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Raes S, Prezzi A, Willems R, Heidbuchel H, Annemans L. Investigating the Cost-Effectiveness of Telemonitoring Patients With Cardiac Implantable Electronic Devices: Systematic Review. J Med Internet Res 2024; 26:e47616. [PMID: 38640471 PMCID: PMC11069092 DOI: 10.2196/47616] [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: 03/28/2023] [Revised: 09/13/2023] [Accepted: 02/13/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Telemonitoring patients with cardiac implantable electronic devices (CIEDs) can improve their care management. However, the results of cost-effectiveness studies are heterogeneous. Therefore, it is still a matter of debate whether telemonitoring is worth the investment. OBJECTIVE This systematic review aims to investigate the cost-effectiveness of telemonitoring patients with CIEDs, focusing on its key drivers, and the impact of the varying perspectives. METHODS A systematic review was performed in PubMed, Web of Science, Embase, and EconLit. The search was completed on July 7, 2022. Studies were included if they fulfilled the following criteria: patients had a CIED, comparison with standard care, and inclusion of health economic evaluations (eg, cost-effectiveness analyses and cost-utility analyses). Only complete and peer-reviewed studies were included, and no year limits were applied. The exclusion criteria included studies with partial economic evaluations, systematic reviews or reports, and studies without standard care as a control group. Besides general study characteristics, the following outcome measures were extracted: impact on total cost or income, cost or income drivers, cost or income drivers per patient, cost or income drivers as a percentage of the total cost impact, incremental cost-effectiveness ratios, or cost-utility ratios. Quality was assessed using the Consensus Health Economic Criteria checklist. RESULTS Overall, 15 cost-effectiveness analyses were included. All studies were performed in Western countries, mainly Europe, and had primarily a male participant population. Of the 15 studies, 3 (20%) calculated the incremental cost-effectiveness ratio, 1 (7%) the cost-utility ratio, and 11 (73%) the health and cost impact of telemonitoring. In total, 73% (11/15) of the studies indicated that telemonitoring of patients with implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy ICDs was cost-effective and cost-saving, both from a health care and patient perspective. Cost-effectiveness results for telemonitoring of patients with pacemakers were inconclusive. The key drivers for cost reduction from a health care perspective were hospitalizations and scheduled in-office visits. Hospitalization costs were reduced by up to US $912 per patient per year. Scheduled in-office visits included up to 61% of the total cost reduction. Key drivers for cost reduction from a patient perspective were loss of income, cost for scheduled in-office visits and transport. Finally, of the 15 studies, 8 (52%) reported improved quality of life, with statistically significance in only 1 (13%) study (P=.03). CONCLUSIONS From a health care and patient perspective, telemonitoring of patients with an ICD or a cardiac resynchronization therapy ICD is a cost-effective and cost-saving alternative to standard care. Inconclusive results were found for patients with pacemakers. However, telemonitoring can lead to a decrease in providers' income, mainly due to a lack of reimbursement. Introducing appropriate reimbursement could make telemonitoring sustainable for providers while still being cost-effective from a health care payer perspective. TRIAL REGISTRATION PROSPERO CRD42022322334; https://tinyurl.com/puunapdr.
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Affiliation(s)
- Sarah Raes
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Andrea Prezzi
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, Universiteit Leuven, Leuven, Belgium
| | - Hein Heidbuchel
- Department of Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR), Antwerp University, Antwerp, Belgium
| | - Lieven Annemans
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
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Varma N, Braunschweig F, Burri H, Hindricks G, Linz D, Michowitz Y, Ricci RP, Nielsen JC. Remote monitoring of cardiac implantable electronic devices and disease management. Europace 2023; 25:euad233. [PMID: 37622591 PMCID: PMC10451003 DOI: 10.1093/europace/euad233] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 08/26/2023] Open
Abstract
This reviews the transition of remote monitoring of patients with cardiac electronic implantable devices from curiosity to standard of care. This has been delivered by technology evolution from patient-activated remote interrogations at appointed intervals to continuous monitoring that automatically flags clinically actionable information to the clinic for review. This model has facilitated follow-up and received professional society recommendations. Additionally, continuous monitoring has provided a new level of granularity of diagnostic data enabling extension of patient management from device to disease management. This ushers in an era of digital medicine with wider applications in cardiovascular medicine.
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Affiliation(s)
- Niraj Varma
- Cardiac Pacing and Electrophysiology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
| | | | - Haran Burri
- University Hospital of Geneva, 1205 Geneva, Switzerland
| | | | - Dominik Linz
- Maastricht University Medical Center, 6211 LK Maastricht, The Netherlands
| | - Yoav Michowitz
- Department of Cardiology, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University, Jerusalem 9112001, Israel
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Boriani G, Burri H, Svennberg E, Imberti JF, Merino JL, Leclercq C. Current status of reimbursement practices for remote monitoring of cardiac implantable electrical devices across Europe. Europace 2022; 24:1875-1880. [PMID: 35904006 PMCID: PMC9384581 DOI: 10.1093/europace/euac118] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/09/2022] [Indexed: 12/14/2022] Open
Abstract
Remote monitoring (RM) of cardiac implantable electrical devices (CIEDs) is currently proposed as a standard of care for CIEDs follow-up, as recommended by major cardiology societies worldwide. By detecting a series of relevant device and patient-related parameters, RM is a valuable option for early detection of CIEDs' technical issues, as well as changes in parameters related to cardio-respiratory functions. Moreover, RM may allow longer spacing between in-office follow-ups and better organization of in-hospital resources. Despite these potential advantages, resulting in improved patient safety, we are still far from a widespread diffusion of RM across Europe. Reimbursement policies across Europe still show an important heterogeneity and have been considered as an important barrier to full implementation of RM as a standard for the follow-up of all the patients with pacemakers, defibrillators, devices for cardiac resynchronization, or implantable loop recorders. Indeed, in many countries, there are still inertia and unresponsiveness to the request for widespread implementation of RM for CIEDs, although an improvement was found in some countries as compared to years ago, related to the provision of some form of reimbursement. As a matter of fact, the COVID-19 pandemic has promoted an increased use of digital health for connecting physicians to patients, even if digital literacy may be a limit for the widespread implementation of telemedicine. CIEDs have the advantage of making possible RM with an already defined organization and reliable systems for data transmissions that can be easily implemented as a standard of care for present and future cardiology practice.
