS 2023; 17:103-115. [PMID: 37305214 PMCID: PMC10122094 DOI: 10.1007/s12170-023-00720-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 06/13/2023]
Abstract
Purpose of Review Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is an important part of patient follow-up. The increasing number of patients with CIEDs and the recent pandemic pose several challenges for already limited device clinic resources. This review focuses on recent evolutions in RM and identifies future needs to improve RM. Recent Findings RM has been associated with multiple clinical benefits, including improved survival, early detection of actionable events, reduction in inappropriate shocks, longer battery lives, and more efficient healthcare utilization. The survival benefit was driven by studies using alert-based continuous RM with daily transmissions and fast reaction times. Patients report a high satisfaction rate without significant differences in quality of life between RM and in-office follow-up.The increasing workload, due to the increasing number of CIEDs implanted with daily remote transmissions, results in several challenges for the future of RM. RM requires appropriate reimbursement for RM device clinics to optimize patient/staff ratios, including sufficient non-clinical and administrative support. Universal alert programming and data processing may minimize inter-manufacturer differences, improve the signal-to-noise ratio, and allow the development of standard operating protocols and workflows. In the future, programming by remote control and true remote programming may further improve remote CIED management, patient quality of life, and device clinic workflows. Summary RM should be considered standard of care in management of patients with CIEDs. The clinical benefits of RM can be maximized by an alert-based continuous RM model. Adapted healthcare policies are required to keep RM manageable for the future.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Satish R. Raj
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, GAC70 HRIC Building, 3280 Hospital Dr NW, Calgary, AB T2N 4Z6 Canada
- Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
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Swartz J, Roloff S. Nonsustained ventricular tachycardia importance on a remote transmission. HeartRhythm Case Rep 2023; 9:266. [PMID: 37101679 PMCID: PMC10123927 DOI: 10.1016/j.hrcr.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Affiliation(s)
- Jenny Swartz
- Address reprint requests and correspondence: Jennifer R. Swartz, conductRM, 7 N Pinckney St, Suite 300, Madison, WI 53703.
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23
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Cronin EM, Green JC, Lande J, Holmes TR, Lexcen D, Taigen T. Performance of alert transmissions from cardiac implantable electronic devices to the CareLinkTM network: A retrospective analysis. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2023. [DOI: 10.1016/j.cvdhj.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
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Kolk MZH, Narayan SM, Clopton P, Wilde AAM, Knops RE, Tjong FVY. Reduction in long-term mortality using remote device monitoring in a large real-world population of patients with implantable defibrillators. Europace 2023; 25:969-977. [PMID: 36636951 PMCID: PMC10062290 DOI: 10.1093/europace/euac280] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/23/2022] [Indexed: 01/14/2023] Open
Abstract
AIMS Remote monitoring (RM) for implantable cardioverter-defibrillators (ICDs) is advocated for the potential of early detection of disease progression and device dysfunction. While studies have examined the effect of RM on clinical outcomes in carefully selected populations of heart failure patients implanted with ICDs from a single vendor, there is a paucity of data in real-world patients. We aimed to assess the long-term effect of RM in a representative ICD population using real-world data. METHODS AND RESULTS This is an observational retrospective longitudinal study of 1004 patients implanted with an ICD or cardiac resynchronization therapy device (CRT-D) from all device vendors between 2010 and 2021. Patients started on RM (N = 403) within 90 days following de novo device implantation and yearly in-office visits were compared with patients with only bi-yearly in-office follow-up (non-RM, N = 601). In a propensity score matched cohort of 430 patients (mean age 61.4 ± 14.3 years, 26.7% female), all-cause mortality at 4-year was 12.6% in the RM and 27.7% in the non-RM group [hazard ratio (HR) 0.52, 95% confidence interval (CI) 0.32-0.82; P = 0.005]. No difference in inappropriate ICD-therapy (HR 1.90, 95% CI 0.86-4.21; P = 0.122) was observed. The risk of appropriate ICD-therapy (HR 1.71, 95% CI 1.07-2.74; P = 0.026) was higher in the RM group. CONCLUSION Remote monitoring was associated with a reduction in long-term all-cause and cardiac mortality compared with traditional office visits in a real-world ICD population.
