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Boriani G, Schnabel RB, Healey JS, Lopes RD, Verbiest-van Gurp N, Lobban T, Camm JA, Freedman B. Consumer-led screening for atrial fibrillation using consumer-facing wearables, devices and apps: A survey of health care professionals by AF-SCREEN international collaboration. Eur J Intern Med 2020; 82:97-104. [PMID: 32933842 DOI: 10.1016/j.ejim.2020.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/06/2020] [Accepted: 09/06/2020] [Indexed: 12/13/2022]
Abstract
AIM A variety of consumer-facing wearables, devices and apps are marketed directly to consumers to detect atrial fibrillation (AF). However, their management is not defined. Our aim was to explore their role for AF screening via a survey. METHODS AND RESULTS An anonymous web-based survey was undertaken by 588 health care professionals (HCPs) (response rate 23.7%). Overall, 57% HCPs currently advise wearables/apps for AF detection in their patients: this was much higher for electrophysiologists and nurses/allied health professionals (74-75%) than cardiologists (57%) or other physicians (34-38%). Approximately 46% recommended handheld (portable) single-lead dedicated ECG devices, or, less frequently, wristband ECG monitors with similar differentials between HCPs . Only 10-15% HCPs advised photoplethysmographic wristband monitors or smartphone apps. In over half of the HCP consultations for AF detected by wearables/apps, the decision to screen was entirely the patient's. About 45% of HCPs perceive a potential role for AF screening in people aged >65 years or in those with risk factors. Almost 70% of HCPs believed we are not yet ready for mass consumer-initiated screening for AF using wearable devices/apps, with patient anxiety, risk of false positives and negatives, and risk of anticoagulant-related bleeding perceived as potential disadvantages, and perceived need for appropriate management pathways. CONCLUSIONS There is a great potential for appropriate use of consumer-facing wearables/apps for AF screening. However, it appears that there is a need to better define suitable individuals for screening and an appropriate mechanism for managing positive results before they can be recommended by HCPs.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; AF-SCREEN International Collaboration.
| | - Renate B Schnabel
- AF-SCREEN International Collaboration; University Heart and Vascular Center Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Jeff S Healey
- AF-SCREEN International Collaboration; Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Renato D Lopes
- AF-SCREEN International Collaboration; Duke University Medical Center, Durham, NC, United States
| | - Nicole Verbiest-van Gurp
- Care and Public Health Research Institute (CAPHRI), Department of Family Medicine, Maastricht University, Limburg, Netherlands
| | - Trudie Lobban
- AF-SCREEN International Collaboration; Atrial Fibrillation Association (AF Assoc)/ Arrhythmia Alliance (A-A), AF Association, Oxfordshire, United Kingdom
| | - John A Camm
- AF-SCREEN International Collaboration; St George's University of London, London, United Kingdom
| | - Ben Freedman
- AF-SCREEN International Collaboration; Heart Research Institute, Sydney Australia; Charles Perkins Centre and Concord Hospital Cardiology, University of Sydney, Sydney, Australia
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Raatikainen MJP, Arnar DO, Merkely B, Nielsen JC, Hindricks G, Heidbuchel H, Camm J. A Decade of Information on the Use of Cardiac Implantable Electronic Devices and Interventional Electrophysiological Procedures in the European Society of Cardiology Countries: 2017 Report from the European Heart Rhythm Association. Europace 2018; 19:ii1-ii90. [PMID: 28903470 DOI: 10.1093/europace/eux258] [Citation(s) in RCA: 198] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 07/07/2017] [Indexed: 12/19/2022] Open
Abstract
Aims The aim of this analysis was to provide comprehensive information on invasive cardiac arrhythmia therapies in the European Society of Cardiology (ESC) area over the past 10 years. Methods and results The European Heart Rhythm Association (EHRA) has collected data on invasive arrhythmia therapies since 2008. This year 53 of the 56 ESC member countries provided data for the EHRA White Book. Here we present updated data on procedure rates together with information on demographics, economy, vital statistics, local healthcare systems and training activities. Considerable heterogeneity in the access to invasive arrhythmia therapies still exists across the five geographical ESC regions. In 2016, the device implantation rates per million population were 3-6 times higher in the Western region than in the non-European and Eastern ESC member countries. Catheter ablation activity was highest in the Western countries followed by the Northern and Southern areas. In the non-European countries, atrial fibrillation ablation rate was more than tenfold lower than in the European countries. On the other hand, the growth rate over the past ten years was highest in the non-European and Eastern countries. In some Eastern European countries with relative low gross domestic product the procedure rates exceeded the average values. Conclusion It was encouraging to note that during the past decade the growth in invasive arrhythmia therapies was greatest in the areas historically with relatively low activity. Nevertheless, there is substantial disparity and continued efforts are needed to improve harmonization of cardiac arrhythmia therapies in the ESC area.