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Affiliation(s)
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Service, University Hospital of Geneva, 1211 Geneva, Switzerland
| | - Emma Svennberg
- Karolinska Institutet, Department of Medicine, Karolinska University Hospital Huddinge, 17177 Stockholm, Sweden
| | - Jacopo Francesco Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124 Modena, Italy,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Josè Luis Merino
- University Hospital La Paz, Autonoma University, Arrhythmia & Robotic EP Unit, IdiPaz, 28046 Madrid, Spain
| | - Christophe Leclercq
- Department of Cardiology, University Hospital of Rennes, 35000 Rennes, France
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Liljeroos M, Thylén I, Strömberg A. Patients' and Nurses' Experiences and Perceptions of Remote Monitoring of Implantable Cardiac Defibrillators in Heart Failure: Cross-Sectional, Descriptive, Mixed Methods Study. J Med Internet Res 2020; 22:e19550. [PMID: 32985997 PMCID: PMC7551113 DOI: 10.2196/19550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/08/2020] [Accepted: 07/26/2020] [Indexed: 12/28/2022] Open
Abstract
Background The new generation of implantable cardioverter-defibrillators (ICDs) supports wireless technology, which enables remote patient monitoring (RPM) of the device. In Sweden, it is mainly registered nurses with advanced education and training in ICD devices who handle the arrhythmias and technical issues of the remote transmissions. Previous studies have largely focused on the perceptions of physicians, and it has not been explored how the patients’ and nurses’ experiences of RPM correspond to each other. Objective Our objective is to describe, explore, and compare the experiences and perceptions, concerning RPM of ICD, of patients with heart failure (HF) and nurses performing ICD follow-up. Methods This study has a cross-sectional, descriptive, mixed methods design. All patients with HF and an ICD with RPM from one region in Sweden, who had transitioned from office-based visits to implementing RPM, and ICD nurses from all ICD clinics in Sweden were invited to complete a purpose-designed, 8-item questionnaire to assess experiences of RPM. The questionnaire started with a neutral question: “What are your experiences of RPM in general?” This was followed by one positive subscale with three questions (score range 3-12), with higher scores reflecting more positive experiences, and one negative subscale with three questions (score range 3-12), with lower scores reflecting more negative experiences. One open-ended question was analyzed with qualitative content analysis. Results The sample consisted of 175 patients (response rate 98.9%) and 30 ICD nurses (response rate 60%). The majority of patients (154/175, 88.0%) and nurses (23/30, 77%) experienced RPM as very good; however, the nurses noted more downsides than did the patients. The mean scores of the negative experiences subscale were 11.5 (SD 1.1) for the patients and 10.7 (SD 0.9) for the nurses (P=.08). The mean scores of the positive experiences subscale were 11.1 (SD 1.6) for the patients and 8.5 (SD 1.9) for the nurses (P=.04). A total of 11 out of 175 patients (6.3%) were worried or anxious about what the RPM entailed, while 15 out of 30 nurses (50%) felt distressed by the responsibility that accompanied their work with RPM (P=.04). Patients found that RPM increased their own (173/175, 98.9%) and their relatives’ (169/175, 96.6%) security, and all nurses (30/30, 100%) answered that they found RPM to be necessary from a safety perspective. Most patients found it to be an advantage with fewer office-based visits. Nurses found it difficult to handle different systems with different platforms, especially for smaller clinics with few patients. Another difficulty was to set the correct number of alarms for the individual patient. This caused a high number of transmissions and a risk to miss important information. Conclusions Both patients and nurses found that RPM increased assurance, reliance, and safety. Few patients were anxious about what the RPM entailed, while about half of the nurses felt distressed by the responsibility that accompanied their work with RPM. To increase nurses’ sense of security, it seems important to adjust organizational routines and reimbursement systems and to balance the workload.
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Affiliation(s)
- Maria Liljeroos
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Ingela Thylén
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden
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Sequeira S, Jarvis CI, Benchouche A, Seymour J, Tadmouri A. Cost-effectiveness of remote monitoring of implantable cardioverter-defibrillators in France: a meta-analysis and an integrated economic model derived from randomized controlled trials. Europace 2020; 22:1071-1082. [DOI: 10.1093/europace/euaa082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/23/2020] [Accepted: 03/24/2020] [Indexed: 01/23/2023] Open
Abstract
Abstract
Aims
Cost-effectiveness data on the remote monitoring (RM) of implantable cardioverter-defibrillators (ICDs) compared to the current standard of care (SC) remains limited. This meta-analysis was performed to assess the economic burden, and to develop an integrated economic model evaluating the efficiency of the RM strategy vs. SC in the context of French healthcare.
Methods and results
Randomized controlled trials, comparing RM to SC in patients implanted with ICDs with or without resynchronization therapy (±CRT-D), were identified through a systematic search of scientific literature databases dating from 2005. Seventeen trials (10 229 patients) reporting data on clinical outcomes, quality of life, cost, and/or utility, either as primary or secondary endpoints were identified. Compared to SC, RM resulted in significant reductions in annual costs per patient for direct healthcare costs (seven studies, difference in means −276.1, 95% standard error [SE]: 66.0, I2 = 76.3%) and for labour costs (two studies, difference in means −11.3, 95% SE: 1.4, I2 = 96.3%). A three-state Markov Model showed that RM resulted in cost-savings of €4142 per patient over a 5-year time horizon, with a quality-adjusted life year (QALY) gain of 0.29. The incremental cost-effectiveness ratio was −14 136 €/QALY, in favour of RM. Furthermore, probabilistic sensitivity analyses confirmed that the RM strategy was dominant over SC in 70% of cases.
