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Al-Khatib SM. Cardiac Implantable Electronic Devices. N Engl J Med 2024; 390:442-454. [PMID: 38294976 DOI: 10.1056/nejmra2308353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- Sana M Al-Khatib
- From the Division of Cardiology and the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
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Diaz JC, Cañas F, Duque M, Aristizabal J, Niño C, Bastidas O, Marin J, Rivera E, Hoyos C, Matos C, Peralta A, Martin DT, Romero J. Assisted reality device to guide cardiac implantable device programming in distant rural areas. J Cardiovasc Electrophysiol 2023; 34:497-501. [PMID: 36640437 DOI: 10.1111/jce.15815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Patients with cardiac implantable electronic devices (CIEDs) living in rural areas have difficulty obtaining follow-up visits for device interrogation and programming in specialized healthcare facilities. OBJECTIVE To describe the use of an assisted reality device designed to provide front-line workers with real-time online support from a remotely located specialist (Realwear HTM-1; Realwear) during CIED assistance in distant rural areas. METHODS This is a prospective study of patients requiring CIED interrogation using the Realwear HMT-1 in a remote rural population in Colombia between April 2021 and June 2022. CIED interrogation and device programming were performed by a general practitioner and guided by a cardiac electrophysiologist. Non-CIED-related medical interventions were allowed and analyzed. The primary objective was to determine the incidence of clinically significant CIED alerts. Secondary objectives were the changes medical interventions used to treat the events found in the device interrogations regarding non-CIED related conditions. RESULTS A total of 205 CIED interrogations were performed on 139 patients (age 69 ± 14 years; 54% female). Clinically significant CIED alerts were reported in 42% of CIED interrogations, consisting of the detection of significant arrhythmias (35%), lead malfunction (3%), and device in elective replacement interval (3.9%). Oral anticoagulation was initiated in 8% of patients and general medical/cardiac interventions unrelated to the CIED were performed in 52% of CIED encounters. CONCLUSION Remote assistance using a commercially available assisted reality device has the potential to provide specialized healthcare to patients in difficult-to-reach areas, overcoming current difficulties associated with RM, including the inability to change device programming. Additionally, these interactions provided care beyond CIED-related interventions, thus delivering significant social and clinical impact to remote rural populations.
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Affiliation(s)
- Juan C Diaz
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Clinica Las Vegas Grupo Quiron Salud, Universidad CES, Medellin, Colombia
| | - Felipe Cañas
- Universidad CES School of Medicine, Medellin, Colombia
| | | | - Julian Aristizabal
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Clinica Las Vegas Grupo Quiron Salud, Universidad CES, Medellin, Colombia
| | - Cesar Niño
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Clinica Las Vegas Grupo Quiron Salud, Universidad CES, Medellin, Colombia
| | - Oriana Bastidas
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Clinica Las Vegas Grupo Quiron Salud, Universidad CES, Medellin, Colombia
| | - Jorge Marin
- Universidad CES School of Medicine, Medellin, Colombia
| | - Estefania Rivera
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Hoyos
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos Matos
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Adelqui Peralta
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts, USA
| | - David T Martin
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge Romero
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Lehmann HI, Sharma K, Bhatia R, Mills T, Lang J, Li G, Andrews C, Cullivan J, Singh J, Mela T. Real-World Disparities in Remote Follow-Up of Cardiac Implantable Electronic Devices and Impact of the COVID-19 Pandemic: A Single-Center Experience. J Am Heart Assoc 2023; 12:e027500. [PMID: 36688364 PMCID: PMC9973665 DOI: 10.1161/jaha.122.027500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/16/2022] [Indexed: 01/24/2023]
Abstract
Background Remote monitoring (RM) of cardiac implantable electronic devices has been shown to improve cardiovascular morbidity and mortality. To date, no studies have investigated disparities in use and delivery of RM. This study was performed to investigate if racial and socioeconomic disparities are present in cardiac implantable electronic device RM. Methods and Results This was a retrospective observational cohort study at a single tertiary care center in the United States. Patients who received a newly implanted cardiac implantable electronic device or device upgrade between January 2017 and December 2020 were included. Patients were classified as RM positive (RM+) when they underwent at least ≥2 remote interrogations per year during follow-up. Of all eligible patients, 2520 patients were included, and 34% were women. The mean follow-up was 25 months. Mean age was 71±14 years. Pacemakers constituted 66% of implanted devices, whereas 26% were implantable cardioverter-defibrillators, and 8% were cardiac resynchronization therapy with implantable cardioverter-defibrillators. Most patients (83%) were of European American ancestry. During follow-up, 66% of patients were classified as RM+. Patients who were younger, European American, college-educated, lived in a county with higher median household income, and were active on the hospital's patient portals were more frequently RM+. In an adjusted regression model, RM+ remained associated with the use of the online patient portal (odds ratio [OR], 2.889 [95% CI, 2.387-3.497]), presence of an implantable cardioverter-defibrillator (OR, 1.489 [95% CI, 1.207-1.835]), advanced college degree (OR, 1.244 [95% CI, 1.014-1.527]), and lastly with European American ancestry (P<0.05). During the years of the COVID-19 pandemic, the number of RM+ patients increased, whereas the association with ancestry and ethnicity decreased. Conclusions Despite being offered to all patients at implantation, significant disparities were present in cardiovascular implantable electronic device RM in this cohort. Disparities were partly reversed during COVID-19. Further studies are needed to examine health center- and patient-specific factors to overcome these barriers, and to facilitate equal opportunities to participate in RM.
