Technical reliability and clinical safety of a remote monitoring system for antiarrhythmic cardiac devices

Health-related quality of life on tele-monitoring for users with pacemakers 6 months after implant: the NORDLAND study, a randomized trial

BACKGROUND

With an ageing population and widening indications for pacemakers implantation, the number of persons carrying an implant is steadily increasing. The routine follow-up is thus a heavy burden for the respective NHS as well as for the patients and their relatives. Most of them of the studies have been performed in densely populated areas and nearby to the hospital. It is thus unknown whether these results could be applied also in rural areas such as Northern Norway with a more scattered population. The aim of this study was to assess the effectiveness of tele-monitoring (TM) in patients with pacemakers regarding reliability, safety and health-related quality of life, compared to traditional follow-up in outpatient clinic in a setting where geographical effects could possible influence the results.

METHODS

The NORDLAND study is a controlled, randomized, non-masked clinical trial in pacemaker patients, with data collection carried out during the pre-implant stage and after 6 months. Between August of 2014 and November of 2015, 50 patients were assigned to either a tele-monitoring group (n = 25) or a conventional hospital monitoring (HM) group (n = 25). The EuroQol-5D (EQ-5D) utilities and visual analogue scale (VAS) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) were used to measure Health-Related Quality of Life. Baseline characteristics and number of hospital visits were also analyzed.

RESULTS

The baseline characteristics of the two study groups were similar for EQ-5D utilities (TM:0.81; HM:0.76; p = 0.47), EQ-5D VAS (TM: 64.00; HM:64.88; p = 0.86) and the MLHFQ (TM:20.20; HM:28.96; p = 0.07). At the 6 month follow-up, there were no significant differences between the groups in EQ-5D utilities (TM: 0.81; HM: 0.76; p = 0.54) and EQ-5D VAS scores (TM: 72.71; HM: 59.79; p = 0.08). The MLHFQ score was improved in both groups (TM: -4.40; HM: -15.13; p <  0.001). The number of in-office visits was similar in both groups (TM: 1.24 vs HM: 1.12; P = 0.30).

CONCLUSIONS

The NORDLAND trial shows that HRQoL is improved after implant in both groups. Without significant differences with regards to effectiveness and safety. In addition, provides a scientifically rigorous method to the field of HRQoL evaluations in patients with pacemakers.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02237404 , September 11, 2014.

Supportive home health care technology for older adults: Attitudes and implementation

Healthcare delivered at home via telehealth technology may save on both individual and societal healthcare costs. Three studies investigated potential attitudinal barriers to home healthcare adoption. Results from the first concerning adults' privacy concerns and mobile device preferences showed that attitudes clustered into 4 factors and that older adults, particularly males, showed less concern than younger adults about privacy. The second and third studies explored comfort with a wearable device and the role of aesthetics over 2-week and 6-month intervals. Results showed that older adults had stable ratings for comfort while wearing a watch device designed to collect data in real time and that aspects of physical comfort predicted use over a six-month time period. Taken together, the studies provide evidence that attitudes about privacy and comfort for wearable health devices are unlikely to be significant barriers to adoption, though first impressions are important for all age groups.

Workload, time and costs of the informal cares in patients with tele-monitoring of pacemakers: the PONIENTE study

OBJECTIVES

The purpose of this study was to assess the burden borne by and the costs to informal caregivers of patients with remotely monitored (RM) pacemakers.

METHODS

The PONIENTE study was a controlled, non-randomised clinical trial, with data collected from informal caregivers, 12 months after implantation of pacemakers. The survey on disabilities, personal autonomy, and dependency situations was used to gather information on demographic and social characteristics, levels of professionalism, time and types of care, difficulties in providing care, health status, professional aspects, economic and family or leisure impacts due to informal caregiving for patients with pacemakers.

RESULTS

During 14 months, 76 caregivers were enrolled in the PONIENTE trial. Of which, 26 were included in the RM group and 50 in the hospital-monitored group (HM). The mean ages were 58.62 ± 16.51 and 61.10 ± 12.67 years, respectively (p = 0.56) in the groups, and 69.7 % were females. The majority (96.1 %) of the caregivers declared that they had to provide their services between 6 and 7 days per week (88.5 % in RM group versus 100 % in HM group; p = 0.037). The costs related to care provided by the informal caregivers were 21.38 % lower in the RM group than in the HM group (p = 0.033).

CONCLUSIONS

The PONIENTE study shows a significant impact of informal care on relatives and friends of patients with pacemakers in terms of their well-being and costs.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02234245.

Metrics for assessing the reliability of a telemedicine remote monitoring system

OBJECTIVE

The goal of this study was to assess using new metrics the reliability of a real-time health monitoring system in homes of older adults.

MATERIALS AND METHODS

The "MobileCare Monitor" system was installed into the homes of nine older adults >75 years of age for a 2-week period. The system consisted of a wireless wristwatch-based monitoring system containing sensors for location, temperature, and impacts and a "panic" button that was connected through a mesh network to third-party wireless devices (blood pressure cuff, pulse oximeter, weight scale, and a survey-administering device). To assess system reliability, daily phone calls instructed participants to conduct system tests and reminded them to fill out surveys and daily diaries. Phone reports and participant diary entries were checked against data received at a secure server.

RESULTS

Reliability metrics assessed overall system reliability, data concurrence, study effectiveness, and system usability. Except for the pulse oximeter, system reliability metrics varied between 73% and 92%. Data concurrence for proximal and distal readings exceeded 88%. System usability following the pulse oximeter firmware update varied between 82% and 97%. An estimate of watch-wearing adherence within the home was quite high, about 80%, although given the inability to assess watch-wearing when a participant left the house, adherence likely exceeded the 10 h/day requested time. In total, 3,436 of 3,906 potential measurements were obtained, indicating a study effectiveness of 88%.

CONCLUSIONS

The system was quite effective in providing accurate remote health data. The different system reliability measures identify important error sources in remote monitoring systems.