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Affiliation(s)
| | - David O Arnar
- Division of Cardiology, Department of Medicine, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Bela Merkely
- Semmelweis University of Budapest, Heart and Vascular Center, Budapest, Hungary
| | | | - Gerhard Hindricks
- Department of Electrophysiology, Heart Centre, University of Leipzig, Leipzig
| | - Hein Heidbuchel
- Cardiology - Electrophysiology, Antwerp University and University Hospital, Antwerp, Belgium
| | - John Camm
- Division of Cardiovascular Sciences, St George's University of London, London, United Kingdom; ICMS, Imperial College, London, United Kingdom
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Tarricone R, Torbica A, Drummond M. Challenges in the Assessment of Medical Devices: The MedtecHTA Project. HEALTH ECONOMICS 2017; 26 Suppl 1:5-12. [PMID: 28139084 DOI: 10.1002/hec.3469] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 07/23/2016] [Accepted: 11/23/2016] [Indexed: 05/12/2023]
Abstract
Assessing medical devices (MDs) raises challenges which require us to reflect on whether current methods are adequate. Major features of devices are: (i) device-operator interaction can generate learning curve effects; (ii) incremental nature of innovation needs to be addressed by careful identification of the alternatives for comparative and incremental cost-effectiveness analysis; and (iii) broader organizational impact in terms of training and infrastructure, coupled with dynamic pricing, requires a more flexible approach to costing. The objective of the MedtecHTA project was to investigate improvements in HTA methods to allow for more comprehensive evaluation of MDs. It consisted of several work packages concerning (i) the available evidence on the currently adopted approaches for regulation and HTA of medical devices; (ii) the geographical variation in access to MDs; (iii) the development of methodological frameworks for conducting comparative effectiveness research and economic evaluation of MDs; and (iv) the organizational impact of MDs. This introductory paper summarizes the main results of the project and draws out the main overarching themes. This supplement represents a comprehensive report of all the main findings of the MedtecHTA project, and it is intended to be the main source for researchers and policy makers wanting information on the project. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Rosanna Tarricone
- Cergas, Bocconi University, Milan, Italy
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Aleksandra Torbica
- Cergas, Bocconi University, Milan, Italy
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Michael Drummond
- Cergas, Bocconi University, Milan, Italy
- Centre for Health Economics, University of York, York, UK
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Xiang MX, Wang DQ, Xu J, Zhang Z, Hu JX, Wang DM, Gu X, Liu HP, Guo T, Yang XJ, Ling F, Lin JF, Cai SL, Zhu GB, Wang JA. Evaluation of Safety and Efficacy of Qinming8631 DR Implantable Cardiac Pacemaker in Chinese Patients. Chin Med J (Engl) 2016; 129:2659-2665. [PMID: 27823996 PMCID: PMC5126155 DOI: 10.4103/0366-6999.193443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Raatikainen MP, Arnar DO, Merkely B, Camm AJ, Hindricks G. Access to and clinical use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European Society of Cardiology Countries: 2016 Report from the European Heart Rhythm Association. Europace 2016; 18 Suppl 3:iii1-iii79. [DOI: 10.1093/europace/euw244] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 07/07/2016] [Indexed: 11/13/2022] Open
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Raatikainen MP, Arnar DO, Zeppenfeld K, Merino JL, Kuck KH, Hindricks G. Current trends in the use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European Society of Cardiology member countries: 2015 report from the European Heart Rhythm Association. Europace 2015; 17 Suppl 4:iv1-72. [DOI: 10.1093/europace/euv265] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Raatikainen MJP, Arnar DO, Zeppenfeld K, Merino JL, Levya F, Hindriks G, Kuck KH. Statistics on the use of cardiac electronic devices and electrophysiological procedures in the European Society of Cardiology countries: 2014 report from the European Heart Rhythm Association. Europace 2015; 17 Suppl 1:i1-75. [DOI: 10.1093/europace/euu300] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nattel S, Andrade J, Macle L, Rivard L, Dyrda K, Mondesert B, Khairy P. New directions in cardiac arrhythmia management: present challenges and future solutions. Can J Cardiol 2014; 30:S420-30. [PMID: 25432137 DOI: 10.1016/j.cjca.2014.09.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 09/25/2014] [Accepted: 09/26/2014] [Indexed: 12/19/2022] Open