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Affiliation(s)
- Maarten Z H Kolk
- Amsterdam UMC location AMC, Department of Cardiology, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands
| | - Sanjiv M Narayan
- Department of Medicine and Cardiovascular Institute, Stanford University, 780 Welch Road, MC 5773, Stanford, CA 94305, USA
| | - Paul Clopton
- Department of Medicine and Cardiovascular Institute, Stanford University, 780 Welch Road, MC 5773, Stanford, CA 94305, USA
| | - Arthur A M Wilde
- Amsterdam UMC location AMC, Department of Cardiology, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands
| | - Reinoud E Knops
- Amsterdam UMC location AMC, Department of Cardiology, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands
| | - Fleur V Y Tjong
- Amsterdam UMC location AMC, Department of Cardiology, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands
- Department of Medicine and Cardiovascular Institute, Stanford University, 780 Welch Road, MC 5773, Stanford, CA 94305, USA
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25
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Chew DS, Piccini JP, Au F, Frazier-Mills CG, Michalski J, Varma N. Alert-driven vs scheduled remote monitoring of implantable cardiac defibrillators: A cost-consequence analysis from the TRUST trial. Heart Rhythm 2023; 20:440-447. [PMID: 36503177 PMCID: PMC11103640 DOI: 10.1016/j.hrthm.2022.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/22/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Alert-driven remote patient monitoring (RPM) or fully virtual care without routine evaluations may reduce clinic workload and promote more efficient resource allocation, principally by diminishing nonactionable patient encounters. OBJECTIVE The purpose of this study was to conduct a cost-consequence analysis to compare 3 postimplant implantable cardioverter-defibrillator (ICD) follow-up strategies: (1) in-person evaluation (IPE) only; (2) RPM-conventional (hybrid of IPE and RPM); and (3) RPM-alert (alert-based ICD follow-up). METHODS We constructed a decision-analytic Markov model to estimate the costs and benefits of the 3 strategies over a 2-year time horizon from the perspective of the US Medicare payer. Aggregate and patient-level data from the TRUST (Lumos-T Safely RedUceS RouTine Office Device Follow-up) randomized clinical trial informed clinical effectiveness model inputs. TRUST randomized 1339 patients 2:1 to conventional RPM or IPE alone, and found that RPM was safe and reduced the number of nonactionable encounters. Cost data were obtained from the published literature. The primary outcome was incremental cost. RESULTS Mean cumulative follow-up costs per patient were $12,688 in the IPE group, $12,001 in the RPM-conventional group, and $11,011 in the RPM-alert group. Compared to the IPE group, both the RPM-conventional and RPM-alert groups were associated with lower incremental costs of -$687 (95% confidence interval [CI] -$2138 to +$638) and -$1,677 (95% CI -$3134 to -$304), respectively. Therefore, the RPM-alert strategy was most cost-effective, with an estimated cost-savings in 99% of simulations. CONCLUSIONS Alert-driven RPM was economically attractive and, if patient outcomes and safety are comparable to those of conventional RPM, may be the preferred strategy for ICD follow-up.
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Affiliation(s)
- Derek S Chew
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Jonathan P Piccini
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Flora Au
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Camille G Frazier-Mills
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | | | - Niraj Varma
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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26
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Aktaa S, Tzeis S, Gale CP, Ackerman MJ, Arbelo E, Behr ER, Crotti L, d'Avila A, de Chillou C, Deneke T, Figueiredo M, Friede T, Leclercq C, Merino JL, Semsarian C, Verstrael A, Zeppenfeld K, Tfelt-Hansen J, Reichlin T. European Society of Cardiology quality indicators for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Europace 2023; 25:199-210. [PMID: 36753478 PMCID: PMC10103575 DOI: 10.1093/europace/euac114] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 02/09/2023] Open
Abstract
To develop a suite of quality indicators (QIs) for the management of patients with ventricular arrhythmias (VA) and the prevention of sudden cardiac death (SCD). The Working Group comprised experts in heart rhythm management including Task Force members of the 2022 European Society of Cardiology (ESC) Clinical Practice Guidelines for the management of patients with VA and the prevention of SCD, members of the European Heart Rhythm Association, international experts, and a patient representative. We followed the ESC methodology for QI development, which involves (i) the identification of the key domains of care for the management of patients with VA and the prevention of SCD by constructing a conceptual framework of care, (ii) the development of candidate QIs by conducting a systematic review of the literature, (iii) the selection of the final set of QIs using a modified-Delphi method, and (iv) the evaluation of the feasibility of the developed QIs. We identified eight domains of care for the management of patients with VA and the prevention of SCD: (i) structural framework, (ii) screening and diagnosis, (iii) risk stratification, (iv) patient education and lifestyle modification, (v) pharmacological treatment, (vi) device therapy, (vii) catheter ablation, and (viii) outcomes, which included 17 main and 4 secondary QIs across these domains. Following a standardized methodology, we developed 21 QIs for the management of patients with VA and the prevention of SCD. The implementation of these QIs will improve the care and outcomes of patients with VA and contribute to the prevention of SCD.
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Affiliation(s)
- Suleman Aktaa
- Leeds Institute for Data Analytics, University of Leeds, Leeds LS29JT, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS29JT, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | | | - Chris P Gale
- Leeds Institute for Data Analytics, University of Leeds, Leeds LS29JT, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS29JT, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | - Michael J Ackerman
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Genetic Heart Rhythm Clinic and Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN 55905, USA
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona 08007, Spain
- IDIBAPS, Institut d’Investigació August Pi i Sunyer (IDIBAPS), Barcelona 08036, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid 28029, Spain
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group and Cardiology Research Centre, St. George’s, University of London, London SW17 0RE, UK
- St. George’s University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Lia Crotti
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan 20149, Italy
- Departments of Medicine and Surgery, University of Milano-Bicocca, Milan 20126, Italy
| | - Andre d'Avila
- Director – Cardiac Arrhythmia Service The Harvard Thorndike EP Institute Beth Israel Deaconess Medical Center Harvard Medical School, Boston, MA 02215, USA
| | - Christian de Chillou