Conclusion
Our economic model demonstrates that once implemented, RM of ICD ± CRT-D patients would result in increased effectiveness for lower costs over a 5-year period, compared to the current SC in France.
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Affiliation(s)
- Saannya Sequeira
- Scientific Department, ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France
| | - Christopher I Jarvis
- Scientific Department, ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France
| | - Akram Benchouche
- Scientific Department, ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France
| | - Jerome Seymour
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France
| | - Abir Tadmouri
- Scientific Department, ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France
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Roberts PR, ElRefai MH. The Use of App-based Follow-up of Cardiac Implantable Electronic Devices. Card Fail Rev 2020; 6:e03. [PMID: 32377382 PMCID: PMC7199159 DOI: 10.15420/cfr.2019.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/19/2019] [Indexed: 11/04/2022] Open
Abstract
There has been a steady rise in the number of patients treated with cardiac implantable electrical devices. Remote monitoring and remote follow-up have proven superior to conventional care in the follow-up of these patients and represent the new standard of care. With the widespread availability of smartphones and with more people using them for health queries, app-based remote care offers a promising new digital health solution promoting the shift of follow-up to exception-based assessments. It focuses on patients’ enablement and has shown promising results, but also highlights the need to increase the system’s automaticity to achieve acceptable follow-up adherence rates. MyCareLink Heart is a fully automated app-based system that represents the next generation of app-based monitoring and is currently being evaluated in an international study with promising initial results.
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Zanotto G, D'Onofrio A, Della Bella P, Solimene F, Pisanò EC, Iacopino S, Dondina C, Giacopelli D, Gargaro A, Ricci RP. Organizational model and reactions to alerts in remote monitoring of cardiac implantable electronic devices: A survey from the Home Monitoring Expert Alliance project. Clin Cardiol 2018; 42:76-83. [PMID: 30421438 DOI: 10.1002/clc.23108] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/22/2018] [Accepted: 10/25/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND This survey aimed to describe the organizational workflow of cardiac implantable electronic devices (CIEDs) remote monitoring (RM) service in ordinary practice. METHODS A questionnaire was designed for our purpose and completed by 49 sites participating to the Italian Home Monitoring Expert Alliance. RESULTS A dedicated organizational model for RM was set up for 86% of centers. The median RM team consisted of 2 (Interquartile range [IQR]: 1-3) physicians and 1 (IQR: 0-2) nurse. RM service was available in working hours and the median percentage of patients included was 100% (IQR: 10%-100%) for implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) recipients and 5% (IQR:0%-30%) for pacemakers. In-office follow-up was performed every 12 and 6 months for pacemaker and ICD/CRT recipients, respectively. More than 90% of sites used to activate all technical alerts, with a prompt reaction in case of an out-of-range parameter. The threshold for atrial fibrillation (AF) daily burden notification in most cases ranged from 2.4 to 7.2 hours. All ventricular arrhythmias alerts were usually switched on: an inappropriate therapy or more than one appropriate episode triggered an urgent in-hospital visit. Concerning heart failure, low CRT percentage pacing alert was always used, while the other available notifications were less frequently switched on. CONCLUSIONS This survey showed that RM service was usually set up with a primary nursing model including on average two responsible physicians and one nurse and mainly offered to ICD/CRT patients. Technical, AF and ventricular arrhythmia alerts triggered prompt reactions, while heart failure related indexes were generally less applied.
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Bohora S, Vora A, Kapoor A, Arora V, Naik N, Selvaraj R, Namboodiri N, Saxena A, Naik A, Singh B, Narsimhan C, Nair M, Kler TS. Consensus statement for implantation and follow-up of cardiac implantable electronic devices in India. Indian Pacing Electrophysiol J 2018; 18:188-192. [PMID: 30391596 PMCID: PMC6303166 DOI: 10.1016/j.ipej.2018.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Cardiac implantable electronic device (CIED) procedures are being done by many operators/centers and it is projected that this therapy will remarkably increase in India in the coming years. This document by IHRS, aims at guiding the Indian medical community in the appropriate use and method of implantation with emphasis on implanter training and center preparedness to deliver a safe and effective therapy to patients with cardiac rhythm disorders and heart failure.
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Affiliation(s)
- Shomu Bohora
- U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, India.