Abstract
Cardiac arrhythmias are a major contributor to population morbidity and mortality. Enormous advances in arrhythmia management have occurred over the 60 years since the founding of the Montreal Heart Institute, but important challenges remain. The purpose of this article is to identify the areas of cardiac arrhythmia therapy that need improvement and to discuss the evolving approaches that promise solutions. Challenges in diagnosis, detection, and risk-stratification include difficulties in separating benign from high-risk syncope and pinpointing the underlying causes, the detection of silent atrial fibrillation in patients at risk of stroke, and inadequate identification of sudden-death risk. Implantable devices are limited by the need for battery and device replacements, device complications like infection and dysfunction, and lead complications like fracture, infection, or displacement. Antiarrhythmic drug therapy, although widely used, is plagued by a very limited range of available agents, supply issues, insufficient efficacy, and significant adverse effect risk. Health economic concerns include the high cost of new technologies, challenges in establishing cost effectiveness, and restrictive practices of government or third-party payers. Major improvements in arrhythmia management can be expected from new discoveries and technological developments in genetics, innovative diagnostic tools for arrhythmia monitoring, imaging and analysis, new approaches to antiarrhythmic drug development, biological therapies, and continuing improvement in implantable device technology like further miniaturization, leadless technology, and use of novel energy sources. As exciting as the developments in arrhythmia management have been in the past, we can look forward to exponential improvement in our ability to manage arrhythmia patients in the near future.
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Affiliation(s)
- Stanley Nattel
- Research Center and Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
| | - Jason Andrade
- Research Center and Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Laurent Macle
- Research Center and Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Lena Rivard
- Research Center and Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Katia Dyrda
- Research Center and Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Blandine Mondesert
- Research Center and Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Paul Khairy
- Research Center and Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
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Arribas F, Auricchio A, Boriani G, Brugada J, Deharo JC, Hindriks G, Kuck KH, Merino JL, Vardas P, Wolpert C, Zeppenfeld K. Statistics on the use of cardiac electronic devices and electrophysiological procedures in 55 ESC countries: 2013 report from the European Heart Rhythm Association (EHRA). Europace 2014; 16 Suppl 1:i1-78. [DOI: 10.1093/europace/euu049] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Boriani G, Maniadakis N, Auricchio A, Muller-Riemenschneider F, Fattore G, Leyva F, Mantovani L, Siebert M, Willich SN, Vardas P, Kirchhof P. Health technology assessment in interventional electrophysiology and device therapy: a position paper of the European Heart Rhythm Association. Eur Heart J 2013; 34:1869-1874. [DOI: 10.1093/eurheartj/eht031] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Blomstrom Lundqvist C, Auricchio A, Brugada J, Boriani G, Bremerich J, Cabrera JA, Frank H, Gutberlet M, Heidbuchel H, Kuck KH, Lancellotti P, Rademakers F, Winkels G, Wolpert C, Vardas PE. The use of imaging for electrophysiological and devices procedures: a report from the first European Heart Rhythm Association Policy Conference, jointly organized with the European Association of Cardiovascular Imaging (EACVI), the Council of Cardiovascular Imaging and the European Society of Cardiac Radiology. Europace 2013; 15:927-36. [DOI: 