- Department of Cardiology, University Hospital Nancy,Vandœuvre lès Nancy 54500, France
| | - Thomas Deneke
- Heart Center Rhön-Clinic Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt 97616, Germany
| | - Márcio Figueiredo
- Cardiology, Electrophysiology Service, University of Campinas (UNICAMP) Hospital, Campinas 13083-888, Brazil
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen,Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen 10785, Germany
| | | | - Jose L Merino
- La Paz University Hospital, IdiPaz, Autonoma University, Madrid 28046, Spain
| | - Chris Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, University of Sydney, Sydney 2050, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney 2050, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney 2050, Australia
| | | | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden 2333, TheNetherlands
| | - Jacob Tfelt-Hansen
- Section of genetics, Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen 2100, Denmark
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet 2100, Denmark
| | - Tobias Reichlin
- Department of Cardiology, Inselspial Bern, Bern University Hospital, University of Bern, Bern 3010, Switzerland
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Heath K, O'Shea C, Thomas G, Harper C, Campbell K, Sanders P, Middeldorp ME. Impact of intensive follow-up of cardiac implantable electronic devices via remote monitoring: A pilot study. Heart Rhythm O2 2023; 4:90-96. [PMID: 36873319 PMCID: PMC9975000 DOI: 10.1016/j.hroo.2022.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background The volume of remote monitoring (RM) data generates a significant workload and is generally dealt with by clinic staff during standard office hours, potentially delaying clinical action. Objective The purpose of this study was to determine the clinical efficiency and workflow of implementing intensive RM (IRM) in patients with cardiac implantable electronic device (CIED) when compared with standard RM (SRM). Methods From a cohort of >1500 remotely monitored devices, 70 patients were randomly selected to undergo IRM. For comparison, an equal number of matched patients were prospectively selected for SRM. Intensive follow-up occurred via automated vendor-neutral software with rapid alert processing by International Board of Heart Rhythm Examiners-certified device specialists. Standard follow-up was conducted by clinic staff during office hours via individual device vendor interfaces. Alerts were categorized on the basis of the level of acuity as actionable (red [high], yellow [moderate]), or green [not requiring action]). Results Over 9 months of follow-up, 922 remote transmissions were received; 339 (36.8%) were coded as actionable alerts (118 in IRM and 221 in SRM; P < .001). The median time from initial transmission to review was 6 hours (interquartile range [IQR] 1.8-16.8 hours) in the IRM group compared with 10.5 hours (IQR 6.0-32.2 hours) in the SRM group (P < .001). The median time from transmission to review of actionable alerts in the IRM group was 5.1 hours (IQR 2.3-8.9 hours) compared with 9.1 hours (IQR 6.7-32.5 hours) in the SRM group (P < .001). Conclusion Intensive and managed RM results in a significant reduction in time to review alerts and number of actionable alerts. Monitoring with enhanced alert adjudication is needed to facilitate device clinic efficiency and optimize patient care. Study Registration ACTRN12621001275853.
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Affiliation(s)
- Kyle Heath
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide, Adelaide, South Australia, Australia
| | - Catherine O'Shea
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide, Adelaide, South Australia, Australia.,Royal Adelaide Hosptial, Adelaide, South Australia, Australia
| | - Gijo Thomas
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide, Adelaide, South Australia, Australia
| | | | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide, Adelaide, South Australia, Australia.,Royal Adelaide Hosptial, Adelaide, South Australia, Australia
| | - Melissa E Middeldorp
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide, Adelaide, South Australia, Australia.,Cedar-Sinai Smidt Heart Institute, Los Angeles, California
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Kowal D, Katarzyńska-Szymańska A, Prech M, Rubiś B, Mitkowski P. Early Smartphone App-Based Remote Diagnosis of Silent Atrial Fibrillation and Ventricular Fibrillation in a Patient with Cardiac Resynchronization Therapy Defibrillator. J Cardiovasc Dev Dis 2023; 10:jcdd10010030. [PMID: 36661925 PMCID: PMC9865368 DOI: 10.3390/jcdd10010030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Due to distressing statistics concerning cardiovascular diseases, remote monitoring of cardiac implantable electronic devices (CIED) has received a priority recommendation in daily patient care. However, most bedside systems available so far are not optimal due to limited patient adherence. We report that smartphone app technology communicating with CIED improved the patient's engagement and adherence, as well as the accuracy of atrial and ventricular arrhythmias diagnosis, thus offering more efficient treatment and, consequently, better patient clinical outcomes. Our findings are in concordance with previously published results for implantable loop recorders and pacemakers, and provide new insight for heart failure patients with an implanted cardiac resynchronization therapy defibrillator.
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Affiliation(s)
- Dagmar Kowal
- Department of Clinical Chemistry and Molecular Diagnostics, Poznan University of Medical Sciences, 60-806 Poznan, Poland
- Doctoral School, Poznan University of Medical Sciences, 60-812 Poznan, Poland
- Correspondence: ; Tel.: +48-696-495-222 or +48-616-418-303
| | | | - Marek Prech
- Department of Cardiology, Provincial Hospital, 64-100 Leszno, Poland
| | - Błażej Rubiś
- Department of Clinical Chemistry and Molecular Diagnostics, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Przemysław Mitkowski
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-355 Poznan, Poland
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29
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Ho RT. "Wireless telegraphy" 100 years later-Good for the world or a menace? Heart Rhythm 2023; 20:520-521. [PMID: 36640855 DOI: 10.1016/j.hrthm.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Affiliation(s)
- Reginald T Ho
- Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
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30
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Management of Heart Failure With Arrhythmia in Adults With Congenital Heart Disease. J Am Coll Cardiol 2022; 80:2224-2238. [DOI: 10.1016/j.jacc.2022.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/08/2022] [Indexed: 11/29/2022]
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Rodrigues G, Adragão P. Cardiac device remote monitoring in 2022: Are digital and remote monitoring synonymous with ease and improvement? Rev Port Cardiol 2022; 41:999-1000. [PMID: 36228666 DOI: 10.1016/j.repc.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Gustavo Rodrigues
- Serviço de Cardiologia, Hospital de Santa Cruz, CHLO, Carnaxide, Portugal
| | - Pedro Adragão
- Serviço de Cardiologia, Hospital de Santa Cruz, CHLO, Carnaxide, Portugal.
