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García-Fernández FJ, Calvo Simal S, Cano Pérez Ó, Calvo Cuervo D, Pombo Jiménez M, Fernández Lozano I, Villagraz Tercedor L, Fernández Palacios G, Martín González J. Impact of the COVID-19 pandemic on implantation of cardiac implantable electronic devices and remote monitoring activations. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:243-253. [PMID: 37516312 DOI: 10.1016/j.rec.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/07/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION AND OBJECTIVES Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is considered more reliable, efficient, and safer than conventional in-person follow-up. However, the implementation of RM is still suboptimal. This study aimed to analyze the impact of the COVID-19 pandemic on the rates of CIED implants and RM activations in Spain. METHODS The COVID-19 RM Spain Registry was used to analyze the monthly number of all CIED implantations and RM activations from January 2018 to December 2021. A descriptive analysis was performed using aggregated data from the five major CIED manufacturers. RESULTS A total of 205 345 CIEDs were recorded. The number of implants decreased sharply (48.2%) during the pandemic lockdown (March-June 2020) but gradually increased thereafter, compensating for the previous reduction. However, pacemakers and implantable cardiac defibrillators (ICD) showed an aggregate loss of 7% and 3%, respectively, from the annual average during 2020-2021. In contrast, cardiac resynchronization therapy defibrillators (CRT-D) increased by 17%, and pacemakers (CRT-P) by 4.5% over the 2-year period. The percentage of RM activations increased from 24.5% in 2018 to 49.0% in 2021, with a sharp increase during the lockdown. The RM activation rates consistently increased during the lockdown for all devices: pacemakers (14.4% vs 37.2%; P <.001); ICD (75.6% vs 94.2%; P <.001); CRT-D/CRT-P (68.6-44.2% vs 81.6-61%; P <.001), and implantable loop recorders (50.2% vs 68.7%; P <.001). CONCLUSIONS The significant decline in implants during the lockdown gradually recovered, except for pacemakers and ICD. However, the COVID-19 pandemic boosted RM for all CIEDs in Spain.
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Affiliation(s)
- F J García-Fernández
- Unidad de Arritmias, Servicio de Cardiología., Hospital Universitario de Burgos, Burgos, Spain.
| | - Sara Calvo Simal
- Unidad de Investigación, Fundación Burgos por las Ciencias de la Salud, Universidad de Burgos, Burgos, Spain
| | - Óscar Cano Pérez
- Unidad de Arritmias, área de Enfermedades Cardiovasculares, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - David Calvo Cuervo
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - Marta Pombo Jiménez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Ignacio Fernández Lozano
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Lola Villagraz Tercedor
- Unidad de Arritmias, Servicio de Cardiología., Hospital Universitario de Burgos, Burgos, Spain
| | | | - Javier Martín González
- Unidad de Arritmias, Servicio de Cardiología., Hospital Universitario de Burgos, Burgos, Spain
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2
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Mette C, Prost D, Baud J, Taieb J, Marijon E, Piot O. Paramedics and remote monitoring of cardiac implantable electronic devices in France. Arch Cardiovasc Dis 2024; 117:117-118. [PMID: 38087663 DOI: 10.1016/j.acvd.2023.10.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/17/2023] [Indexed: 02/20/2024]
Affiliation(s)
- Carole Mette
- Centre cardiologique du Nord, 32-36, rue des Moulins Gémeaux, 93200 Saint-Denis, France
| | - Diane Prost
- Cardiology, centre hospitalier du Pays d'Aix, 13100 Aix-en-Provence, France
| | - Julien Baud
- Cardiology, hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Jerome Taieb
- Cardiology, centre hospitalier du Pays d'Aix, 13100 Aix-en-Provence, France
| | - Eloi Marijon
- Cardiology, hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Olivier Piot
- Centre cardiologique du Nord, 32-36, rue des Moulins Gémeaux, 93200 Saint-Denis, France.
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3
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Svennberg E, Caiani EG, Bruining N, Desteghe L, Han JK, Narayan SM, Rademakers FE, Sanders P, Duncker D. The digital journey: 25 years of digital development in electrophysiology from an Europace perspective. Europace 2023; 25:euad176. [PMID: 37622574 PMCID: PMC10450797 DOI: 10.1093/europace/euad176] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 08/26/2023] Open
Abstract
AIMS Over the past 25 years there has been a substantial development in the field of digital electrophysiology (EP) and in parallel a substantial increase in publications on digital cardiology.In this celebratory paper, we provide an overview of the digital field by highlighting publications from the field focusing on the EP Europace journal. RESULTS In this journey across the past quarter of a century we follow the development of digital tools commonly used in the clinic spanning from the initiation of digital clinics through the early days of telemonitoring, to wearables, mobile applications, and the use of fully virtual clinics. We then provide a chronicle of the field of artificial intelligence, a regulatory perspective, and at the end of our journey provide a future outlook for digital EP. CONCLUSION Over the past 25 years Europace has published a substantial number of papers on digital EP, with a marked expansion in digital publications in recent years.
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Affiliation(s)
- Emma Svennberg
- Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden
| | - Enrico G Caiani
- Politecnico di Milano, Electronic, Information and Biomedical Engineering Department, Milan, Italy
- Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Nico Bruining
- Department of Clinical and Experimental Information processing (Digital Cardiology), Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Lien Desteghe
- Research Group Cardiovascular Diseases, University of Antwerp, 2000 Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, 2056 Edegem, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium
| | - Janet K Han
- Division of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Cardiac Arrhythmia Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Sanjiv M Narayan
- Cardiology Division, Cardiovascular Institute and Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 5005 Adelaide, Australia
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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4
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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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Brunetti ND, Curcio A, Nodari S, Parati G, Carugo S, Molinari M, Acquistapace F, Gensini G, Molinari G. The Italian Society of Cardiology and Working Group on Telecardiology and Informatics 2023 updated position paper on telemedicine and artificial intelligence in cardiovascular disease. J Cardiovasc Med (Hagerstown) 2023; 24:e168-e177. [PMID: 37186567 DOI: 10.2459/jcm.0000000000001447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
In 2015, the Italian Society of Cardiology and its Working Group on Telemedicine and Informatics issued a position paper on Telecardiology, resuming the most eminent evidence supporting the use of information and communication technology in principal areas of cardiovascular care, ranked by level of evidence. More than 5 years later and after the global shock inflicted by the SARS-CoV-2 pandemic, an update on the topic is warranted. Recent evidence and studies on principal areas of cardiovascular disease will be therefore reported and discussed, with particular focus on telemedicine for cardiovascular care in the COVID-19 context. Novel perspectives and opportunities disclosed by artificial intelligence and its applications in cardiovascular disease will also be discussed. Finally, modalities by which machine learning have realized remote patient monitoring and long-term care in recent years, mainly filtering critical clinical data requiring selective hospital admission, will be provided.
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Affiliation(s)
- Natale D Brunetti
- Division of Cardiology, Department of Medical & Surgical Sciences, University of Foggia, Foggia
| | - Antonio Curcio
- Division of Cardiology, Department of Medical and Surgical Sciences, University 'Magna Graecia' of Catanzaro, Catanzaro
| | - Savina Nodari
- Dept. of Medical and Surgical Specialities, Radiological Sciences and Public Health-University of Brescia Medical School
- University of Brescia Medical School, Brescia
| | | | - Stefano Carugo
- Department of Clinical Sciences and Community Health
- Cardiology Unit, Dept. of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore, University of Milan, Milan
| | - Martina Molinari
- Department of Cardiology, Ospedale 'P.A. Micone', ASL 3 Genovese, Genoa, Italy
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6
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Mette C, Prost D, Baud J, Taieb J, Marijon E, Piot O. Survey on the paramedical role in the remote monitoring of cardiac implantable electronic devices in France. Ann Cardiol Angeiol (Paris) 2023; 72:101599. [PMID: 37060874 DOI: 10.1016/j.ancard.2023.101599] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 04/17/2023]
Abstract
Remote monitoring of cardiac implantable electronic devices (CIEDs) has become an expansive priority in many European countries, with nurses playing a central role in it. In France, a national survey for paramedics was set up to assess the organization of remote monitoring in the different institutions and to determine the paramedical role. A self-administered questionnaire (supplementary material), developed and validated by the College of Paramedics in partnership with the Working Group of Pacing and Electrophysiology of the French Society of Cardiology (SFC).