| | - Amit Vora
- Glenmark Cardiac Centre, Mumbai, India
| | - Aditya Kapoor
- Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPI) Lucknow, India
| | | | - Nitish Naik
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Raja Selvaraj
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Narayan Namboodiri
- Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India
| | - Anil Saxena
- Fortis Escorts Heart Institute, New Delhi, India
| | | | | | | | | | - T S Kler
- Pushpawati Singhania Research Institute & Heart Institute, New Delhi, India
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Auricchio A, Hudnall JH, Schloss EJ, Sterns LD, Kurita T, Meijer A, Fagan DH, Rogers T. Inappropriate shocks in single-chamber and subcutaneous implantable cardioverter-defibrillators: a systematic review and meta-analysis. Europace 2017; 19:1973-1980. [PMID: 28340005 PMCID: PMC5834016 DOI: 10.1093/europace/euw415] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/25/2016] [Accepted: 12/18/2016] [Indexed: 11/14/2022] Open
Abstract
AIMS Single-chamber (VR-ICD) and subcutaneous (S-ICD) implantable cardioverter-defibrillators are effective to protect patients against sudden death but expose them to higher risk of inappropriate shock (IS). We sought to quantify the annual rate and influencing factors of ISs in VR- and S-ICDs from the literature. METHODS AND RESULTS PubMed, Embase, and Cochrane Library were searched for full text articles with IS rates. Poisson distribution estimated proportion of patients with ISs; rates were annualized based on follow-up duration. Random effects meta-analysis accounted for study-to-study variation. Out of 3264 articles, 16 qualified for the meta-analysis. Across studies, 6.4% [95% confidence interval (CI) 5.1-7.9%] of patients received an IS per year. Meta-regression analyses demonstrated that IS rates were lower in more recent studies [rate ratio (RR) per year: 0.93, 95% CI: 0.87-0.98; P = 0.01] and trended lower in studies with longer follow-up (RR per year: 0.78, 95% CI: 0.60-1.01; P = 0.06). Use of S-ICDs (RR: 1.81, 95% CI: 0.86-3.81; P = 0.12) and ventricular tachycardia zone programmed on (RR: 1.13, 95% CI: 0.65-1.97; P = 0.66) were not associated with a significantly increased change in risk. The IS rate observed in one of the more recent studies was significantly lower than predicted after accounting for covariates (RR: 0.29, 95% CI: 0.14-0.60; P < 0.001). CONCLUSIONS A comprehensive review of the literature shows that 6.4% of patients with ICDs experienced their first IS annually. One of the 16 studies was better than predicted with the lowest reported rate (1.9%) and could not be explained by timing of the study or other covariates.
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Affiliation(s)
- Angelo Auricchio
- Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete, 48, CH-6900 Lugano, Switzerland
| | | | - Edward J Schloss
- The Christ Hospital/The Ohio Heart & Vascular Center, Cincinnati, OH, USA
| | | | - Takashi Kurita
- Division of Cardiology, Kinki University School of Medicine, Osaka, Japan
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Hutchison K, Sparrow R. What Pacemakers Can Teach Us about the Ethics of Maintaining Artificial Organs. Hastings Cent Rep 2016; 46:14-24. [DOI: 10.1002/hast.644] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Akar JG, Hummel JP. Editorial commentary: Virtual medicine-A better reality? Trends Cardiovasc Med 2016; 26:731-732. [PMID: 27737760 DOI: 10.1016/j.tcm.2016.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 06/27/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Joseph G Akar
- Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT.
| | - James P Hummel
- Division of Cardiology, University of North Carolina, Chapel Hill, NC
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Boriani G, Da Costa A, Quesada A, Ricci RP, Favale S, Boscolo G, Clementy N, Amori V, Mangoni di S. Stefano L, Burri H. Effects of remote monitoring on clinical outcomes and use of healthcare resources in heart failure patients with biventricular defibrillators: results of the MORE-CARE multicentre randomized controlled trial. Eur J Heart Fail 2016; 19:416-425. [DOI: 10.1002/ejhf.626] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 07/27/2016] [Accepted: 07/27/2016] [Indexed: 12/19/2022] Open
Affiliation(s)
- Giuseppe Boriani
- University of Modena and Reggio Emilia; Policlinico di Modena; Modena Italy
- University of Bologna; S. Orsola-Malpighi University Hospital; Bologna Italy
| | | | | | | | | | | | | | | | | | - Haran Burri
- University Hospital of Geneva; Geneva Switzerland
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Heidbuchel H, Hindricks G, Broadhurst P, Van Erven L, Fernandez-Lozano I, Rivero-Ayerza M, Malinowski K, Marek A, Romero Garrido RF, Löscher S, Beeton I, Garcia E, Cross S, Vijgen J, Koivisto UM, Peinado R, Smala A, Annemans L. EuroEco (European Health Economic Trial on Home Monitoring in ICD Patients): a provider perspective in five European countries on costs and net financial impact of follow-up with or without remote monitoring. Eur Heart J 2014; 36:158-69. [PMID: 25179766 PMCID: PMC4297469 DOI: 10.1093/eurheartj/ehu339] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim Remote follow-up (FU) of implantable cardiac defibrillators (ICDs) allows for fewer in-office visits in combination with earlier detection of relevant findings. Its implementation requires investment and reorganization of care. Providers (physicians or hospitals) are unsure about the financial impact. The primary end-point of this randomized prospective multicentre health economic trial was the total FU-related cost for providers, comparing Home Monitoring facilitated FU (HM ON) to regular in-office FU (HM OFF) during the first 2 years after ICD implantation. Also the net financial impact on providers (taking national reimbursement into account) and costs from a healthcare payer perspective were evaluated. Methods and results A total of 312 patients with VVI- or DDD-ICD implants from 17 centres in six EU countries were randomised to HM ON or OFF, of which 303 were eligible for data analysis. For all contacts (in-office, calendar- or alert-triggered web-based review, discussions, calls) time-expenditure was tracked. Country-specific cost parameters were used to convert resource use into monetary values. Remote FU equipment itself was not included in the cost calculations. Given only two patients from Finland (one