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Carrington M, Providência R, Chahal CAA, Ricci F, Epstein AE, Gallina S, Fedorowski A, Sutton R, Khanji MY. Clinical applications of heart rhythm monitoring tools in symptomatic patients and for screening in high-risk groups. Europace 2022; 24:1721-1729. [PMID: 35983729 DOI: 10.1093/europace/euac088] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/12/2022] [Indexed: 12/15/2022] Open
Abstract
Recent technological advances have facilitated and diversified the options available for the diagnosis of cardiac arrhythmias. Ranging from simple resting or exercise electrocardiograms to more sophisticated and expensive smartphones and implantable cardiac monitors. These tests and devices may be used for varying periods of time depending on symptom frequency. The choice of the most appropriate heart rhythm test should be guided by clinical evaluation and optimized following accurate characterization of underlying symptoms, 'red flags', risk factors, and consideration of cost-effectiveness of the different tests. This review provides evidence-based guidance for assessing suspected arrhythmia in patients who present with symptoms or in the context of screening, such as atrial fibrillation or advanced conduction disturbances following transcatheter aortic valve implantation in high-risk groups. This is intended to help clinicians choose the most appropriate diagnostic tool to facilitate the management of patients with suspected arrhythmias.
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Affiliation(s)
- Mafalda Carrington
- Department of Cardiology, Hospital do Espírito Santo de Évora, Évora, Portugal
| | - Rui Providência
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Department of Cardiology, Newham University Hospital, BartsHealth NHS Trust, London, UK.,Institute of Health Informatics Research, University College London, London, UK
| | - C Anwar A Chahal
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Cardiovascular Division, University of Pennsylvania, Philadelphia, PA, USA.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G.d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy.,Department of Cardiology, Casa di Cura Villa Serena, Città Sant'Angelo, Italy.,Department of Clinical Sciences, Lund University, 205 02 Malmö, Sweden
| | - Andrew E Epstein
- Cardiovascular Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, "G.d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Artur Fedorowski
- Department of Cardiology, Casa di Cura Villa Serena, Città Sant'Angelo, Italy.,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Richard Sutton
- Department of Clinical Sciences, Lund University, 205 02 Malmö, Sweden.,Department of Cardiology, Hammersmith Hospital Campus, Imperial College, London, UK
| | - Mohammed Y Khanji
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Department of Cardiology, Newham University Hospital, BartsHealth NHS Trust, London, UK.,NIHR Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK
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Manyam H, Burri H, Casado-Arroyo R, Varma N, Lennerz C, Klug D, Carr-White G, Kolli K, Reyes I, Nabutovsky Y, Boriani G. Smartphone-based cardiac implantable electronic device remote monitoring: improved compliance and connectivity. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 4:43-52. [PMID: 36743871 PMCID: PMC9890086 DOI: 10.1093/ehjdh/ztac071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/04/2022] [Indexed: 11/13/2022]
Abstract
Aims Remote monitoring (RM) is the standard of care for follow up of patients with cardiac implantable electronic devices. The aim of this study was to compare smartphone-based RM (SM-RM) using patient applications (myMerlinPulse™ app) with traditional bedside monitor RM (BM-RM). Methods and results The retrospective study included de-identified US patients who received either SM-RM or BM-RM capable of implantable cardioverter defibrillators or cardiac resynchronization therapy defibrillators (Abbott, USA). Patients in SM-RM and BM-RM groups were propensity-score matched on age and gender, device type, implant year, and month. Compliance with RM was quantified as the proportion of patients enrolling in the RM system (Merlin.net™) and transmitting data at least once. Connectivity was measured by the median number of days between consecutive transmissions per patient. Of the initial 9714 patients with SM-RM and 26 679 patients with BM-RM, 9397 patients from each group were matched. Remote monitoring compliance was higher in SM-RM; significantly more patients with SM-RM were enrolled in RM compared with BM-RM (94.4 vs. 85.0%, P < 0.001), similar number of patients in the SM-RM group paired their device (95.1 vs. 95.0%, P = 0.77), but more SM-RM patients transmitted at least once (98.1 vs. 94.3%, P < 0.001). Connectivity was significantly higher in the SM-RM, with patients transmitting data every 1.2 (1.1, 1.7) vs. every 1.7 (1.5, 2.0) days with BM-RM (P < 0.001) and remained better over time. Significantly more SM-RM patients utilized patient-initiated transmissions compared with BM-RM (55.6 vs. 28.1%, P < 0.001). Conclusion In this large real-world study, patients with SM-RM demonstrated improved compliance and connectivity compared with BM-RM.