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Affiliation(s)
- Carole Mette
- Centre Cardiologique du Nord, Saint Denis, France
| | - Diane Prost
- Cardiologie, Centre Hospitalier du Pays d'Aix, Aix en Provence, France
| | - Julien Baud
- Cardiologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Jerome Taieb
- Cardiologie, Centre Hospitalier du Pays d'Aix, Aix en Provence, France
| | - Eloi Marijon
- Cardiologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Olivier Piot
- Centre Cardiologique du Nord, Saint Denis, France.
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7
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Guasti L, Dilaveris P, Mamas MA, Richter D, Christodorescu R, Lumens J, Schuuring MJ, Carugo S, Afilalo J, Ferrini M, Asteggiano R, Cowie MR. Digital health in older adults for the prevention and management of cardiovascular diseases and frailty. A clinical consensus statement from the ESC Council for Cardiology Practice/Taskforce on Geriatric Cardiology, the ESC Digital Health Committee and the ESC Working Group on e-Cardiology. ESC Heart Fail 2022; 9:2808-2822. [PMID: 35818770 PMCID: PMC9715874 DOI: 10.1002/ehf2.14022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/04/2022] [Accepted: 06/03/2022] [Indexed: 12/14/2022] Open
Abstract
Digital health technology is receiving increasing attention in cardiology. The rise of accessibility of digital health tools including wearable technologies and smart phone applications used in medical practice has created a new era in healthcare. The coronavirus pandemic has provided a new impetus for changes in delivering medical assistance across the world. This Consensus document discusses the potential implementation of digital health technology in older adults, suggesting a practical approach to general cardiologists working in an ambulatory outpatient clinic, highlighting the potential benefit and challenges of digital health in older patients with, or at risk of, cardiovascular disease. Advancing age may lead to a progressive loss of independence, to frailty, and to increasing degrees of disability. In geriatric cardiology, digital health technology may serve as an additional tool both in cardiovascular prevention and treatment that may help by (i) supporting self-caring patients with cardiovascular disease to maintain their independence and improve the management of their cardiovascular disease and (ii) improving the prevention, detection, and management of frailty and supporting collaboration with caregivers. Digital health technology has the potential to be useful for every field of cardiology, but notably in an office-based setting with frequent contact with ambulatory older adults who may be pre-frail or frail but who are still able to live at home. Cardiologists and other healthcare professionals should increase their digital health skills and learn how best to apply and integrate new technologies into daily practice and how to engage older people and their caregivers in a tailored programme of care.
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Affiliation(s)
- Luigina Guasti
- University of Insubria ‐ Department of Medicine and Surgery; ASST‐settelaghiVareseItaly
| | - Polychronis Dilaveris
- First Department of Cardiology, Hippokration HospitalNational and Kapodistrian University of AthensAthensGreece
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis ResearchKeele UniversityKeeleUK
| | | | | | - Joost Lumens
- CARIM School for Cardiovascular DiseasesMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Mark J. Schuuring
- Department of Cardiology, Amsterdam UMC location AMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Stefano Carugo
- University of Milan, Cardiology, Policlinico di MilanoMilanItaly
| | - Jonathan Afilalo
- Division of Experimental Medicine, McGill University; Centre for Clinical Epidemiology, Jewish General Hospital; Division of Cardiology, Jewish General Hospital, McGill University; Research InstituteMcGill University Health CentreMontrealQuebecCanada
| | | | - Riccardo Asteggiano
- University of Insubria ‐ Department of Medicine and Surgery; ASST‐settelaghiVareseItaly
- LARC (Laboratorio Analisi e Ricerca Clinica)TurinItaly
| | - Martin R. Cowie
- Royal Brompton Hospital (Guy's& St Thomas' NHS Foundation Trust) & Faculty of Lifesciences & MedicineKing's College LondonLondonUK
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8
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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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9
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Lopez-Villegas A, Leal-Costa C, Perez-Heredia M, Villegas-Tripiana I, Catalán-Matamoros D. Knowledge Update on the Economic Evaluation of Pacemaker Telemonitoring Systems. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212120. [PMID: 34831876 PMCID: PMC8624333 DOI: 10.3390/ijerph182212120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/16/2022]
Abstract
(1) Introduction: In the last two decades, telemedicine has been increasingly applied to telemonitoring (TM) of patients with pacemakers; however, presently, its growth has significantly accelerated because of the COVID-19 pandemic, which has pushed patients and healthcare workers alike to seek new ways to stay healthy with minimal physical contact. Therefore, the main objective of this study was to update the current knowledge on the differences in the medium-and long-term effectiveness of TM and conventional monitoring (CM) in relation to costs and health outcomes. (2) Methods: Three databases and one scientific registry were searched (PubMed, EMBASE, Scopus, and Google Scholar), with no restrictions on language or year of publication. Studies published until July 2021 were included. The inclusion criteria were: (a) experimental or observational design, (b) complete economic evaluation, (c) patients with implanted pacemakers, and (d) comparison of TM with CM. Measurements of study characteristics (author, study duration, sample size, age, sex, major indication for implantation, and pacemaker used), analysis, significant results of the variables (analysis performed, primary endpoints, secondary endpoints, health outcomes, and cost outcomes), and further miscellaneous measurements (methodological quality, variables coded, instrument development, coder training, and intercoder reliability, etc.) were included. (3) Results: 11 studies met the inclusion criteria, consisting of 3372 enrolled patients; 1773 (52.58%) of them were part of randomized clinical trials. The mean age was 72 years, and the atrioventricular block was established as the main indication for device implantation. TM was significantly effective in detecting the presence or absence of pacemaker problems, leading to a reduction in the number of unscheduled hospital visits (8.34-55.55%). The cost of TM was up to 87% lower than that of CM. There were no significant differences in health-related quality of life (HRQoL) and the number of cardiovascular events. (4) Conclusions: Most of the studies included in this systematic review confirm that in the TM group of patients with pacemakers, cardiovascular events are detected and treated earlier, and the number of unscheduled visits to the hospital is significantly reduced, without affecting the HRQoL of patients. In addition, with TM modality, both formal and informal costs are significantly reduced in the medium and long term.