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Affiliation(s)
- H. Immo Lehmann
- Department of CardiologyMassachusetts General HospitalBostonMA
- Harvard Medical SchoolCambridgeMA
| | - Krishan Sharma
- Department of CardiologyMassachusetts General HospitalBostonMA
- Harvard Medical SchoolCambridgeMA
| | - Roma Bhatia
- Harvard Medical SchoolCambridgeMA
- Department of MedicineMassachusetts General HospitalBostonMA
| | - Theresa Mills
- Department of CardiologyMassachusetts General HospitalBostonMA
| | | | - Guoping Li
- Department of CardiologyMassachusetts General HospitalBostonMA
- Harvard Medical SchoolCambridgeMA
| | - Carl Andrews
- Department of CardiologyMassachusetts General HospitalBostonMA
| | - Jay Cullivan
- Department of CardiologyMassachusetts General HospitalBostonMA
| | - Jagmeet Singh
- Department of CardiologyMassachusetts General HospitalBostonMA
- Harvard Medical SchoolCambridgeMA
| | - Theofanie Mela
- Department of CardiologyMassachusetts General HospitalBostonMA
- Harvard Medical SchoolCambridgeMA
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Lebedeva NB, Talibullin IV, Parfenov PG, Kashtalap VV, Barbarash OL. Long-term outcomes in patients with an implanted cardioverter-defibrillator according to the Kuzbass registry. KARDIOLOGIIA 2022; 62:57-63. [PMID: 36636977 DOI: 10.18087/cardio.2022.12.n2082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/28/2022] [Indexed: 01/14/2023]
Abstract
Aim To analyze long-term outcomes by results of the prospective part of the Kuban registry of patients with an implantable cardioverter defibrillator (ICD).Material and methods A prospective analysis of the incidence of hard endpoints and changes in the condition was performed for 260 patients with ICD successively added to the Registry of Patients with Implantable Cardioverter Defibrillator" from 2015 through 2019.Results At the time of ICD implantation, all patients had chronic heart failure (CHF), mostly of ischemic etiology with a low left ventricular ejection fraction (LVEF); median LVEF was 30 (25; 36.5) %. 54 of 266 (21.9 %) patients died by 2021; 17 of them (31.5 %) died in the hospital; in 76.5 % of cases, death was caused by acute decompensated heart failure (HF). 139 (53.5%) patients were readmitted; 66 (25.4 %) hospitalizations were related with ICDs (lead revision or reimplantation); acute cardiovascular events developed in 38 (14.6 %) patients; 12 (4.6%) patients underwent percutaneous coronary interventions; orthotopic heart transplantation was performed for 4 patients. ICD shocks were recorded in 27 (10.4 %) patients. After the ICD implantation, median LVEF remained unchanged, 31 (25; 42) vs. 30 (25; 36.5) % (р>0.05). However, both objective and subjective HF symptoms worsened. Thus, the number of patients with IIB stage CHF increased from 29.6 to 88.8 % (р<0.01) and with NYHA III CHF from 24.2 to 34.5 % (p<0.05). 80 (30.8%) patients visited cardiologists on a regular basis. Only 7.3% of patients received an optimal drug therapy. During the observation period, the rate of beta-blocker treatment considerably decreased, from 90.6 to 64.3 % (р<0.01), and the rate of the mineralocorticoid receptor antagonist treatment decreased from 50.8 to 17.4 % (р<0.01). The rate of the diuretic treatment was inconsistent with the severity of patients' condition.Conclusion Most of the problems the patients encountered after the ICD implantation were related with an inadequate treatment of the underlying disease. Since the majority of patients with ICD have a low LVEF, it is essential to focus on prescribing an optimal drug therapy and maintaining compliance with this therapy.