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Affiliation(s)
- Harish Manyam
- Corresponding author. Tel: +1 423 778 5661, Fax: +1 423 778 5664,
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Rue Gabrielle Perret Gentil 4, 1205 Geneva, Switzerland
| | - Ruben Casado-Arroyo
- Department of Cardiology, Université Libre de Bruxelles, 1070 Bruxelles, Belgium
| | - Niraj Varma
- Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA
| | - Carsten Lennerz
- Department of Electrophysiology, German Heart Centre Munich, 80636 Munich, Germany
| | - Didier Klug
- Department of Cardiology, University Hospital of Lille, 59037 Lille, France
| | - Gerald Carr-White
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Kranthi Kolli
- Abbott, Global Data Science and Analytics, CA 95054, USA
| | - Ignacio Reyes
- Abbott, Global Data Science and Analytics, CA 95054, USA
| | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
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Yang S, Stabenau HF, Kiernan K, Diamond JE, Kramer DB. Clinical utility of remote monitoring for patients with cardiac implantable electrical devices. J Interv Card Electrophysiol 2022; 66:961-969. [PMID: 36327060 PMCID: PMC9632596 DOI: 10.1007/s10840-022-01406-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022]
Abstract
Background Remote monitoring of cardiac implantable electronic devices (CIEDs) offers practical and clinical benefits juxtaposed against burdens associated with high transmission volume. Methods We identified patients receiving de novo pacemakers (PPMs) and implantable cardiac defibrillators (ICDs) at a single academic medical center (January 2016–December 2019) with at least 1 year of follow-up device care. We collected patient- and device-specific data at time of implant and assessed all remote and in-person interrogation reports for clinically actionable findings based on pre-specified criteria. Results Among 963 patients (mean age of 71 (± 14) years, 37% female), 655 (68%) underwent PPM, and 308 (32%) underwent ICD implant. Median follow-up was 874 (627–1221) days, during which time patients underwent a mean of 13 (10–16) total interrogations; remote interrogations comprised 53% of all device evaluations; and of these, 96% were scheduled transmissions. Overall, 22% of all CIED interrogations yielded significant findings with a slightly higher rate in the PPM than in the ICD group (23% vs. 20%, p < 0.01). Only 8% of remote interrogations produced clinically meaningful results, compared with 38% of in-person ones. In adjusted models, routine, remote transmissions were least likely to be useful for both PPM and ICD patients (p < 0.001), whereas time from initial device implant was inversely associated with probability of obtaining a useful interrogation (p < 0.001). Conclusions Routine remote interrogations constitute the majority of device evaluations performed, but uncommonly identify clinically actionable findings.
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Affiliation(s)
- Shu Yang
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Ave, 4Th Floor, Boston, MA 02215 USA ,Harvard Medical School, Boston, MA USA
| | - Hans F. Stabenau
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Ave, 4Th Floor, Boston, MA 02215 USA ,Harvard Medical School, Boston, MA USA
| | - Katherine Kiernan
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Ave, 4Th Floor, Boston, MA 02215 USA ,Harvard Medical School, Boston, MA USA
| | - Jamie E. Diamond
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Ave, 4Th Floor, Boston, MA 02215 USA ,Harvard Medical School, Boston, MA USA
| | - Daniel B. Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Ave, 4Th Floor, Boston, MA 02215 USA ,Harvard Medical School, Boston, MA USA
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Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 890] [Impact Index Per Article: 445.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Muniyappa AN, Raitt MH, Judson GL, Shen H, Tarasovsky G, Whooley MA, Dhruva SS. Factors associated with remote monitoring adherence for cardiovascular implantable electronic devices. Heart Rhythm 2022; 19:1499-1507. [PMID: 35500792 DOI: 10.1016/j.hrthm.2022.04.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/11/2022] [Accepted: 04/22/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Professional societies strongly recommend remote monitoring (RM) of all cardiac implantable electronic devices, and higher RM adherence is associated with improved patient outcomes. However, adherence with RM is suboptimal. OBJECTIVE The purpose of this study was to better understand factors associated with RM adherence. METHODS We linked RM data from the Veterans Affairs National Cardiac Device Surveillance Program to clinical data for patients monitored between October 25, 2018, and October 24, 2020. RM adherence was defined as the percentage of days covered by an RM transmission during the study period. Patients were classified into 3 categories: complete (100% of days covered by an RM transmission), intermediate (above median in patients with <100% adherence), and low (below median in patients with <100% adherence) adherence. We used multivariable logistic regression to examine patient, device, and facility characteristics associated with adherence. RESULTS In 52,574 patients, average RM adherence was 71.9%. Only 30.9% (16,224) of patients had complete RM adherence. Black or African American patients had a lower odds of complete RM adherence than white patients (odds ratio 0.88; 95% confidence interval 0.82-0.94), and Hispanic or Latino patients had a lower odds of complete RM adherence (odds ratio 0.79; 95% confidence interval 0.70-0.89) than non-Hispanic or Latino patients. Dementia, depression, and posttraumatic stress disorder were associated with a lower odds of RM adherence. CONCLUSION There are significant disparities in RM adherence by race, ethnicity, and neuropsychiatric comorbidities. These findings can inform strategies to improve health equity and ensure that all patients with cardiac implantable electronic devices receive the evidence-based clinical benefits of RM.
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Affiliation(s)
- Anoop N Muniyappa
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Merritt H Raitt
- Knight Cardiovascular Institute, Oregon Health and Sciences University, Portland, Oregon; Portland Veterans Affairs Health Care System, Portland, Oregon
| | - Gregory L Judson
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Hui Shen
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Gary Tarasovsky
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Mary A Whooley
- Department of Medicine, University of California, San Francisco, San Francisco, California; San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Sanket S Dhruva
- Department of Medicine, University of California, San Francisco, San Francisco, California; San Francisco Veterans Affairs Health Care System, San Francisco, California.
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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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Corbisiero R, Muller D. The Gallant™ system heart rhythm management device: making a connection. Future Cardiol 2022; 18:605-614. [PMID: 35748496 DOI: 10.2217/fca-2021-0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Implantable cardiac defibrillators have revolutionized the way we prevent sudden cardiac death via arrhythmias. The addition of cardiac resynchronization pacing to defibrillators has broadened that treatment to include patients with heart failure and reduced ejection fraction. As with all technology, new devices and platforms expand the capabilities and interface with patients across the world. This review discusses the evolution from the initial modalities and methods of communication of implantable devices up to the most recent advances in implantable defibrillators and their integration into patient lives and clinical practice. This review is focused on the integration of Bluetooth communication into modern healthcare with the Gallant™ family of devices, the first branded launch by Abbott Laboratories.