in each group) a monetary valuation analysis was not performed for Finland. Average age was 62.4 ± 13.1 years, 81% were male, 39% received a DDD system, and 51% had a prophylactic ICD. Resource use with HM ON was clearly different: less FU visits (3.79 ± 1.67 vs. 5.53 ± 2.32; P < 0.001) despite a small increase of unscheduled visits (0.95 ± 1.50 vs. 0.62 ± 1.25; P < 0.005), more non-office-based contacts (1.95 ± 3.29 vs. 1.01 ± 2.64; P < 0.001), more Internet sessions (11.02 ± 15.28 vs. 0.06 ± 0.31; P < 0.001) and more in-clinic discussions (1.84 ± 4.20 vs. 1.28 ± 2.92; P < 0.03), but with numerically fewer hospitalizations (0.67 ± 1.18 vs. 0.85 ± 1.43, P = 0.23) and shorter length-of-stay (6.31 ± 15.5 vs. 8.26 ± 18.6; P = 0.27), although not significant. For the whole study population, the total FU cost for providers was not different for HM ON vs. OFF [mean (95% CI): €204 (169–238) vs. €213 (182–243); range for difference (€−36 to 54), NS]. From a payer perspective, FU-related costs were similar while the total cost per patient (including other physician visits, examinations, and hospitalizations) was numerically (but not significantly) lower. There was no difference in the net financial impact on providers [profit of €408 (327–489) vs. €400 (345–455); range for difference (€−104 to 88), NS], but there was heterogeneity among countries, with less profit for providers in the absence of specific remote FU reimbursement (Belgium, Spain, and the Netherlands) and maintained or increased profit in cases where such reimbursement exists (Germany and UK). Quality of life (SF-36) was not different. Conclusion For all the patients as a whole, FU-related costs for providers are not different for remote FU vs. purely in-office FU, despite reorganized care. However, disparity in the impact on provider budget among different countries illustrates the need for proper reimbursement to ensure effective remote FU implementation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Johan Vijgen
- Heart Center, Jessa Ziekenhuis, Hasselt, Belgium
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Ricci RP, Morichelli L, D'Onofrio A, Calò L, Vaccari D, Zanotto G, Curnis A, Buja G, Rovai N, Gargaro A. Manpower and outpatient clinic workload for remote monitoring of patients with cardiac implantable electronic devices: data from the HomeGuide Registry. J Cardiovasc Electrophysiol 2014; 25:1216-23. [PMID: 24964380 DOI: 10.1111/jce.12482] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/22/2014] [Accepted: 05/30/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to assess manpower and resource consumption of the HomeGuide workflow model for remote monitoring (Biotronik Home Monitoring [HM], Biotronik SE & Co. KG, Berlin, Germany) of cardiac implantable electronic devices in daily clinical practice. METHODS The model established a cooperative interaction between a reference nurse (RN) for ordinary management, and a responsible physician (RP) for medical decisions in each outpatient clinic. RN reviewed remote transmissions and alerts, addressing critical cases to the RP. RESULTS A total of 1,650 patients were enrolled in 75 sites: 25% pacemakers (PM), 22% dual-, 27% single-chamber implantable defibrillators (ICD), 2% PM with cardiac resynchronization therapy (CRT), and 24% ICD-CRT. During a median follow-up of 18 (10-31) months, 3,364 HM sessions were performed (74% by the RN, 26% by the RP) to complete 18,478 remote follow-ups. Median duration of remote follow-ups was 1.2 (0.6-2.0) minutes, corresponding to a manpower of 43.3 (4.2-94.8) minutes/month every 100 patients for nurses and 10.2 (0.1-31.1) for physicians (P < 0.0001). RN submitted 15% of remote transmissions to RP, who decided unscheduled follow-ups in 12% of the cases. The median manpower for phone calls was 1.9 (0.8-16.5) minutes/month every 100 contacted patients. There were 2.84 in-hospital visits/patient, 0.46 of which triggered by HM findings. A cumulative per-patient HM follow-up time of 15.4 minutes (20% of total follow-up time) allowed remote detection of 73% of actionable events. CONCLUSIONS HM implemented in the HomeGuide workflow model required <1 hour/month every 100 patients to detect the majority of actionable events with limited administrative workload.
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FREEDBERG NAHUMA, FELDMAN ALEXANDER. Remote Monitoring of Patients with Implantable Cardioverter Defibrillators (ICD): A Cute Gimmick or an Essential Tool for Clinical Excellence? J Cardiovasc Electrophysiol 2014; 25:771-3. [DOI: 10.1111/jce.12415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Boriani G, Diemberger I, Ziacchi M, Valzania C, Gardini B, Cimaglia P, Martignani C, Biffi M. AF burden is important - fact or fiction? Int J Clin Pract 2014; 68:444-52. [PMID: 24499075 DOI: 10.1111/ijcp.12326] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Asymptomatic atrial fibrillation (AF) is common and in view of its prognostic impact (the same as of clinically overt AF) knowledge of the overall AF burden (defined as the amount of time spent in AF) appears to be important, both for scientific and clinical reasons. Data collected on more than 12,000 patients indicate that cardiac implantable electrical devices (CIEDs) are validated tools for measuring AF burden and that AF burden is associated with an increased risk of stroke. A maximum daily AF burden of ≥ 1 h carries important negative prognostic implications and may be a clinically relevant parameter for improving risk stratification for stroke. Decision-making should primarily consider the context in which asymptomatic, subclinical arrhythmias are detected (i.e. primary or secondary prevention of stroke and systemic embolism) and the risk profile of every individual patient with regard to thromboembolic and haemorrhagic risk, as well as patient preferences and values. Continuous monitoring using CIEDs with extensive data storage capabilities allow in-depth study of the temporal relationship between AF and ischaemic stroke. The relationships between AF and stroke are complex. AF is certainly a risk factor for cardioembolic stroke, with a cause-effect relationship between the arrhythmia and a thromboembolic event, the latter being related to atrial thrombi. However, AF can also be a simple 'marker of risk', with a non-causal association between the arrhythmia and stroke, the latter being possibly related to atheroemboli from the aorta, the carotid arteries or from other sources.