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Affiliation(s)
- Antonio Lopez-Villegas
- Social Involvement of Critical and Emergency Medicine, CTS-609 Research Group, Poniente Hospital, 04700 El Ejido-Almería, Spain;
| | - César Leal-Costa
- Nursing Department, University of Murcia, 30120 Murcia, Spain
- Correspondence: ; Tel.: +34-868-889-771
| | - Mercedes Perez-Heredia
- Research Management Department, Primary Care District Poniente of Almería, 04700 El Ejido-Almería, Spain;
| | | | - Daniel Catalán-Matamoros
- UC3M MediaLab, Department of Communication and Media Studies, Madrid University Carlos III, 28903 Madrid, Spain;
- Health Sciences Research Institute, University of Almería, 04120 Almería, Spain
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10
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Ploux S, Strik M, Varma N, Eschalier R, Bordachar P. Remote monitoring of pacemakers. Arch Cardiovasc Dis 2021; 114:588-597. [PMID: 34561150 DOI: 10.1016/j.acvd.2021.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/17/2022]
Abstract
Exactly two decades have elapsed since pacemakers first provided automatic remote monitoring. This innovation has been well received by patients. However, there is still a widely held perception that remote monitoring of pacemakers is non-essential, despite the very similar gains that are achieved compared with remote monitoring of implantable cardioverter defibrillators. Reducing in-office evaluations and overall staff workload is important when these resources are stretched to their limits. The early detection ability provided by remote monitoring facilitates device management (extending battery longevity) and the ability to exercise vigilance over recalled components. Clinical complications, such as arrhythmic events, are also detected earlier. Remote monitoring has been shown to produce similar reductions in the risk of all-cause hospitalization and death for pacemakers and implantable cardioverter defibrillators in a mega-cohort observational study. This review is an evidence-based plea for the recognition and systematic implementation of remote monitoring for pacemakers.
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Affiliation(s)
- Sylvain Ploux
- Electrophysiology and Heart Modelling Institute (IHU-LIRYC), Fondation Bordeaux Université, 33600 Pessac, France; Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), 33600 Pessac, France.
| | - Marc Strik
- Electrophysiology and Heart Modelling Institute (IHU-LIRYC), Fondation Bordeaux Université, 33600 Pessac, France; Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), 33600 Pessac, France
| | - Niraj Varma
- Cleveland Clinic, 44195 Cleveland, Ohio, USA
| | - Romain Eschalier
- UMR6284, Cardio-Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), Clermont Université, Université d'Auvergne, 63001 Clermont-Ferrand, France; Cardiology department, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - Pierre Bordachar
- Electrophysiology and Heart Modelling Institute (IHU-LIRYC), Fondation Bordeaux Université, 33600 Pessac, France; Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), 33600 Pessac, France
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11
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Ogawa T, Saito N, Fukuzawa K, Kiuchi K, Takami M, Hayashi M, Tanioka R, Ota M, Komoriya K, Miyawaki I, Hirata KI. Device nurse intervention facilitates the patients' adaptation to cardiac shock devices in the remote monitoring era. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1874-1883. [PMID: 34455601 DOI: 10.1111/pace.14348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/10/2021] [Accepted: 08/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND A substantial number of patients with shock devices (implantable cardioverter defibrillators [ICDs] or ICDs with resynchronization [CRTDs]) experience psychological distress. OBJECTIVE We investigated the device nurse telephone intervention's effect on improving the patient's adaptation to shock devices, quality of life (QOL), and anxiety in the remote monitoring era. METHODS The patient's adaptation to the device, health-related QOL, and anxiety were investigated by the modified Implanted Devices Adjustment-Japan score (IDAS), Short Form-36, and State-Trait Anxiety Inventory (STAI) before and 1-year after the device nurse telephone intervention, performed every 3 months. A total of 95 patients (median age 69 years and 25 females) participated. Sixty patients had ICDs and 35 CRTDs. Structural heart disease was observed in 72 patients, and idiopathic ventricular arrhythmias in the others. The mean left ventricular ejection fraction was 46% ± 15%. The median duration since the device implantation was 5.2 years. RESULTS The total IDAS score significantly improved from 28.42 ± 7.11 at baseline to 26.77 ± 7.68 (p = 0.0076) at 1 year. Both the state and trait anxiety significantly improved (from 38.9 ± 9.6 to 35.3 ± 9.0 [<0.0001] and 38.8 ± 10.3 to 36.2±9.8 [p = 0.0044], respectively). The prevalence of patients with a state and trait anxiety of more than 40 decreased from 44 (46%) and 38 (40%) patients before the study to 27 (28 %) and 32 (34 %) at 1 year. The SF-36 mental component summary score significantly increased (50.8 ± 8.3 at baseline to 53.1 ± 7.7 at 1 year, p = 0.0031). CONCLUSIONS The device nurse intervention facilitated the patient's adaptation to the shock device, increased the health-related QOL, and reduced the patient's anxiety.
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Affiliation(s)
- Tomomi Ogawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nao Saito
- School of Nursing, Miyagi University, Miyagi, Japan
| | - Koji Fukuzawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kunihiko Kiuchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mitsuru Takami
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Megumi Hayashi
- Department of Nursing, Kobe University Hospital, Kobe, Japan
| | - Ryo Tanioka
- Department of Clinical Engineer, Kobe University Hospital, Kobe, Japan
| | | | | | - Ikuko Miyawaki
- Department of Nursing, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Nielsen JC, Kautzner J, Casado-Arroyo R, Burri H, Callens S, Cowie MR, Dickstein K, Drossart I, Geneste G, Erkin Z, Hyafil F, Kraus A, Kutyifa V, Marin E, Schulze C, Slotwiner D, Stein K, Zanero S, Heidbuchel H, Fraser AG. Remote monitoring of cardiac implanted electronic devices: legal requirements and ethical principles - ESC Regulatory Affairs Committee/EHRA joint task force report. Europace 2021; 22:1742-1758. [PMID: 32725140 DOI: 10.1093/europace/euaa168] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/25/2020] [Indexed: 11/13/2022] Open
Abstract
The European Union (EU) General Data Protection Regulation (GDPR) imposes legal responsibilities concerning the collection and processing of personal information from individuals who live in the EU. It has particular implications for the remote monitoring of cardiac implantable electronic devices (CIEDs). This report from a joint Task Force of the European Heart Rhythm Association and the Regulatory Affairs Committee of the European Society of Cardiology (ESC) recommends a common legal interpretation of the GDPR. Manufacturers and hospitals should be designated as joint controllers of the data collected by remote monitoring (depending upon the system architecture) and they should have a mutual contract in place that defines their respective roles; a generic template is proposed. Alternatively, they may be two independent controllers. Self-employed cardiologists also are data controllers. Third-party providers of monitoring platforms may act as data processors. Manufacturers should always collect and process the minimum amount of identifiable data necessary, and wherever feasible have access only to pseudonymized data. Cybersecurity vulnerabilities have been reported concerning the security of transmission of data between a patient's device and the transceiver, so manufacturers should use secure communication protocols. Patients need to be informed how their remotely monitored data will be handled and used, and their informed consent should be sought before their device is implanted. Review of consent forms in current use revealed great variability in length and content, and sometimes very technical language; therefore, a standard information sheet and generic consent form are proposed. Cardiologists who care for patients with CIEDs that are remotely monitored should be aware of these issues.