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Affiliation(s)
| | - David Muller
- Abbott Laboratories, 15900 Valley View Ct, Sylmar, CA 91342, USA
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Klein C, Finat L, Abbey S, Eschalier R, Fossati F, Lazarus A, Marijon E, Pasquié JL, Ploux S, Salerno F, Williatte L, Gras D, Sacher F, Taieb J, Boveda S, Guédon-Moreau L. Remote monitoring for cardiac implantable electronic devices: A practical guide. Arch Cardiovasc Dis 2022; 115:406-407. [DOI: 10.1016/j.acvd.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/28/2022]
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Masuno H, Kato A, Kurosaki K. Exacerbation of heart failure due to total pacemaker extrusion. J Cardiol Cases 2022; 26:144-147. [DOI: 10.1016/j.jccase.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 11/30/2022] Open
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Cheung CC, Lee BK. From Improving Survival to Cost-Savings for the Health System - Remote Monitoring for All? Can J Cardiol 2022; 38:712-714. [PMID: 35150823 DOI: 10.1016/j.cjca.2022.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Byron K Lee
- Section of Cardiac Electrophysiology, University of California San Francisco
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42
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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] [MESH Headings] [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). 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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43
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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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Koike A, Sobue Y, Kawai M, Yamamoto M, Banno Y, Harada M, Kiyono K, Watanabe E. Safety and feasibility of a telemonitoring-guided exercise program in patients receiving cardiac resynchronization therapy. Ann Noninvasive Electrocardiol 2021; 27:e12926. [PMID: 34863002 PMCID: PMC8916563 DOI: 10.1111/anec.12926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Telerehabilitation is an alternative clinic-based rehabilitation. A remote monitoring (RM) system attached to a cardiac rhythm device can collect physiological data and the device function. This study aimed to evaluate the safety and feasibility of telerehabilitation supervised by an RM in patients receiving cardiac resynchronization therapy (CRT). METHODS A single group pre-post exercise program was implemented for 3 months in 18 CRT recipients. The exercise regimen consisted of walking a prescribed number of steps based on a 6-min walk distance (6MWD) achieved at baseline. The patients were asked to exercise 3 to 5 times per week for up to 30 min per session, wearing an accelerometer to document the number of steps taken. The safety was assessed by the heart failure hospitalizations and all-cause death. The feasibility was measured by the improvement in the quality of life (QOL) using the EuroQol 5 dimensions, and daily active time measured by the CRT, 6MWD, B-type natriuretic peptide (BNP) level, and left ventricular ejection fraction (LVEF). RESULTS No patients had heart failure hospitalizations or died. No patients had any ventricular tachyarrhythmias. One patient needed to suspend the exercise due to signs of exacerbated heart failure by the RM. Compared to baseline, there were significant improvements in the QOL (-0.037, p < .05), active time (1.12%/day, p < .05), and 6MWD (11 m, p < .001), but not the BNP (-32.4 pg/ml, p = .07) or LVEF (0.28%, p = .55). CONCLUSIONS Three months of RM-guided walking exercise in patients with CRT significantly increased the QOL, active time, and exercise capacity without any adverse effects.
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Affiliation(s)
- Asami Koike
- Department of Laboratory MedicineFujita Health University HospitalToyoakeJapan
| | - Yoshihiro Sobue
- Division of CardiologyDepartment of Internal MedicineFujita Health University Bantane HospitalNagoyaJapan
| | - Mayumi Kawai
- Department of CardiologyFujita Health University School of MedicineToyoakeJapan
| | - Masaru Yamamoto
- Department of Laboratory MedicineFujita Health University HospitalToyoakeJapan
| | - Yukina Banno
- Department of Laboratory MedicineFujita Health University HospitalToyoakeJapan
| | - Mashide Harada
- Department of CardiologyFujita Health University School of MedicineToyoakeJapan
| | - Ken Kiyono
- Division of BioengineeringGraduate School of Engineering ScienceOsaka UniversityToyonakaJapan
| | - Eiichi Watanabe
- Division of CardiologyDepartment of Internal MedicineFujita Health University Bantane HospitalNagoyaJapan
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Lopez-Villegas A, Leal-Costa C, Perez-Heredia M, Villegas-Tripiana I, Catalán-Matamoros D. Knowledge Update on the Economic Evaluation of Pacemaker Telemonitoring Systems. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212120. [PMID: 34831876 PMCID: PMC8624333 DOI: 10.3390/ijerph182212120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/16/2022]
Abstract
(1) Introduction: In the last two decades, telemedicine has been increasingly applied to telemonitoring (TM) of patients with pacemakers; however, presently, its growth has significantly accelerated because of the COVID-19 pandemic, which has pushed patients and healthcare workers alike to seek new ways to stay healthy with minimal physical contact. Therefore, the main objective of this study was to update the current knowledge on the differences in the medium-and long-term effectiveness of TM and conventional monitoring (CM) in relation to costs and health outcomes. (2) Methods: Three databases and one scientific registry were searched (PubMed, EMBASE, Scopus, and Google Scholar), with no restrictions on language or year of publication. Studies published until July 2021 were included. The inclusion criteria were: (a) experimental or observational design, (b) complete economic evaluation, (c) patients with implanted pacemakers, and (d) comparison of TM with CM. Measurements of study characteristics (author, study duration, sample size, age, sex, major indication for implantation, and pacemaker used), analysis, significant results of the variables (analysis performed, primary endpoints, secondary endpoints, health outcomes, and cost outcomes), and further miscellaneous measurements (methodological quality, variables coded, instrument development, coder training, and intercoder reliability, etc.) were included. (3) Results: 11 studies met the inclusion criteria, consisting of 3372 enrolled patients; 1773 (52.58%) of them were part of randomized clinical trials. The mean age was 72 years, and the atrioventricular block was established as the main indication for device implantation. TM was significantly effective in detecting the presence or absence of pacemaker problems, leading to a reduction in the number of unscheduled hospital visits (8.34-55.55%). The cost of TM was up to 87% lower than that of CM. There were no significant differences in health-related quality of life (HRQoL) and the number of cardiovascular events. (4) Conclusions: Most of the studies included in this systematic review confirm that in the TM group of patients with pacemakers, cardiovascular events are detected and treated earlier, and the number of unscheduled visits to the hospital is significantly reduced, without affecting the HRQoL of patients. In addition, with TM modality, both formal and informal costs are significantly reduced in the medium and long term.