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Affiliation(s)
- G Boriani
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
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Guédon-Moreau L, Lacroix D, Sadoul N, Clémenty J, Kouakam C, Hermida JS, Aliot E, Kacet S. Costs of remote monitoring vs. ambulatory follow-ups of implanted cardioverter defibrillators in the randomized ECOST study. Europace 2014; 16:1181-8. [PMID: 24614572 PMCID: PMC4114330 DOI: 10.1093/europace/euu012] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS The Effectiveness and Cost of ICD follow-up Schedule with Telecardiology (ECOST) trial evaluated prospectively the economic impact of long-term remote monitoring (RM) of implantable cardioverter defibrillators (ICDs). METHODS AND RESULTS The analysis included 310 patients randomly assigned to RM (active group) vs. ambulatory follow-ups (control group). Patients in the active group were seen once a year unless the system reported an event mandating an ambulatory visit, while patients in the control group were seen in the ambulatory department every 6 months. The costs of each follow-up strategy were compared, using the actual billing documents issued by the French health insurance system, including costs of (i) (a) ICD-related ambulatory visits and transportation, (b) other ambulatory visits, (c) cardiovascular treatments and procedures, and (ii) hospitalizations for the management of cardiovascular events. The ICD and RM system costs were calculated on the basis of the device remaining longevity at the end of the study. The characteristics of the study groups were similar. Over a follow-up of 27 months, the mean non-hospital costs per patient-year were €1695 ± 1131 in the active, vs. €1952 ± 1023 in the control group (P = 0.04), a €257 difference mainly due to device management. The hospitalization costs per patient-year were €2829 ± 6382 and €3549 ± 9714 in the active and control groups, respectively (P = 0.46). Adding the ICD to the non-hospital costs, the savings were €494 (P = 0.005) or, when the monitoring system was included, €315 (P = 0.05) per patient-year. CONCLUSION From the French health insurance perspective, the remote management of ICD patients is cost saving. CLINICAL TRIALS REGISTRATION NCT00989417, www.clinicaltrials.gov.
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Affiliation(s)
| | | | - Nicolas Sadoul
- Centre Hospitalier Universitaire Brabois, F-54500 Nancy, France
| | - Jacques Clémenty
- Centre Hospitalier Universitaire Haut-Lévêque, F-33064 Pessac, France
| | - Claude Kouakam
- Centre Hospitalier Régional Universitaire, F-59037 Lille, France
| | | | - Etienne Aliot
- Centre Hospitalier Universitaire Brabois, F-54500 Nancy, France
| | - Salem Kacet
- Centre Hospitalier Régional Universitaire, F-59037 Lille, France
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Morken IM, Norekvål TM, Bru E, Larsen AI, Karlsen B. Perceptions of healthcare professionals’ support, shock anxiety and device acceptance among implantable cardioverter defibrillator recipients. J Adv Nurs 2014; 70:2061-2071. [PMID: 24506575 DOI: 10.1111/jan.12364] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 09/13/2013] [Accepted: 01/11/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Ingvild M. Morken
- Department of Cardiology; Stavanger University Hospital; Norway
- Department of Health Studies; University of Stavanger; Norway
| | - Tone M. Norekvål
- Department of Heart Disease; Haukeland University Hospital; Bergen Norway
- Institute of Medicine; University of Bergen; Norway
| | - Edvin Bru
- Department of Health Studies; University of Stavanger; Norway
- Norwegian Centre for Learning Environment and Behavioural Research in Education; University of Stavanger; Norway
| | - Alf I. Larsen
- Department of Cardiology; Stavanger University Hospital; Norway
- Institute of Medicine; University of Bergen; Norway
| | - Bjørg Karlsen
- Department of Health Studies; University of Stavanger; Norway
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Norekvål TM, Peersen LRL, Seivaag K, Fridlund B, Wentzel-Larsen T. Temporal trend analysis of nurses' knowledge about implantable cardioverter defibrillators. Nurs Crit Care 2014; 20:146-54. [DOI: 10.1111/nicc.12075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 11/18/2013] [Accepted: 11/25/2013] [Indexed: 12/20/2022]
Affiliation(s)
- Tone M Norekvål
- Department of Heart Disease; Haukeland University Hospital and Faculty of Health and Social Sciences; Bergen University College; Bergen Norway
| | - Lene RL Peersen
- Department of Medicine, Section of Cardiology; Sørlandet Hospital; Kristiansand Norway
| | - Kirsten Seivaag
- Department of Medicine, Section of Cardiology; Sørlandet Hospital; Kristiansand Norway
| | - Bengt Fridlund
- Faculty of Health and Social Sciences; Bergen University College, Bergen, Norway and School of Health Sciences, Jönköping University; Jönköping Sweden
| | - Tore Wentzel-Larsen
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway; Centre for Child and Adolescent Mental Health, Eastern and Southern Norway and Norwegian Centre for Violence and Traumatic Stress Studies; Oslo Norway
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20
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Varma N, Auricchio A. Recommendations for post-implant monitoring of patients with cardiovascular implantable electronic devices: where do we stand today? Europace 2014; 15 Suppl 1:i11-i13. [PMID: 23737222 DOI: 10.1093/europace/eut115] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Niraj Varma
- Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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21
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Luzi M, De Simone A, Leoni L, Amellone C, Pisanò E, Favale S, Iacoviello M, Luise R, Bongiorni MG, Stabile G, La Rocca V, Folino F, Capucci A, D'Onofrio A, Accardi F, Valsecchi S, Buia G. Remote monitoring for implantable defibrillators: a nationwide survey in Italy. Interact J Med Res 2013; 2:e27. [PMID: 24055720 PMCID: PMC3786126 DOI: 10.2196/ijmr.2824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 08/01/2013] [Accepted: 08/09/2013] [Indexed: 11/13/2022] Open
Abstract
Background Remote monitoring (RM) permits home interrogation of implantable cardioverter defibrillator (ICD) and provides an alternative option to frequent in-person visits. Objective The Italia-RM survey aimed to investigate the current practice of ICD follow-up in Italy and to evaluate the adoption and routine use of RM. Methods An ad hoc questionnaire on RM adoption and resource use during in-clinic and remote follow-up sessions was completed in 206 Italian implanting centers. Results The frequency of routine in-clinic ICD visits was 2 per year in 158/206 (76.7%) centers, 3 per year in 37/206 (18.0%) centers, and 4 per year in 10/206 (4.9%) centers. Follow-up examinations were performed by a cardiologist in 203/206 (98.5%) centers, and by more than one health care worker in 184/206 (89.3%) centers. There were 137/206 (66.5%) responding centers that had already adopted an RM system, the proportion of ICD patients remotely monitored being 15% for single- and dual-chamber ICD and 20% for cardiac resynchronization therapy ICD. Remote ICD interrogations were scheduled every 3 months, and were performed by a cardiologist in 124/137 (90.5%) centers. After the adoption of RM, the mean time between in-clinic visits increased from 5 (SD 1) to 8 (SD 3) months (P<.001). Conclusions In current clinical practice, in-clinic ICD follow-up visits consume a large amount of health care resources. The results of this survey show that RM has only partially been adopted in Italy and, although many centers have begun to implement RM in their clinical practice, the majority of their patients continue to be routinely followed-up by means of in-clinic visits.