10.1093/europace/eut084] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Assessing the outcomes of implantable cardioverter defibrillator treatment in a real world setting: results from hospital record data. BMC Health Serv Res 2013; 13:100. [PMID: 23496994 PMCID: PMC3602059 DOI: 10.1186/1472-6963-13-100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 03/08/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A plethora of clinical studies have assessed the benefits of implantable cardioverter defibrillators (ICDs) and supported their use in clinical practice. However, evidence on the safety and efficacy of ICDs appears insufficient to support expansion of their use in clinical practice, and more information on their impact in real life settings is warranted. This paper aims to investigate the impact of ICDs using a large administrative dataset reflecting actual clinical practice. METHODS Data were obtained from the hospital discharge database of the Friuli Venezia Giulia region in Italy containing patient-level information on 169,488 cases. Data on mortality outside hospital were obtained from regional sources. Exact matching method was used to estimate the outcomes associated with ICDs: mortality, length of stay, re-hospitalization and regional expenditure. The method was applied in two steps. First, patients with ICDs were matched with those without using the following: age class (by 5 years), gender, year of admission, type of admission (day hospital vs. ordinary) and primary diagnosis. In the second step, matching included also Charlson Comorbidities Index. Exact matching average treatment effect on the treated (ATT) was used as a main measure of impact. RESULTS Compared with matched controls, treatment with ICDs was associated with lower mortality (absolute risk reduction 10.6% at 1 year and 8.3% at 2 and 8.4% at 3 years, p < 0.001 and hazard ratio 0.80, p < 0.001), greater regional expenditure at index hospitalization (ATT: €9459.64, p < 0.001) and during follow up (ATT: €1707.29, p < 0.001) and higher re-hospitalization rate (ATT: 0.53, p < 0.001). No significant difference was found for length of stay (9.07 vs. 8.86 days). The results were maintained after more restrictive matching was applied. CONCLUSIONS Assessing the impact of innovative, expensive medical technologies on the basis of real world data is warranted, especially when there are barriers to implementation. Hospital administrative datasets can be of great value when a technology such as the ICD is implemented in a relatively small sample of patients, to allow use of exact matching techniques.
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Arribas F, Auricchio A, Wolpert C, Merkely B, Merino JL, Boriani G, van der Velde E, Camm J, Vardas P. The EHRA White Book. ACTA ACUST UNITED AC 2012; 14 Suppl 3:iii1-55. [DOI: 10.1093/europace/eus256] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Boriani G, Gardini B, Diemberger I, Reggiani MLB, Biffi M, Martignani C, Ziacchi M, Valzania C, Gasparini M, Padeletti L, Branzi A. Meta‐analysis of randomized controlled trials evaluating left ventricular vs. biventricular pacing in heart failure: effect on all‐cause mortality and hospitalizations. Eur J Heart Fail 2012; 14:652-660. [DOI: 10.1093/eurjhf/hfs040] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
| | | | | | | | - Mauro Biffi
- Institute of Cardiology University of Bologna Bologna Italy
| | | | - Matteo Ziacchi
- Institute of Cardiology University of Bologna Bologna Italy
| | | | - Maurizio Gasparini
- Electrophysiology and Pacing Unit, Cardiology Department IRCCS Istituto Clinico Humanitas Rozzano Milano Italy
| | - Luigi Padeletti
- Department of Heart and Vessels University of Florence Florence Italy
| | - Angelo Branzi
- Institute of Cardiology University of Bologna Bologna Italy