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Affiliation(s)
- N B Lebedeva
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - I V Talibullin
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - P G Parfenov
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - V V Kashtalap
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - O L Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases
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Yang S, Stabenau HF, Kiernan K, Diamond JE, Kramer DB. Clinical utility of remote monitoring for patients with cardiac implantable electrical devices. J Interv Card Electrophysiol 2022; 66:961-969. [PMID: 36327060 PMCID: PMC9632596 DOI: 10.1007/s10840-022-01406-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022]
Abstract
Background Remote monitoring of cardiac implantable electronic devices (CIEDs) offers practical and clinical benefits juxtaposed against burdens associated with high transmission volume. Methods We identified patients receiving de novo pacemakers (PPMs) and implantable cardiac defibrillators (ICDs) at a single academic medical center (January 2016–December 2019) with at least 1 year of follow-up device care. We collected patient- and device-specific data at time of implant and assessed all remote and in-person interrogation reports for clinically actionable findings based on pre-specified criteria. Results Among 963 patients (mean age of 71 (± 14) years, 37% female), 655 (68%) underwent PPM, and 308 (32%) underwent ICD implant. Median follow-up was 874 (627–1221) days, during which time patients underwent a mean of 13 (10–16) total interrogations; remote interrogations comprised 53% of all device evaluations; and of these, 96% were scheduled transmissions. Overall, 22% of all CIED interrogations yielded significant findings with a slightly higher rate in the PPM than in the ICD group (23% vs. 20%, p < 0.01). Only 8% of remote interrogations produced clinically meaningful results, compared with 38% of in-person ones. In adjusted models, routine, remote transmissions were least likely to be useful for both PPM and ICD patients (p < 0.001), whereas time from initial device implant was inversely associated with probability of obtaining a useful interrogation (p < 0.001). Conclusions Routine remote interrogations constitute the majority of device evaluations performed, but uncommonly identify clinically actionable findings.
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Affiliation(s)
- Shu Yang
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Ave, 4Th Floor, Boston, MA 02215 USA ,Harvard Medical School, Boston, MA USA
| | - Hans F. Stabenau
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Ave, 4Th Floor, Boston, MA 02215 USA ,Harvard Medical School, Boston, MA USA
| | - Katherine Kiernan
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Ave, 4Th Floor, Boston, MA 02215 USA ,Harvard Medical School, Boston, MA USA
| | - Jamie E. Diamond
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Ave, 4Th Floor, Boston, MA 02215 USA ,Harvard Medical School, Boston, MA USA
| | - Daniel B. Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Ave, 4Th Floor, Boston, MA 02215 USA ,Harvard Medical School, Boston, MA USA
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Rakhshan M, Khoshnood Z, Ansari L, Aslani A. Body Image and Adjustment among Patients with Heart Rhythm Management Devices following Cardiac Rehabilitation Program: A Randomized, Controlled Clinical Trial. Clin Med Res 2022; 20:1-8. [PMID: 34996819 PMCID: PMC9390850 DOI: 10.3121/cmr.2021.1530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/27/2020] [Accepted: 07/20/2021] [Indexed: 11/18/2022]
Abstract
Introduction: Heart rhythm management devices save patients' lives. However, they may cause problems with the patient's perspective of their body image. Therefore, given the significance of the heart function and cardiac rehabilitation, this study was conducted to investigate and compare the effect of the cardiac rehabilitation program on adjustment and body image among patients who use heart rhythm management devices.Methods: This two-group clinical trial was conducted with 100 patients who used various heart rhythm management devices. The patients were randomly assigned into either the control group or intervention group (50 patients in each group) via four triad blocks. The intervention was 16 sessions of the cardiac rehabilitation program and 4 telephone follow-ups over twelve weeks. Data was gathered before the intervention and both eight and twelve weeks after the intervention using the psychosocial adjustment to illness scale and the body image and relationships scale.Findings: The majority of the patients were male and in the age range of 40-60 years. Before the intervention, no statistically significant differences were reported between the groups in terms of adjustment control = 68.13 ± 9.1, intervention = 67.13 ± 4.6) and body image (control = 93.14 ± 8.5, intervention = 91.16 ± 8.4) (P>0.5). However, in the intervention group, with each of three devices (pacemaker, ICD, CRT), significant improvements were observed in all aspects of adjustment (16.7 ± 9.3, 25.3 ± 9.5, 20.6 ± 10.3) and body image (45.50 ± 9.80, 55.10 ± 8.80, 42.90 ± 6.10) over time respectively (P<0.001).Conclusion: The effectiveness of the cardiac rehabilitation program in improving the body image was reported in this study. Therefore, the cardiac rehabilitation program can have a vital role in improving body image and adjustment among patients who use various cardiac rhythm management devices.