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Affiliation(s)
- Antonio Lopez-Villegas
- Social Involvement of Critical and Emergency Medicine, CTS-609 Research Group, Poniente Hospital, 04700 El Ejido-Almería, Spain;
| | - César Leal-Costa
- Nursing Department, University of Murcia, 30120 Murcia, Spain
- Correspondence: ; Tel.: +34-868-889-771
| | - Mercedes Perez-Heredia
- Research Management Department, Primary Care District Poniente of Almería, 04700 El Ejido-Almería, Spain;
| | | | - Daniel Catalán-Matamoros
- UC3M MediaLab, Department of Communication and Media Studies, Madrid University Carlos III, 28903 Madrid, Spain;
- Health Sciences Research Institute, University of Almería, 04120 Almería, Spain
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Mastoris I, Spall HGCV, Sheldon SH, Pimentel RC, Steinkamp L, Shah Z, Al-Khatib SM, Singh JP, Sauer AJ. Emerging Implantable Device Technology for Patients at the Intersection of Electrophysiology and Heart Failure Interdisciplinary Care. J Card Fail 2021; 28:991-1015. [PMID: 34774748 DOI: 10.1016/j.cardfail.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 01/01/2023]
Abstract
Cardiac implantable electronic devices (CIEDs), including implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT), are part of guideline- indicated treatment for a subset of patients with heart failure with reduced ejection fraction (HFrEF). Current technological advancements in CIEDs have allowed the detection of specific patient physiologic parameters used for forecasting clinical decompensation through algorithmic, multiparameter remote monitoring. Other recent emerging technologies, including cardiac contractility modulation (CCM) and baroreflex activation therapy (BAT), may provide symptomatic or physiologic benefit in patients without an indication for CRT. Our goal in this state-of-the-art review is to describe the commercially available new technologies, purported mechanisms of action, evidence surrounding their clinical role, limitations, and future directions. Finally, we underline the need for standardized workflow and close interdisciplinary management of this population to ensure the delivery of high-quality care.
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Affiliation(s)
- Ioannis Mastoris
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Harriette G C Van Spall
- Department of Medicine, Department of Health Research Methods, Evidence, and Impact, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Seth H Sheldon
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Rhea C Pimentel
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Leslie Steinkamp
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Zubair Shah
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Sana M Al-Khatib
- Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Jagmeet P Singh
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew J Sauer
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas.
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Tarakji KG, Zaidi AM, Zweibel SL, Varma N, Sears SF, Allred J, Roberts PR, Shaik NA, Silverstein JR, Maher A, Mittal S, Patwala A, Schoenhard J, Emert M, Molon G, Augello G, Patel N, Seide H, Porfilio A, Maus B, Di Jorio SL, Holloman K, Natera AC, Turakhia MP. Performance of first pacemaker to use smart device app for remote monitoring. Heart Rhythm O2 2021; 2:463-471. [PMID: 34667961 PMCID: PMC8505204 DOI: 10.1016/j.hroo.2021.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background High adherence to remote monitoring (RM) in pacemaker (PM) patients improves outcomes; however, adherence remains suboptimal. Bluetooth low-energy (BLE) technology in newer-generation PMs enables communication directly with patient-owned smart devices using an app without a bedside console. Objective To evaluate the success rate of scheduled RM transmissions using the app compared to other RM methods. Methods The BlueSync Field Evaluation was a prospective, international cohort evaluation, measuring the success rate of scheduled RM transmissions using a BLE PM or cardiac resynchronization therapy PM coupled with the MyCareLink Heart app. App transmission success was compared to 3 historical “control” groups from the Medtronic de-identified CareLink database: (1) PM patients with manual communication using a wand with a bedside console (PM manual transmission), (2) PM patients with wireless automatic communication with the bedside console (PM wireless); (3) defibrillator patients with similar automatic communication (defibrillator wireless). Results Among 245 patients enrolled (age 64.8±15.6 years, 58.4% men), 953 transmissions were scheduled through 12 months, of which 902 (94.6%) were successfully completed. In comparison, transmission success rates were 56.3% for PM manual transmission patients, 77.0% for PM wireless patients, and 87.1% for defibrillator wireless patients. Transmission success with the app was superior across matched cohorts based on age, sex, and device type (single vs dual vs triple chamber). Conclusion The success rate of scheduled RM transmissions was higher among patients using the smart device app compared to patients using traditional RM using bedside consoles. This novel technology may improve patient engagement and adherence to RM.