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Affiliation(s)
- Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague and Palacky University Medical School, Olomouc, Czech Republic
| | - Ruben Casado-Arroyo
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Service, University Hospital of Geneva, Geneva, Switzerland
| | - Stefaan Callens
- Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | - Martin R Cowie
- Imperial College London (Royal Brompton Hospital) & National Heart and Lung Institute, Dovehouse Street, London SW3 6LY, UK
| | - Kenneth Dickstein
- University of Bergen, Stavanger University Hospital, Stavanger, Norway
| | | | - Ginger Geneste
- Cyber Security Group, Delft University of Technology, Delft, The Netherlands
| | - Zekeriya Erkin
- Cyber Security Group, Delft University of Technology, Delft, The Netherlands
| | - Fabien Hyafil
- Départment Médico-Universitaire DREAM, Bichat University Hospital, APHP.7, Inserm 1148, Université de Paris, Paris, France
| | | | - Valentina Kutyifa
- University of Rochester Medical Center, Clinical Cardiovascular Research Center, Rochester, NY, USA
| | - Eduard Marin
- School of Computer Science, University of Birmingham, Birmingham, UK.,Telefonica Research, Spain
| | - Christian Schulze
- Division of Cardiology, Angiology, Pneumonology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Am Klinikum 1, Jena, Germany
| | - David Slotwiner
- Division of Cardiology, New York Presbyterian Queens and School of Health Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | | | - Stefano Zanero
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Hein Heidbuchel
- Department of Cardiology, UniversityHospital Antwerp, University of Antwerp, Antwerp, Belgium
| | - Alan G Fraser
- School of Medicine, Cardiff University, Cardiff, UK.,Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
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13
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Iacopino S, Placentino F, Colella J, Pesce F, Pardeo A, Filannino P, Artale P, Desiro D, Sorrenti P, Campagna G, Fabiano G, Peluso G, Giacopelli D, Petretta A. Remote monitoring of cardiac implantable devices during COVID-19 outbreak: "keep people safe" and "focus only on health care needs". Acta Cardiol 2021; 76:158-161. [PMID: 33203312 DOI: 10.1080/00015385.2020.1847459] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The COVID-19 pandemic has challenged the ability of health care organisations to provide adequate care. We report the experience of a national tertiary electrophysiology centre in the management of patients with cardiac implantable electronic devices (CIEDs) through the use of a fully remote follow-up model. METHODS We daily and prospectively collected remote monitoring (RM) relevant findings and following clinical actions performed from March 10th to April 3rd 2020, a period of suspension of routine ambulatory activity due to the national lockdown. RESULTS During the study period (25 days), we received 2,215 transmissions from 2,955 devices. Among them, 129 patients reported potential clinically actionable RM observations (event rate: 12.0/1000 patient-week). In 77 patients (60%), RM events triggered a clinical action, but only 5 patients needed an urgent in-hospital access (4 urgent procedures and 1 device reprogramming). CONCLUSIONS In the unprecedented COVID-19 pandemic, RM became an essential tool in healthcare delivery for CIED patients. We observed that RM was effective in "keep people safe" and "focus only on individuals with health care needs".
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Affiliation(s)
- Saverio Iacopino
- Arrhythnology Department, Maria Cecilia Hospital, Cotignola, Italy
| | | | - Jacopo Colella
- Arrhythnology Department, Maria Cecilia Hospital, Cotignola, Italy
| | - Francesca Pesce
- Arrhythnology Department, Maria Cecilia Hospital, Cotignola, Italy
| | - Antonino Pardeo
- Arrhythnology Department, Maria Cecilia Hospital, Cotignola, Italy
| | | | - Paolo Artale
- Arrhythnology Department, Maria Cecilia Hospital, Cotignola, Italy
| | - Dalila Desiro
- Arrhythnology Department, Maria Cecilia Hospital, Cotignola, Italy
| | - Paolo Sorrenti
- Arrhythnology Department, Maria Cecilia Hospital, Cotignola, Italy
| | | | - Gennaro Fabiano
- Arrhythnology Department, Maria Cecilia Hospital, Cotignola, Italy
| | - Gianluca Peluso
- Arrhythnology Department, Maria Cecilia Hospital, Cotignola, Italy
| | | | - Andrea Petretta
- Arrhythnology Department, Maria Cecilia Hospital, Cotignola, Italy
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14
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Singhal A, Cowie MR. Digital Health: Implications for Heart Failure Management. Card Fail Rev 2021; 7:e08. [PMID: 34035953 PMCID: PMC8135017 DOI: 10.15420/cfr.2020.28] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/29/2020] [Indexed: 12/24/2022] Open
Abstract
Digital health encompasses the use of information and communications technology and the use of advanced computing sciences in healthcare. This review covers the application of digital health in heart failure patients, focusing on teleconsultation, remote monitoring and apps and wearables, looking at how these technologies can be used to support care and improve outcomes. Interest in and use of these technologies, particularly teleconsultation, have been accelerated by the coronavirus disease 2019 pandemic. Remote monitoring of heart failure patients, to identify those patients at high risk of hospitalisation and to support clinical stability, has been studied with mixed results. Remote monitoring of pulmonary artery pressure has a consistent effect on reducing hospitalisation rates for patients with moderately severe symptoms and multiparameter monitoring shows promise for the future. Wearable devices and apps are increasingly used by patients for health and lifestyle support. Some wearable technologies have shown promise in AF detection, and others may be useful in supporting self-care and guiding prognosis, but more evidence is required to guide their optimal use. Support for patients and clinicians wishing to use these technologies is important, along with consideration of data validity and privacy and appropriate recording of decision-making.
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Affiliation(s)
| | - Martin R Cowie
- Royal Brompton Hospital London, UK
- School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London London, UK
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15
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Mugnai G, Volpiana A, Cavedon S, Paolini C, Perrone C, Bilato C. Boosting telemedicine through remote monitoring of cardiac electronic devices during the Italian COVID-19 outbreak. Cardiol J 2021; 28:336-338. [PMID: 33634839 DOI: 10.5603/cj.a2021.0011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/13/2021] [Accepted: 01/23/2021] [Indexed: 01/10/2023] Open
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16
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Palmisano P, Melissano D, Zanotto G, Perego GB, Toselli T, Landolina M, Ricci RP. Change in the use of remote monitoring of cardiac implantable electronic devices in Italian clinical practice over a 5-year period: results of two surveys promoted by the AIAC (Italian Association of Arrhythmology and Cardiac Pacing). J Cardiovasc Med (Hagerstown) 2020; 21:305-314. [PMID: 32073430 DOI: 10.2459/jcm.0000000000000950] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to evaluate the use of remote monitoring in Italian clinical practice and its trend over the last 5 years. METHODS In 2012 and 2017, two surveys were conducted. Both were open to all Italian implanting centres and consisted of 25 questions on the characteristics of the centre, their actual use of remote monitoring, applied organizational models and administrative and legal aspects. RESULTS The questionnaires were completed by 132 and 108 centres in 2012 and 2017, respectively (30.6 and 24.7% of all Italian implanting centres). In 2017, significantly fewer centres followed up fewer than 200 patients by remote monitoring than in 2012, while more followed up more than 500 patients (all P < 0.005). In most of the centres (77.6%) that responded to both surveys, the number of patients remotely monitored significantly increased from 2012 to 2017.In both surveys, remote monitoring was usually managed by physicians and nurses. Over the period, primary review of transmissions by physicians declined, while it was increasingly performed by nurses; the involvement of technicians rose, while that of manufacturers' technical personnel decreased. The percentage of centres in which transmissions were submitted to the physician only in critical cases rose (from 28.3 to 64.3%; P < 0.001). In 86.7% of centres, the lack of a reimbursement system was deemed the main barrier to implementing remote monitoring. CONCLUSION In the last 5 years, the number of patients followed up by remote monitoring has increased markedly. In most Italian centres, remote monitoring has increasingly been managed through a primary nursing model. The lack of a specific reimbursement system is perceived as the main barrier to implementing remote monitoring .