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Affiliation(s)
- Mario Luzi
- Azienda Ospedaliero Universitaria Ospedali Riuniti, Cardiology Clinic, Ancona, Italy.
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22
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Morken IM, Bru E, Norekvål TM, Larsen AI, Idsoe T, Karlsen B. Perceived support from healthcare professionals, shock anxiety and post-traumatic stress in implantable cardioverter defibrillator recipients. J Clin Nurs 2013; 23:450-60. [DOI: 10.1111/jocn.12200] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2012] [Indexed: 12/19/2022]
Affiliation(s)
- Ingvild M Morken
- Department of Cardiology; Stavanger University Hospital; Stavanger Norway
- Department of Health Studies; University of Stavanger; Stavanger Norway
| | - Edvin Bru
- Department of Health Studies; University of Stavanger; Stavanger Norway
- Centre for Behavioural Research; University of Stavanger; Stavanger Norway
| | - Tone M Norekvål
- Department of Heart Disease; Haukeland University Hospital; Bergen Norway
- Institute of Medicine; University of Bergen; Bergen Norway
| | - Alf I Larsen
- Department of Cardiology; Stavanger University Hospital; Stavanger Norway
- Institute of Medicine; University of Bergen; Bergen Norway
| | - Thormod Idsoe
- Centre for Behavioural Research; University of Stavanger; Stavanger Norway
- Norwegian
Institute of Public Health; Oslo Norway
| | - Bjørg Karlsen
- Department of Health Studies; University of Stavanger; Stavanger Norway
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23
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Boriani G, Da Costa A, Ricci RP, Quesada A, Favale S, Iacopino S, Romeo F, Risi A, Mangoni di S Stefano L, Navarro X, Biffi M, Santini M, Burri H. The MOnitoring Resynchronization dEvices and CARdiac patiEnts (MORE-CARE) randomized controlled trial: phase 1 results on dynamics of early intervention with remote monitoring. J Med Internet Res 2013; 15:e167. [PMID: 23965236 PMCID: PMC3758044 DOI: 10.2196/jmir.2608] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 05/20/2013] [Accepted: 06/09/2013] [Indexed: 11/13/2022] Open
Abstract
Background Remote monitoring (RM) in patients with advanced heart failure and cardiac resynchronization therapy defibrillators (CRT-D) may reduce delays in clinical decisions by transmitting automatic alerts. However, this strategy has never been tested specifically in this patient population, with alerts for lung fluid overload, and in a European setting. Objective The main objective of Phase 1 (presented here) is to evaluate if RM strategy is able to reduce time from device-detected events to clinical decisions. Methods In this multicenter randomized controlled trial, patients with moderate to severe heart failure implanted with CRT-D devices were randomized to a Remote group (with remote follow-up and wireless automatic alerts) or to a Control group (with standard follow-up without alerts). The primary endpoint of Phase 1 was the delay between an alert event and clinical decisions related to the event in the first 154 enrolled patients followed for 1 year. Results The median delay from device-detected events to clinical decisions was considerably shorter in the Remote group compared to the Control group: 2 (25th-75th percentile, 1-4) days vs 29 (25th-75th percentile, 3-51) days respectively, P=.004. In-hospital visits were reduced in the Remote group (2.0 visits/patient/year vs 3.2 visits/patient/year in the Control group, 37.5% relative reduction, P<.001). Automatic alerts were successfully transmitted in 93% of events occurring outside the hospital in the Remote group. The annual rate of all-cause hospitalizations per patient did not differ between the two groups (P=.65). Conclusions RM in CRT-D patients with advanced heart failure allows physicians to promptly react to clinically relevant automatic alerts and significantly reduces the burden of in-hospital visits. Trial Registration Clinicaltrials.gov NCT00885677; http://clinicaltrials.gov/show/NCT00885677 (Archived by WebCite at http://www.webcitation.org/6IkcCJ7NF).
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Affiliation(s)
- Giuseppe Boriani
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S Orsola-Malpighi University Hospital, Bologna, Italy.
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Cronin EM, Varma N. Remote monitoring of cardiovascular implanted electronic devices: a paradigm shift for the 21st century. Expert Rev Med Devices 2013; 9:367-76. [PMID: 22905841 DOI: 10.1586/erd.12.18] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Traditional follow-up of cardiac implantable electronic devices involves the intermittent download of largely nonactionable data. Remote monitoring represents a paradigm shift from episodic office-based follow-up to continuous monitoring of device performance and patient and disease state. This lessens device clinical burden and may also lead to cost savings, although data on economic impact are only beginning to emerge. Remote monitoring technology has the potential to improve the outcomes through earlier detection of arrhythmias and compromised device integrity, and possibly predict heart failure hospitalizations through integration of heart failure diagnostics and hemodynamic monitors. Remote monitoring platforms are also huge databases of patients and devices, offering unprecedented opportunities to investigate real-world outcomes. Here, the current status of the field is described and future directions are predicted.