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Affiliation(s)
- Mahnaz Rakhshan
- Associate professor, Community Based Psychiatric Care Research Center. School of nursing and midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zeinab Khoshnood
- Student research committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Ansari
- Student research committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Aslani
- Associate Professor, School of Medicine, Shiraz University of Medical Sciences. Shiraz, Iran
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Daley C, Toscos T, Allmandinger T, Ahmed R, Wagner S, Mirro M. Organizational Models for Cardiac Implantable Electronic Device Remote Monitoring: Current and Future Directions. Card Electrophysiol Clin 2021; 13:483-497. [PMID: 34330375 DOI: 10.1016/j.ccep.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This review provides an overview of the literature on the organization, staffing, and structure of remote monitoring (RM) clinics, primarily from countries in Western Europe and United States, as well as the challenges, considerations, and future directions for RM clinic models of care. Using a current case example of an RM clinic in the Midwestern United States, this document provides key information from the viewpoint of a clinic undergoing a shift in workflow. Finally, this review distills key considerations for RM management for electrophysiology clinics, vendors and industry, and policy makers.
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Affiliation(s)
- Carly Daley
- Health Services and Informatics Research Department, Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Dr., Fort Wayne, IN 46845, USA; Department of BioHealth Informatics, IUPUI School of Informatics and Computing, 535 W. Michigan St., Indianapolis, IN 46202, USA.
| | - Tammy Toscos
- Health Services and Informatics Research Department, Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Dr., Fort Wayne, IN 46845, USA; Department of BioHealth Informatics, IUPUI School of Informatics and Computing, 535 W. Michigan St., Indianapolis, IN 46202, USA
| | - Tina Allmandinger
- Arrhythmia Diagnostic Center, Parkview Physicians Group, 11108 Parkview Circle, Fort Wayne, IN 46845, USA
| | - Ryan Ahmed
- Health Services and Informatics Research Department, Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Dr., Fort Wayne, IN 46845, USA
| | - Shauna Wagner
- Health Services and Informatics Research Department, Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Dr., Fort Wayne, IN 46845, USA
| | - Michael Mirro
- Health Services and Informatics Research Department, Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Dr., Fort Wayne, IN 46845, USA; Department of BioHealth Informatics, IUPUI School of Informatics and Computing, 535 W. Michigan St., Indianapolis, IN 46202, USA; Department of Medicine, Indiana University School of Medicine, 340 West 10th St., Indianapolis, IN 46202, USA
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Lebedeva NB, Talibullin IV, Temnikova TB, Mamchur SE, Barbarash OL. [Clinical and anamnestic characteristics of patients with an implanted cardioverter-defibrillator in real clinical practice (data from the Kuzbass register)]. KARDIOLOGIYA 2021; 61:40-47. [PMID: 34549692 DOI: 10.18087/cardio.2021.8.n1651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/12/2021] [Indexed: 11/18/2022]
Abstract
Aim To study the consistency of the practice of management, selection and routing of patients at high risk of sudden cardiac death (SCD) selected for cardioverter-defibrillator implantation (CDI) with current clinical guidelines and to evaluate the quality of subsequent outpatient follow-up and treatment based on a retrospective analysis of clinical amnestic data from the Kuzbass Registry of Patients with CDI.Material and methods The study was based on the Registry of Patients with Implanted Cardioverter Defibrillator and included successive data of 28 patients hospitalized to the Kizbass Cardiological Center from 2015 through 2019. Social and clinical amnestic characteristics, indications for CVI, and concomitant drug therapy were analyzed retrospectively. Statistical analyses were performed with the Statistica 10.0 software (Statsoft, USA).Results Median age of patients was 59 (53; 66) years; 239 (83.6 %) men were included; 29 (10.1%) people were employed, CHI was performed in 182 (63.6 %) patients for prevention of SCC, and for secondary prevention in 104 (36.4 %) patients. 