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Affiliation(s)
| | | | | | - Giovanni Battista Perego
- Istituto Auxologico Italiano, IRCCS, Dipartimento di Scienze Cardiovascolari, Neurologiche, Metaboliche, Ospedale S. Luca, Milan
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17
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Das S, Siroky GP, Lee S, Mehta D, Suri R. Cybersecurity: The need for data and patient safety with cardiac implantable electronic devices. Heart Rhythm 2020; 18:473-481. [PMID: 33059076 PMCID: PMC7550052 DOI: 10.1016/j.hrthm.2020.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/20/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022]
Abstract
Remote monitoring of cardiac implantable electronic devices (CIEDs) has become routine practice as a result of the advances in biomedical engineering, the advent of interconnectivity between the devices through the Internet, and the demonstrated improvement in patient outcomes, survival, and hospitalizations. However, this increased dependency on the Internet of Things comes with risks in the form of cybersecurity lapses and possible attacks. Although no cyberattack leading to patient harm has been reported to date, the threat is real and has been demonstrated in research laboratory scenarios and echoed in patient concerns. The CIED universe comprises a complex interplay of devices, connectivity protocols, and sensitive information flow between the devices and the central cloud server. Various manufacturers use proprietary software and black-box connectivity protocols that are susceptible to hacking. Here we discuss the fundamentals of the CIED ecosystem, the potential security vulnerabilities, a historical overview of such vulnerabilities reported in the literature, and recommendations for improving the security of the CIED ecosystem and patient safety.
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Affiliation(s)
- Subrat Das
- Department of Medicine, Mount Sinai Morningside-West, Icahn School of Medicine, New York, New York
| | - Gregory P Siroky
- Department of Cardiology, Mount Sinai Morningside, Icahn School of Medicine, New York, New York
| | - Shawn Lee
- Department of Cardiology, Mount Sinai Morningside, Icahn School of Medicine, New York, New York
| | - Davendra Mehta
- Department of Cardiology, Mount Sinai Morningside, Icahn School of Medicine, New York, New York
| | - Ranjit Suri
- Department of Cardiology, Mount Sinai Morningside, Icahn School of Medicine, New York, New York.
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18
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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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19
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Watanabe E, Yamazaki F, Goto T, Asai T, Yamamoto T, Hirooka K, Sato T, Kasai A, Ueda M, Yamakawa T, Ueda Y, Yamamoto K, Tokunaga T, Sugai Y, Tanaka K, Hiramatsu S, Arakawa T, Schrader J, Varma N, Ando K. Remote Management of Pacemaker Patients With Biennial In-Clinic Evaluation: Continuous Home Monitoring in the Japanese At-Home Study: A Randomized Clinical Trial. Circ Arrhythm Electrophysiol 2020; 13:e007734. [PMID: 32342703 PMCID: PMC7237026 DOI: 10.1161/circep.119.007734] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Current expert consensus recommends remote monitoring for cardiac implantable electronic devices, with at least annual in-office follow-up. We studied safety and resource consumption of exclusive remote follow-up (RFU) in pacemaker patients for 2 years. Methods: In Japan, consecutive pacemaker patients committed to remote monitoring were randomized to either RFU or conventional in-office follow-up (conventional follow-up) at twice yearly intervals. RFU patients were only seen if indicated by remote monitoring. All returned to hospital after 2 years. The primary end point was a composite of death, stroke, or cardiovascular events requiring surgery, and the primary hypothesis was noninferiority with 5% margin. Results: Of 1274 randomized patients (50.4% female, age 77±10 years), 558 (RFU) and 550 (Conventional follow-up) patients reached either the primary end point or 24 months follow-up. The primary end point occurred in 10.9% and 11.8%, respectively (P=0.0012 for noninferiority). The median (interquartile range) number of in-office follow-ups was 0.50 (0.50–0.63) in RFU and 2.01 (1.93–2.05) in conventional follow-up per patient-year (P<0.001). Insurance claims for follow-ups and directly related diagnostic procedures were 18 800 Yen (16 500–20 700 Yen) in RFU and 21 400 Yen (16 700–25 900 Yen) in conventional follow-up (P<0.001). Only 1.4% of remote follow-ups triggered an unscheduled in-office follow-up, and only 1.5% of scheduled in-office follow-ups were considered actionable. Conclusions: Replacing periodic in-office follow-ups with remote follow-ups for 2 years in pacemaker patients committed to remote monitoring does not increase the occurrence of major cardiovascular events and reduces resource consumption. Registration: URL: https://clinicaltrials.gov; Unique identifier: NCT01523704.
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Affiliation(s)
- Eiichi Watanabe
- Department of Cardiology, Fujita Health University School of Medicine, Aichi (E.W.)
| | - Fumio Yamazaki
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital (F.Y.)
| | - Toshihiko Goto
- Department of Cardiology, Nagoya City University Hospital (T.G.), Aichi, Japan
| | - Toru Asai
- Department of Cardiology, Ichinomiya Municipal Hospital (T. Asai), Aichi, Japan
| | - Toshihiko Yamamoto
- Department of Cardiology, Handa City Hospital (T. Yamamoto), Aichi, Japan
| | - Keiji Hirooka
- Department of Cardiology, National Hospital Organization Osaka National Hospital (K.H.), Tokyo, Japan
| | - Toshiaki Sato
- Department of Cardiology, Kyorin University Hospital (T.S.), Tokyo, Japan
| | - Atsunobu Kasai
- Department of Cardiology, Japanese Red Cross Ise Hospital, Mie (A.K.)
| | - Marehiko Ueda
- Department of Cardiology, Chiba University Hospital (M.U.), Tokyo, Japan
| | - Takeshi Yamakawa
- Department of Cardiology, Teikyo University Hospital (T. Yamakawa), Tokyo, Japan
| | - Yasunori Ueda
- Department of Cardiology, Osaka Police Hospital, Japan (Y.U.)
| | | | - Takeshi Tokunaga
- Department of Cardiology, JA Toride Medical Ctr, Ibaraki, Japan (T.T.)
| | - Yoshinao Sugai
- Department of Cardiology, Hiraka General Hospital, Akita, Japan (Y.S.)
| | - Kazuhiko Tanaka
- Department of Cardiology, Kasukabe Chuo General Hospital, Saitama, Japan (K.T.)
| | - Shigeki Hiramatsu
- Department of Cardiology, Fukuyama Cardiovascular Hospital, Hiroshima, Japan (S.H.)
| | - Tomoharu Arakawa
- Department of Cardiology, Daido Hospital, Aichi, Japan (T. Arakawa)
| | | | - Niraj Varma
- Cleveland Clinic, Heart & Vascular Institute, OH (N.V.)
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan (K.A.)
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20
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Lopez-Villegas A, Catalan-Matamoros D, Peiro S, Lappegard KT, Lopez-Liria R. Cost-utility analysis of telemonitoring versus conventional hospital-based follow-up of patients with pacemakers. The NORDLAND randomized clinical trial. PLoS One 2020; 15:e0226188. [PMID: 31995558 PMCID: PMC6988929 DOI: 10.1371/journal.pone.0226188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/04/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The aim of our study was to perform an economic assessment in order to check whether or not telemonitoring of users with pacemakers offers a cost-effective alternative to traditional follow-up in outpatient clinics. METHODS We used effectiveness and cost data from the NORDLAND trial, which is a controlled, randomized, non-masked clinical trial. Fifty patients were assigned to receive either telemonitoring (TM; n = 25) or conventional monitoring (CM; n = 25) and were followed up for 12 months after the implantation. A cost-utility analysis was performed in terms of additional costs per additional Quality-Adjusted Life Year (QALY) attained from the perspectives of the Norwegian National Healthcare System and patients and their caregivers. RESULTS Effectiveness was similar between alternatives (TM: 0.7804 [CI: 0.6864 to 0.8745] vs. CM: 0.7465 [CI: 0.6543 to 0.8387]), while cost per patient was higher in the RM group, both from the Norwegian NHS perspective (TM: €2,079.84 [CI: 0.00 to 4,610.58] vs. €271.97 [CI: 158.18 to 385.76]; p = 0.147) and including the patient/family perspective (TM: €2,295.91 [CI: 0.00 to 4,843.28] vs. CM: €430.39 [CI: 0.00 to 4,841.48]), although these large differences-mainly due to a few patients being hospitalized in the TM group, as opposed to none in the CM group-did not reach statistical significance. The Incremental Cost-Effectiveness Ratio (ICER) from the Norwegian NHS perspective (€53,345.27/QALY) and including the patient/caregiver perspective (€55,046.40/QALY), as well as the Incremental Net Benefit (INB), favors the CM alternative, albeit with very broad 95%CIs. The probabilistic analysis confirmed inconclusive results due to the wide CIs even suggesting that TM was not cost-effective in this study. Supplemental analysis excluding the hospitalization costs shows positive INBs, whereby suggesting a discrete superiority of the RM alternative if hospitalization costs were not considered, albeit also with broad CIs. CONCLUSIONS Cost-utility analysis of TM vs. CM shows inconclusive results because of broad confidence intervals with ICER and INB figures ranging from potential savings to high costs for an additional QALY, with the majority of ICERs being above the usual NHS thresholds for coverage decisions. TRIAL REGISTRATION ClinicalTrials.gov NCT02237404.