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Affiliation(s)
- Khaldoun G Tarakji
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Amir M Zaidi
- Central Manchester University Hospitals, NHS Foundation Trust, Manchester, United Kingdom
| | - Steven L Zweibel
- Hartford Healthcare and Vascular Institute, Hartford, Connecticut
| | - Niraj Varma
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Paul R Roberts
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | | | - Abdul Maher
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, United Kingdom
| | | | - Ashish Patwala
- Royal Stoke University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | | | - Martin Emert
- University of Kansas Medical Center, Kansas City, Kansas
| | - Giulio Molon
- Ospedale Sacro Cuore don Calabria, Negrar, Italy
| | | | | | | | | | - Baerbel Maus
- Bakken Research Center, Medtronic plc, Maastricht, The Netherlands
| | | | | | | | - Mintu P Turakhia
- Center for Digital Health, Stanford University, Stanford, California.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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Ploux S, Strik M, Varma N, Eschalier R, Bordachar P. Remote monitoring of pacemakers. Arch Cardiovasc Dis 2021; 114:588-597. [PMID: 34561150 DOI: 10.1016/j.acvd.2021.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/17/2022]
Abstract
Exactly two decades have elapsed since pacemakers first provided automatic remote monitoring. This innovation has been well received by patients. However, there is still a widely held perception that remote monitoring of pacemakers is non-essential, despite the very similar gains that are achieved compared with remote monitoring of implantable cardioverter defibrillators. Reducing in-office evaluations and overall staff workload is important when these resources are stretched to their limits. The early detection ability provided by remote monitoring facilitates device management (extending battery longevity) and the ability to exercise vigilance over recalled components. Clinical complications, such as arrhythmic events, are also detected earlier. Remote monitoring has been shown to produce similar reductions in the risk of all-cause hospitalization and death for pacemakers and implantable cardioverter defibrillators in a mega-cohort observational study. This review is an evidence-based plea for the recognition and systematic implementation of remote monitoring for pacemakers.
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Affiliation(s)
- Sylvain Ploux
- Electrophysiology and Heart Modelling Institute (IHU-LIRYC), Fondation Bordeaux Université, 33600 Pessac, France; Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), 33600 Pessac, France.
| | - Marc Strik
- Electrophysiology and Heart Modelling Institute (IHU-LIRYC), Fondation Bordeaux Université, 33600 Pessac, France; Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), 33600 Pessac, France
| | - Niraj Varma
- Cleveland Clinic, 44195 Cleveland, Ohio, USA
| | - Romain Eschalier
- UMR6284, Cardio-Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), Clermont Université, Université d'Auvergne, 63001 Clermont-Ferrand, France; Cardiology department, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - Pierre Bordachar
- Electrophysiology and Heart Modelling Institute (IHU-LIRYC), Fondation Bordeaux Université, 33600 Pessac, France; Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), 33600 Pessac, France
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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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Tilz RR, Shaik N, Piorkowski C, Hu Y, Connolly AT, Reyes IJ, Nabutovsky Y, Fischer A, Ip J. Real-world Adoption of Smartphone-based Remote Monitoring Using the Confirm Rx™ Insertable Cardiac Monitor. J Innov Card Rhythm Manag 2021; 12:4613-4620. [PMID: 34386274 PMCID: PMC8302208 DOI: 10.19102/icrm.2021.120806] [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] [Received: 04/16/2021] [Accepted: 06/04/2021] [Indexed: 11/18/2022] Open
Abstract
While previous generations of insertable cardiac monitors (ICMs) required a bedside monitor for remote monitoring (RM), the Confirm Rx™ ICM (Abbott, Chicago, IL, USA) utilizes Bluetooth®, Wi-Fi/cellular technology, and a smart device to connect to the RM system. We aimed to characterize compliance, connectivity, and event transmission timing with the Confirm Rx™ ICM RM system. The study cohort included American patients who received the Confirm Rx™ ICM with SharpSense™ technology within three months of release (May–July 2019). Compliance with RM was quantified as the proportion of patients registering the patient app on their smart device and transmitting at least once. Connectivity was measured as the median number of days between consecutive transmissions per patient. Event transmission time was measured from episode detection to availability on the Merlin.net™ RM system (Abbott). Time from transmission until review by a clinician was examined. Values for device connectivity, episode transmission timing, and clinician view times were reported as median [first quartile, third quartile]. Of 5,666 patients who received a Confirm Rx™ ICM, 97% registered their patient app and 92% transmitted data at least once. Among those utilizing RM (aged 66 ± 15 years; 49% female), connectivity occurred every 1.5 [1.2, 2.4] days, or 4.7 times per week. Patient-reported symptoms were transmitted to Merlin.net™ within 2.9 [2.1, 3.8] minutes of event onset and viewed by the clinician within 0.9 [0.4, 3.1] days, while device-detected episodes without symptoms were transmitted within 18.5 [11.2, 36.5] hours and then viewed within 0.8 [0.3, 2.5] days. This real-world study demonstrated excellent patient compliance with the smartphone-based RM paradigm enabled by Confirm Rx™, suggesting the suitability of this technology for future cardiac implantable devices.
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Affiliation(s)
- Roland R Tilz
- Division of Electrophysiology, Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin), Universitäres Herzzentrum Lübeck, Lubeck, Germany
| | | | | | | | | | | | | | | | - John Ip
- Sparrow Cardiovascular Institute, Lansing, MI, USA
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