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Affiliation(s)
- Edmond M Cronin
- Department of Cardiovascular Medicine, Section of Electrophysiology and Pacing, Cleveland Clinic, J2-2, 9500 Euclid Avenue, Cleveland, OH 44106, USA.
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Marinskis G, van Erven L, Bongiorni MG, Lip GYH, Pison L, Blomström-Lundqvist C. Practices of cardiac implantable electronic device follow-up: results of the European Heart Rhythm Association survey. Europace 2012; 14:423-5. [PMID: 22355191 DOI: 10.1093/europace/eus020] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This survey analyses some details of follow-up of patients with cardiac implantable electronic devices (CIEDs) in 40 centres-the members of the European Heart Rhythm Association (EHRA) research network. Results of this survey show that practices of CIED follow-up are not homogeneous between EHRA research network centres, and recommended clinical evaluation of the patients regarding possible device up-grade is not always performed. Remote device monitoring appears to be an evolving practice, mostly used in implantable cardioverter defibrillators and cardiac resynchronization therapy defibrillator recipients.
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Affiliation(s)
- Germanas Marinskis
- Clinic of Heart Diseases, Vilnius University Hospital Santariškių klinikos, Vilnius University, Vilnius, Lithuania.
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Landolina M, Perego GB, Lunati M, Curnis A, Guenzati G, Vicentini A, Parati G, Borghi G, Zanaboni P, Valsecchi S, Marzegalli M. Remote monitoring reduces healthcare use and improves quality of care in heart failure patients with implantable defibrillators: the evolution of management strategies of heart failure patients with implantable defibrillators (EVOLVO) study. Circulation 2012; 125:2985-92. [PMID: 22626743 DOI: 10.1161/circulationaha.111.088971] [Citation(s) in RCA: 248] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Heart failure patients with implantable cardioverter-defibrillators (ICDs) or an ICD for resynchronization therapy often visit the hospital for unscheduled examinations, placing a great burden on healthcare providers. We hypothesized that Internet-based remote interrogation systems could reduce emergency healthcare visits. METHODS AND RESULTS This multicenter randomized trial involving 200 patients compared remote monitoring with standard patient management consisting of scheduled visits and patient response to audible ICD alerts. The primary end point was the rate of emergency department or urgent in-office visits for heart failure, arrhythmias, or ICD-related events. Over 16 months, such visits were 35% less frequent in the remote arm (75 versus 117; incidence density, 0.59 versus 0.93 events per year; P=0.005). A 21% difference was observed in the rates of total healthcare visits for heart failure, arrhythmias, or ICD-related events (4.40 versus 5.74 events per year; P<0.001). The time from an ICD alert condition to review of the data was reduced from 24.8 days in the standard arm to 1.4 days in the remote arm (P<0.001). The patients' clinical status, as measured by the Clinical Composite Score, was similar in the 2 groups, whereas a more favorable change in quality of life (Minnesota Living With Heart Failure Questionnaire) was observed from the baseline to the 16th month in the remote arm (P=0.026). CONCLUSIONS Remote monitoring reduces emergency department/urgent in-office visits and, in general, total healthcare use in patients with ICD or defibrillators for resynchronization therapy. Compared with standard follow-up through in-office visits and audible ICD alerts, remote monitoring results in increased efficiency for healthcare providers and improved quality of care for patients. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00873899.
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Affiliation(s)
- Maurizio Landolina
- Dipartimento di Cardiologia, Fondazione IRCCS Policlinico San Matteo, P. le Golgi 2, 27100, Pavia, Italy
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Ricci RP, D'Onofrio A, Padeletti L, Sagone A, Vicentini A, Vincenti A, Morichelli L, Cavallaro C, Ricciardi G, Lombardi L, Fusco A, Rovaris G, Silvestri P, Guidotto T, Pollastrelli A, Santini M. Rationale and design of the health economics evaluation registry for remote follow-up: TARIFF. Europace 2012; 14:1661-5. [PMID: 22544910 PMCID: PMC3482620 DOI: 10.1093/europace/eus093] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Aims The aims of the study are to develop a cost-minimization analysis from the hospital perspective and a cost-effectiveness analysis from the third payer standpoint, based on direct estimates of costs and QOL associated with remote follow-ups, using Merlin@home and Merlin.net, compared with standard ambulatory follow-ups, in the management of ICD and CRT-D recipients. Methods and results Remote monitoring systems can replace ambulatory follow-ups, sparing human and economic resources, and increasing patient safety. TARIFF is a prospective, controlled, observational study aimed at measuring the direct and indirect costs and quality of life (QOL) of all participants by a 1-year economic evaluation. A detailed set of hospitalized and ambulatory healthcare costs and losses of productivity that could be directly influenced by the different means of follow-ups will be collected. The study consists of two phases, each including 100 patients, to measure the economic resources consumed during the first phase, associated with standard ambulatory follow-ups, vs. the second phase, associated with remote follow-ups. Conclusion Remote monitoring systems enable caregivers to better ensure patient safety and the healthcare to limit costs. TARIFF will allow defining the economic value of remote ICD follow-ups for Italian hospitals, third payers, and patients. The TARIFF study, based on a cost-minimization analysis, directly comparing remote follow-up with standard ambulatory visits, will validate the cost effectiveness of the Merlin.net technology, and define a proper reimbursement schedule applicable for the Italian healthcare system. Trial registration: NCT01075516.
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Affiliation(s)
- Renato P Ricci
- Department of Cardiology, San Filippo Neri Hospital, Via Martinotti 20, 00135 Rome, Italy.
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