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Affiliation(s)
- Antonio Lopez-Villegas
- Social Involvement of Critical and Emergency Medicine, CTS-609 Research Group, Hospital de Poniente, Almería, Spain
- Division of Medicine, Nordland Hospital, Bodø, Norway
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Daniel Catalan-Matamoros
- Department of Journalism and Communication, Universidad Carlos III de Madrid, Madrid, Spain
- Health Sciences CTS-451 Research Group, University of Almería, Almería, Spain
| | - Salvador Peiro
- Health Services Research Unit, FISABIO-PUBLIC HEALTH, Valencia, Spain
| | - Knut Tore Lappegard
- Division of Medicine, Nordland Hospital, Bodø, Norway
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Remedios Lopez-Liria
- Nursing Science, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Almería, Spain
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21
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Hindricks G, Dagres N. Remote monitoring, healthcare costs, and workload for healthcare professionals. Eur Heart J 2019; 40:1847-1849. [PMID: 30838393 DOI: 10.1093/eurheartj/ehz101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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22
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Brahmbhatt DH, Cowie MR. Remote Management of Heart Failure: An Overview of Telemonitoring Technologies. Card Fail Rev 2019; 5:86-92. [PMID: 31179018 PMCID: PMC6545972 DOI: 10.15420/cfr.2019.5.3] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 02/22/2019] [Indexed: 02/06/2023] Open
Abstract
Technological advances have enabled increasingly sophisticated attempts to remotely monitor heart failure. This should allow earlier identification of decompensation, better adherence to lifestyle changes and medication and interventions (such as diuretic dosage changes) that reduce the need for hospitalisation. This review discusses telemonitoring approaches in heart failure, and the evidence for their impact. It is not difficult to collect data remotely, but converting more data into better decision-making that improves the outcome of care is challenging. Policy-makers and technology companies are enthusiastic about the potential of digital technologies to transform healthcare and bring expertise to the patient, rather than the other way round, but guideline writers are not yet convinced, due to the lack of consistent findings in randomised trials.
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Rybak K. [Active cardiac implantable electronic devices: What is possible in ambulatory health care in 2017?]. Herzschrittmacherther Elektrophysiol 2017; 28:279-286. [PMID: 28831556 DOI: 10.1007/s00399-017-0524-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 08/01/2017] [Indexed: 06/07/2023]
Abstract
Telemonitoring (TM) features are implemented in nearly all cardiac implantable electronic devices (CIEDs) that have recently been released to the market. In combination with pacemakers, defibrillators and systems for cardiac resynchronization it is a safe and efficient method for routine technical aftercare of the devices as well as for monitoring heart failure and arrhythmias. Using TM has the potential to optimize patient care with regard to economic, clinical and safety aspects. Despite the good availability of existing data and clear recommendations of the responsible scientific societies, it is often seen as an isolated solution which is not fully integrated into standard care, although it has its own EBM number for implantable cardioverter-defibrillators and cardiac resynchronization therapy systems. The reasons are not only the unsatisfactory reimbursement of costs, different IT structures and the borders between clinics and medical practices, but also acceptance problems of physicians and legal aspects. The compensation of cardiac pacemakers and 'event recorders' is unsolved. TM provides the prospect for optimal and cross-sectoral patient care. Furthermore it has the potential to become the standard method for the care for patients with a CIED.
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Affiliation(s)
- Karin Rybak
- Praxis für Kardiologie und Angiologie, Telemedizinisches Zentrum Dessau, Kochstedter Kreisstraße 11, 06847, Dessau-Roßlau, Deutschland.
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Lee SS, Salole E. Innovative Medical Technology, Health Technology Assessment, and Health Policy: The Case of Remote Patient Monitoring of Cardiac Implantable Electronic Devices in South Korea. Telemed J E Health 2017; 23:25-29. [DOI: 10.1089/tmj.2016.0056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sang-Soo Lee
- Seoul School of Integrated Sciences & Technologies, Seoul, South Korea
| | - Eugene Salole
- Principal, Value-Based Access Pty Ltd, Sydney, Australia
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Abstract
Remote monitoring in the modern era has improved outcomes for patients with cardiac implantable electronic devices. There are many advantages to remote monitoring, including improved quality of life for patients, decreased need for in-office interrogation, and secondary reduced costs. Patient safety and enhanced survival remain the most significant benefit. With most of the published literature on this topic being focussed on adults, paediatric outcomes continue to be defined. This is a review of the benefits of remote monitoring in paediatrics and in patients with CHD.
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Lim PCY, Lee ASY, Chua KCM, Lim ETS, Chong DTT, Tan BY, Ho KL, Teo WS, Ching CK. Remote monitoring of patients with cardiac implantable electronic devices: a Southeast Asian, single-centre pilot study. Singapore Med J 2016; 57:372-7. [PMID: 27439396 PMCID: PMC4958713 DOI: 10.11622/smedj.2016120] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Remote monitoring of cardiac implantable electronic devices (CIED) has been shown to improve patient safety and reduce in-office visits. We report our experience with remote monitoring via the Medtronic CareLink(®) network. METHODS Patients were followed up for six months with scheduled monthly remote monitoring transmissions in addition to routine in-office checks. The efficacy of remote monitoring was evaluated by recording compliance to transmissions, number of device alerts requiring intervention and time from transmission to review. Questionnaires were administered to evaluate the experiences of patients, physicians and medical technicians. RESULTS A total of 57 patients were enrolled; 16 (28.1%) had permanent pacemakers, 34 (59.6%) had implantable cardioverter defibrillators and 7 (12.3%) had cardiac resynchronisation therapy defibrillators. Overall, of 334 remote transmissions scheduled, 73.7% were on time, 14.5% were overdue and 11.8% were missed. 84.6% of wireless transmissions were on time, compared to 53.8% of non-wireless transmissions. Among all transmissions, 4.4% contained alerts for which physicians were informed and only 1.8% required intervention. 98.6% of remote transmissions were reviewed by the second working day. 73.2% of patients preferred remote monitoring. Physicians agreed that remote transmissions provided information equivalent to in-office checks 97.1% of the time. 77.8% of medical technicians felt that remote monitoring would help the hospital improve patient management. No adverse events were reported. CONCLUSION Remote monitoring of CIED is safe and feasible. It has possible benefits to patient safety through earlier detection of arrhythmias or device malfunction, permitting earlier intervention. Wireless remote monitoring, in particular, may improve compliance to device monitoring. Patients may prefer remote monitoring due to possible improvements in quality of life.