208 (72.7 %) patients were diagnosed with ischemic heart disease (IHD), and 145 (67.9 %) of them underwent myocardial revascularization. Noncoronarogenic diseases were found in 78 (27.3 %) patients, and most of them were diagnosed with dilated cardiomyopathy. All patients had chronic heart failure (CHF); half of them had stage IIA CHF. Median left ventricular ejection fraction was 30 (25; 36,5) % according to echocardiography using the Simpson method. Comorbidity was found in 151 (52.8 %) patients. 128 (44.8%) patients received a triple neurohormonal blockade for CHF treatment; titration to target doses was not performed in any of them. Antiarrhythmics were administered to 150 (52.4 %) patients.Conclusion According to the data from the Kuzbass Registry of CVI, the main patient cohort consisted of men of pension age with IHD and CHF. Before CVI, more than a half of them had not received an optimum drug therapy and not all of them had received target lesion revascularization. Creating and analysis of Registries of CHI patients is an effective method for identifying existing problems in patient management before CVI and for optimizing their subsequent follow-up and treatment.
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Affiliation(s)
- N B Lebedeva
- Federal State Budgetary Institution "Research Institute for Complex Issues of Cardiovascular Diseases", Sosnoviy blvd, 6, Kemerovo, 650002, Russian Federation
| | - I V Talibullin
- Federal State Budgetary Institution "Research Institute for Complex Issues of Cardiovascular Diseases", Sosnoviy blvd, 6, Kemerovo, 650002, Russian Federation
| | - T B Temnikova
- Federal State Budgetary Institution "Research Institute for Complex Issues of Cardiovascular Diseases", Sosnoviy blvd, 6, Kemerovo, 650002, Russian Federation
| | - S E Mamchur
- Federal State Budgetary Institution "Research Institute for Complex Issues of Cardiovascular Diseases", Sosnoviy blvd, 6, Kemerovo, 650002, Russian Federation
| | - O L Barbarash
- Federal State Budgetary Institution "Research Institute for Complex Issues of Cardiovascular Diseases", Sosnoviy blvd, 6, Kemerovo, 650002, Russian Federation
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Holtzman JN, Wadhera RK, Choi E, Zhao T, Secemsky EA, Fraiche AM, Shen C, Kramer DB. Trends in utilization and spending on remote monitoring of pacemakers and implantable cardioverter-defibrillators among Medicare beneficiaries. Heart Rhythm 2020; 17:1917-1921. [PMID: 32526349 DOI: 10.1016/j.hrthm.2020.05.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/29/2020] [Accepted: 05/31/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND National trends and costs associated with remote and in-office interrogations of pacemakers and implantable cardioverter-defibrillators (ICDs) have not been previously described. OBJECTIVE The purpose of this study was to evaluate utilization and Medicare spending for remote monitoring and in-office interrogations for pacemakers and ICDs. METHODS We performed a retrospective cohort study of claims and spending for remote and in-office interrogations of pacemakers and ICDs for Medicare fee-for-service beneficiaries from 2012 to 2015. Aggregate and per-beneficiary claims and spending were calculated for each device type. RESULTS Among all patients, 41.9% were female and the mean age was 78.3 years. From 2012 to 2015, remote monitoring utilization increased sharply. Aggregate professional remote monitoring claims for pacemakers increased by 61.3% and for ICDs by 5.6%, with an increase in technical claims (combined for pacemakers and ICDs) of 32.8%. Spending on all remote and in-office interrogations for these devices totaled $160 million per year, with remote costs increasing nearly 25% from $45.4 million in 2012 to $56.7 million in 2015. At the beneficiary level, remote interrogations increased for pacemakers from 0.6 to 0.9 per year, and for ICDs from 1.3 to 1.4 per year, whereas in-office interrogations decreased from 2.8 to 2.7 per year and from 3.0 to 2.9 per year, respectively. Beneficiary-level analysis revealed increased expenditures on remote interrogation offset by decreases in in-office expenditures, with total annual spending decreasing by $2 and $5 per beneficiary, respectively. CONCLUSION Remote monitoring utilization increased substantially from 2012 to 2015, whereas annual costs per beneficiary decreased.