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Boriani G, Mantovani LG, Biffi M, Schalij MJ, Martignani C, Leclercq C, Bax JJ, Auricchio A. Cardiac resynchronization therapy: a cost or an investment? Europace 2011; 13 Suppl 2:ii32-8. [PMID: 21518747 DOI: 10.1093/europace/eur079] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cost-effectiveness estimates can help optimize use of available financial resources and this is especially relevant for implementation of cardiac resynchronization therapy (CRT), given the high upfront costs and the timescale of expected benefits. All available cost-effectiveness estimates for devices with (CRT-P) or without (CRT-D) a defibrillator are based on results of randomized trials of selected patients, with a relatively brief follow-up. Extrapolation suggests that the cost effectiveness of CRT may become more favourable as time horizons increase. Using a lifetime time horizon and comparison with optimal medical therapy, the cost effectiveness of both CRT-P and CRT-D appears to meet the $50 000/QALY benchmark commonly used for health-care interventions in the USA, as well as similar thresholds used in Europe. The absence of direct comparisons of the efficacy/effectiveness of CRT-P and CRT-D hampers cost-effectiveness comparisons, and so clinical judgment in the context of current evidence supporting the benefits of cardioverter-defibrillators may provide a rational basis for choosing between CRT-P and CRT-D. Efforts are currently being dedicated to improve CRT response rates by improved patient selection and, reasonably, any improvement in this field will translate into improved effectiveness, and therefore into improved cost effectiveness. The extended longevity of CRT devices will also positively impact cost-effectiveness estimates.
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Affiliation(s)
- Giuseppe Boriani
- Institute of Cardiology, University of Bologna, Azienda Ospedaliera S.Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy
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Boriani G, Burri H, Mantovani LG, Maniadakis N, Leyva F, Kautzner J, Lubinski A, Braunschweig F, Jung W, Lozano IF, Fattore G. Device therapy and hospital reimbursement practices across European countries: a heterogeneous scenario. Europace 2011; 13:ii59-ii65. [DOI: 10.1093/europace/eur080] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Vardas P, Boriani G. Health economics and the European Heart Rhythm Association. Europace 2011; 13 Suppl 2:ii1-2. [DOI: 10.1093/europace/eur090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Boriani G, Auricchio A, Klersy C, Kirchhof P, Brugada J, Morgan J, Vardas P. Healthcare personnel resource burden related to in-clinic follow-up of cardiovascular implantable electronic devices: a European Heart Rhythm Association and Eucomed joint survey. Europace 2011; 13:1166-73. [PMID: 21345922 DOI: 10.1093/europace/eur026] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS A pilot European survey was conducted to assess the cumulative time spent by healthcare personnel for in-office follow-up of cardiac implantable electrical devices (CIEDs), including cardiac pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy (CRT) devices. METHODS AND RESULTS Resource use data were collected during a session of in-clinic follow-up. Among 407 visits, 93% were scheduled and 7% unscheduled. Visit duration (total cumulative time) lasted a mean of 27 min for scheduled visits, and was ∼30% longer for unscheduled visits. Independent determinants of visit duration were: unscheduled visit (+7.6 min, P = 0.01), the need for device reprogramming (+7.5 min, P < 0.001), and the type of device checked, with CRT devices needing 9.1 and 6.6 more minutes than single- (P < 0.001) and dual-chamber devices (P = 0.002), respectively. Most visits involved two different types of healthcare personnel (239 of 407, 59%), simultaneously. The most frequent combination was the involvement of both a cardiologist and a nurse (216 of 407 visits with both of them only, and 65 additional visits with also an internal technician, an external technician, or both). Overall, an external technician was involved in 18% of visits. CONCLUSIONS In 'real-world' practice, the follow-up of CIEDs nowadays requires important resources in terms of time dedicated by specialized personnel, corresponding to cardiologists, nurses, internal technicians, and external, industry-employed technicians. These observations should be the basis for addressing clinical, organizational, financial, and policy initiatives targeted to optimize follow-up procedures in order to face the increase in the number of patients treated with CIEDs expected for the next years.
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Affiliation(s)
- Giuseppe Boriani
- Institute of Cardiology, University of Bologna, Azienda Ospedaliera S. Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy.
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