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Affiliation(s)
- Paul Chun Yih Lim
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | | | | | | | - Boon Yew Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Kah Leng Ho
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Wee Siong Teo
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Chi Keong Ching
- Department of Cardiology, National Heart Centre Singapore, Singapore
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Abstract
Cardiovascular disease is one of the main fields of application for telemedicine, with benefits in almost all areas in the continuum of cardiovascular disease. The greatest impact has been shown in the early diagnosis of cardiovascular disease, in second consultation, between non-cardiologist and cardiologist and between cardiologists, and in follow-up and secondary prevention of cardiovascular disease. At present, the main area of implementation for telemedicine in cardiovascular disease is represented by pre-hospital triage, with telemedicine electrocardiogram in acute myocardial infarction. Significant results have also been achieved in the second opinion consultation of pediatric subjects with congenital cardiovascular disease, home-monitoring and the management of patients affected by chronic heart failure or with an implanted device. However, there is significant room for further improvement in delivering telemedicine assistance even in 'very-remote' populations, such as detainees, patients in developing countries or in underdeveloped areas of developed countries.
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Affiliation(s)
| | - Simonetta Scalvini
- b U.O. Cardiologia Riabilitativa , IRCCS Fondazione Salvatore Maugeri , Brescia , Italy
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Affiliation(s)
- Nikolaos Dagres
- Department of Electrophysiology, Herzzentrum Leipzig, 04289 Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Herzzentrum Leipzig, 04289 Leipzig, Germany.
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Bongiorni MG, Chen J, Dagres N, Estner H, Hernandez-Madrid A, Hocini M, Larsen TB, Pison L, Potpara T, Proclemer A, Sciaraffia E, Todd D, Blomstrom-Lundqvist C. EHRA research network surveys: 6 years of EP wires activity. Europace 2015; 17:1733-8. [PMID: 26589904 DOI: 10.1093/europace/euv371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Clinical practice should follow guidelines and recommendations mainly based on the results of controlled trials, which are often conducted in selected populations and special conditions, whereas clinical practice may be influenced by factors different from controlled scientific studies. Hence, the real-world setting is better assessed by the observational registries enrolling patients for longer periods of time. However, this may be difficult, expensive, and time-consuming. In 2009, the Scientific Initiatives Committee of the European Heart Rhythm Association (EHRA) has instigated a series of surveys covering the controversial issues in clinical electrophysiology (EP). With this in mind, an EHRA EP research network has been created, which included EP centres in Europe among which the surveys on 'hot topic' were circulated. This review summarizes the overall experience conducting EP wires over the past 6 years, categorizing and assessing the topics regarding clinical EP, and evaluating the acceptance and feedback from the responding centres, in order to improve participation in the surveys and better address the research needs and aspirations of the European EP community.
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Affiliation(s)
| | - Jian Chen
- Department of Clinical Science, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Nikolaos Dagres
- Second Cardiology Department, Attikon University Hospital, University of Athens, Athens, Greece
| | - Heidi Estner
- Department of Cardiology Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Germany
| | - Antonio Hernandez-Madrid
- Cardiology Department, Ramon y Cajal Hospital, Alcalá University, CarreteraColmenar Viejo, Madrid 28034, Spain
| | - Meleze Hocini
- HôpitalCardiologique du Haut Lévêque Université Victor Segalen Bordeaux II, Bordeaux, Pessac 33604, France
| | - Torben Bjerregaard Larsen
- Department of Cardiology, Cardiovascular Research Centre, Aalborg University Hospital, Aalborg, Denmark
| | - Laurent Pison
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tatjana Potpara
- School of Medicine, University of Belgrade, Serbia and Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Alessandro Proclemer
- Division of Cardiology, University Hospital S. Maria della Misericordia, IRCAB Foundation Udine, Udine, Italy
| | - Elena Sciaraffia
- Department of Cardiology, Institution of Medical Science, Uppsala University, Uppsala 75185, Sweden
| | - Derick Todd
- Institute of Cardiovascular Medicine and Science Liverpool Heart & Chest Hospital, UK
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Remote monitoring of implantable devices: Should we continue to ignore it? Int J Cardiol 2015; 202:368-77. [PMID: 26432486 DOI: 10.1016/j.ijcard.2015.09.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/31/2015] [Accepted: 09/19/2015] [Indexed: 11/23/2022]
Abstract
The number of patients with implantable cardioverter defibrillators (ICDs) is increasing. In addition to improve survival, ICD can collect data related to device function and physiological parameters. Remote monitoring (RM) of these data allows early detection of technical or clinical problems and a prompt intervention (reprogramming device or therapy adjustment) before the patient require hospitalization. RM is not a substitute for emergency service and its consultation is now limited during working hours. Thus, a consent form is required to inform patients about benefits and limitations. The available studies indicate that remote monitoring is more effective than traditional calendar face to face based encounters. RM is safe, highly reliable, cost efficient, allows quick reply to failures, and reduces the number of scheduled visits and the incidence of inappropriate shocks with a positive impact on survival. It follows that RM has the credentials to be the standard of care for ICD management; however, unfortunately, there is a delay in physician acceptance and implementation. The recent observations from randomized IN-TIME study that showed a clear survival benefit with RM in heart failure patients have encouraged us to review both the negative and positive aspects of RM collected in a little more than a decade.
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Boriani G. Remote monitoring of cardiac implantable electrical devices in Europe: quo vadis? Europace 2015; 17:674-676. [DOI: 10.1093/europace/euv031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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[Implantable cardioverter-defibrillator: Is remote monitoring obligatory?]. Herzschrittmacherther Elektrophysiol 2015; 26:116-22. [PMID: 25900214 DOI: 10.1007/s00399-015-0368-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The possibilities of telemonitoring (TM) of patients with implantable cardioverter-defibrillators (ICD) have been rapidly improving over the last few years. Numerous studies have examined the effects of this development on the follow-up care of ICD patients. OBJECTIVES Technical implementation and safety of ICD telemonitoring. Effects on the treatment of cardiac arrhythmias, the management of cardiac insufficiency patients and morbidity as well as mortality. Illustration of patient acceptance and cost-benefit assessment. MATERIALS AND METHODS The current research situation regarding TM of ICDs is analyzed and the available evidence for the postulated advantages in the follow-up care of ICD patients are discussed. The current treatment guidelines and recommendations for implementation of TM in daily clinical praxis are presented. RESULTS AND CONCLUSIONS TM offers the possibility of faster reaction times to arrhythmias, cardiac decompensation and ICD malfunctions. At the same time, the outpatient follow-ups can be reduced without negatively affecting safety, quality of life or patient acceptance. TM has the potential to cost-neutrally improve the safety of ICD therapy and could lead to optimized management of heart insufficiency patients, while reducing morbidity and mortality. Following the evidence of these benefits as shown in numerous studies, TM has already been included in the current therapy guidelines.
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De Simone A, Leoni L, Luzi M, Amellone C, Stabile G, La Rocca V, Capucci A, D'onofrio A, Ammendola E, Accardi F, Valsecchi S, Buja G. Remote monitoring improves outcome after ICD implantation: the clinical efficacy in the management of heart failure (EFFECT) study. Europace 2015; 17:1267-75. [PMID: 25842271 DOI: 10.1093/europace/euu318] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 10/21/2014] [Indexed: 11/12/2022] Open
Abstract
AIMS Internet-based remote interrogation systems have been shown to reduce emergency department and in-office visits in patients with implantable cardioverter defibrillators (ICDs), resulting in increased efficiency for healthcare providers. Nonetheless, studies sized to demonstrate the impact of remote monitoring on patients' outcome have been lacking. METHODS AND RESULTS The EFFECT study was a multicentre clinical trial aimed at measuring and comparing the outcome of ICD patients conventionally followed-up by means of in-clinic visits (Standard arm) or by remote monitoring (Remote arm) in the clinical practice of 25 Italian centres. From 2011 to 2013, 987 consecutive patients were enrolled and followed up for at least 12 months. The primary endpoint was the rate of death and cardiovascular hospitalizations. Remote monitoring was adopted by 499 patients. Patients in the Standard and Remote arms did not differ significantly in terms of baseline clinical characteristics, except for a more frequent use of ICD with cardiac resynchronization therapy (CRT-D) in the Remote arm (48 vs. 36%, P < 0.001). One-year rates of the primary combined endpoint were 0.27 events/year for patients in the Standard arm and were 0.15 events/year for those in the Remote arm (incident rate ratio, 0.55; 95% CI, 0.41-0.73; P < 0.001). The endpoint rates in the Standard and Remote arms were 0.27 and 0.08 events/year, respectively, among CRT-D recipients (P < 0.001), and 0.28 vs. 0.21 among ICD patients (P = 0.094). The rates of in-office visits were 1.9 per year in the Standard arm and 1.7 per year in the Remote arm. CONCLUSION Compared with the standard follow-up through in-office visits, remote monitoring is associated with reduced death and cardiovascular hospitalizations in patients with ICD in clinical practice. CLINICAL TRIAL REGISTRATION URL: http://clinicaltrials.gov/ Identifier: NCT01723865.
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Affiliation(s)
- Antonio De Simone
- Laboratorio di Elettrofisiologia, Clinica San Michele, Via Montella, 16, Maddaloni (CE) 81024, Italy
| | | | - Mario Luzi
- Università Politecnica delle Marche, Ancona, Italy
| | | | | | - Vincenzo La Rocca
- Laboratorio di Elettrofisiologia, Clinica San Michele, Via Montella, 16, Maddaloni (CE) 81024, Italy
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García-Bolao I, Ruiz-Mateas F, Bazan V, Berruezo A, Alcalde O, Leal del Ojo J, Acosta J, Martínez Sellés M, Mosquera I. Update in cardiac arrhythmias and pacing. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2015; 68:226-233. [PMID: 25677720 DOI: 10.1016/j.rec.2014.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/11/2014] [Indexed: 06/04/2023]
Abstract
This article discusses the main advances in cardiac arrhythmias and pacing published between 2013 and 2014. Special attention is given to the interventional treatment of atrial fibrillation and ventricular arrhythmias, and on advances in cardiac pacing and implantable cardioverter defibrillators, with particular reference to the elderly patient.
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Affiliation(s)
- Ignacio García-Bolao
- Unidad de Arritmias, Departamento de Cardiología y Cirugía Cardiaca, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain.
| | - Francisco Ruiz-Mateas
- Unidad de Estimulación Cardiaca, Área de Cardiología, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Victor Bazan
- Unidad de Arritmias, Servicio de Cardiología, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Antonio Berruezo
- Unidad de Arritmias, Servicio de Cardiología, Instituto del Tórax, Hospital Clinic e IDIBAPS, Barcelona, Spain
| | - Oscar Alcalde
- Unidad de Arritmias, Departamento de Cardiología y Cirugía Cardiaca, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
| | - Juan Leal del Ojo
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Hospital Nuestra Señora de Valme, Sevilla, Spain
| | - Juan Acosta
- Unidad de Arritmias, Servicio de Cardiología, Instituto del Tórax, Hospital Clinic e IDIBAPS, Barcelona, Spain
| | - Manuel Martínez Sellés
- Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ignacio Mosquera
- Unidad de Arritmias, Hospital Universitario A Coruña, A Coruña, Spain
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Telemedicine for cardiovascular disease continuum: A position paper from the Italian Society of Cardiology Working Group on Telecardiology and Informatics. Int J Cardiol 2015; 184:452-458. [PMID: 25755064 DOI: 10.1016/j.ijcard.2015.02.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 02/02/2015] [Accepted: 02/21/2015] [Indexed: 11/20/2022]
Abstract
Telemedicine is the provision of health care services, through the use of information and communication technology, in situations where the health care professional and the patient, or 2 health care professionals, are not in the same location. It involves the secure transmission of medical data and information, through text, sound, images, or other forms needed for the prevention, diagnosis, treatment, and follow-up of a patient. First data on implementation of telemedicine for the diagnosis and treatment of acute myocardial infarction date from more than 10 years ago. Telemedicine has a potential broad application to the cardiovascular disease continuum and in many branches of cardiology, at least including heart failure, ischemic heart disease and arrhythmias. Telemedicine might have an important role as part of a strategy for the delivery of effective health care for patients with cardiovascular disease. In this document the Working Group on Telecardiology and Informatics of the Italian Society of Cardiology intends to remark some key-points regarding potential benefit achievable with the implementation of telemedicine support in the continuum of cardiovascular disease.
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Mairesse GH, Braunschweig F, Klersy K, Cowie MR, Leyva F. Implementation and reimbursement of remote monitoring for cardiac implantable electronic devices in Europe: a survey from the health economics committee of the European Heart Rhythm Association. ACTA ACUST UNITED AC 2015; 17:814-8. [DOI: 10.1093/europace/euu390] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 12/04/2014] [Indexed: 11/12/2022]
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van den Berg N, Schmidt S, Stentzel U, Mühlan H, Hoffmann W. Telemedizinische Versorgungskonzepte in der regionalen Versorgung ländlicher Gebiete. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 58:367-73. [DOI: 10.1007/s00103-015-2134-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Coma Samartín R, Cano Pérez Ó, Pombo Jiménez M. Registro Español de Marcapasos. XI Informe Oficial de la Sección de Estimulación Cardiaca de la Sociedad Española de Cardiología (2013). Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2014.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Coma Samartín R, Cano Pérez Ó, Pombo Jiménez M. Spanish Pacemaker Registry. Eleventh official report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2013). REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2014; 67:1024-1038. [PMID: 25455755 DOI: 10.1016/j.rec.2014.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 08/16/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES The present report summarizes the analysis of pacemaker implantation and replacement data sent to the Spanish Pacemaker Registry in 2013, with specific discussion of pacing mode selection. METHODS This study was based on information obtained from the European Pacemaker Patient Identification Card. RESULTS Information was received on 118 hospital centers, with a total of 12 831 cards, or 35% of the estimated activity. There were 755 and 58.1 conventional and resynchronization devices per million population, respectively. The mean age of patients receiving an implant was 77.4 years. Men received 59.5% of first implantations and 56.6% of replacements. Most implantations and generator replacements were performed in patients older than 80 years. Almost all endocardial leads used were bipolar, and 78.7% of leads had an active fixation mechanism. Despite being in sinus rhythm, 24% of patients with sick sinus syndrome and 25% of those with atrioventricular block were paced in VVIR mode. CONCLUSIONS The use of pacemaker generators and resynchronization devices per million population continues to increase in Spain. Active fixation mechanisms predominate for leads but just 20% of leads are compatible with magnetic resonance imaging. The factors influencing the correct selection of pacing mode were age and, to a lesser extent, the type of atrioventricular block, and sex. Implementation of home monitoring of pacemakers remains low.
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Affiliation(s)
- Raúl Coma Samartín
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Cuidados Críticos Cardiológicos, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - Óscar Cano Pérez
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Electrofisiología y Arritmias, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Marta Pombo Jiménez
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Estimulación Cardiaca, Hospital Costal de Sol, Marbella, Málaga, Spain
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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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