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Affiliation(s)
- Jessica N Holtzman
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Eunhee Choi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Tianyi Zhao
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Ariane M Fraiche
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Changyu Shen
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Daniel B Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Akella K, Murtaza G, Della Rocca DG, Kodwani N, Gopinathannair R, Natale A, Lakkireddy D. Implantable loop recorders for cardiac dysrhythmia monitoring. Future Cardiol 2020; 16:725-733. [PMID: 32583678 DOI: 10.2217/fca-2020-0035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Incorporation of technological advances in healthcare delivery has played a foundational role in development of modern healthcare. With the use of wireless transmission in conjunction with digitization of electrocardiography, continuous monitoring strategies have redefined our approach to dysrhythmia. These devices show promising results in evolving implantable loop recorder technology. In this review, we summarize the history of remote monitoring, indications for loop recorders, devices available, evidence for specific devices and anticipated studies.
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Affiliation(s)
- Krishna Akella
- Kansas City Heart Rhythm Institute (KCHRI), HCA Midwest Health Heart and Vascular Institute Overland Park, KS 66211, USA
| | - Ghulam Murtaza
- Kansas City Heart Rhythm Institute (KCHRI), HCA Midwest Health Heart and Vascular Institute Overland Park, KS 66211, USA
| | | | - Naresh Kodwani
- Overland Park Regional Medical Center, Department of Internal Medicine Overland Park, KS 66215, USA
| | - Rakesh Gopinathannair
- Kansas City Heart Rhythm Institute (KCHRI), HCA Midwest Health Heart and Vascular Institute Overland Park, KS 66211, USA
| | - Andrea Natale
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX 78705, USA
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute (KCHRI), HCA Midwest Health Heart and Vascular Institute Overland Park, KS 66211, USA
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Hummel JP, Leipold RJ, Amorosi SL, Bao H, Deger KA, Jones PW, Kansal AR, Ott LS, Stern S, Stein K, Curtis JP, Akar JG. Outcomes and costs of remote patient monitoring among patients with implanted cardiac defibrillators: An economic model based on the PREDICT RM database. J Cardiovasc Electrophysiol 2019; 30:1066-1077. [PMID: 30938894 PMCID: PMC6850124 DOI: 10.1111/jce.13934] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 01/08/2023]
Abstract
Background Remote monitoring of implantable cardioverter‐defibrillators has been associated with reduced rates of all‐cause rehospitalizations and mortality among device recipients, but long‐term economic benefits have not been studied. Methods and Results An economic model was developed using the PREDICT RM database comparing outcomes with and without remote monitoring. The database included patients ages 65 to 89 who received a Boston Scientific device from 2006 to 2010. Parametric survival equations were derived for rehospitalization and mortality to predict outcomes over a maximum time horizon of 25 years. The analysis assessed rehospitalization, mortality, and the cost‐effectiveness (expressed as the incremental cost per quality‐adjusted life year) of remote monitoring versus no remote monitoring. Remote monitoring was associated with reduced mortality; average life expectancy and average quality‐adjusted life years increased by 0.77 years and 0.64, respectively (6.85 life years and 5.65 quality‐adjusted life years). When expressed per patient‐year, remote monitoring patients had fewer subsequent rehospitalizations (by 0.08 per patient‐year) and lower hospitalization costs (by $554 per patient year). With longer life expectancies, remote monitoring patients experienced an average of 0.64 additional subsequent rehospitalizations with increased average lifetime hospitalization costs of $2784. Total costs of outpatient and physician claims were higher with remote monitoring ($47 515 vs $42 792), but average per patient‐year costs were lower ($6232 vs $6244). The base‐case incremental cost‐effectiveness ratio was $10 752 per quality‐adjusted life year, making remote monitoring high‐value care. Conclusion Remote monitoring is a cost‐effective approach for the lifetime management of patients with implantable cardioverter‐defibrillators.
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Affiliation(s)
- James P Hummel
- Division of Cardiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | | - Haikun Bao
- Yale University School of Medicine and Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; and on behalf of the NCDR
| | | | - Paul W Jones
- Boston Scientific Corporation, Marlborough, Massachusetts
| | | | - Lesli S Ott
- Yale University School of Medicine and Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; and on behalf of the NCDR
| | | | - Kenneth Stein
- Boston Scientific Corporation, Marlborough, Massachusetts
| | - Jeptha P Curtis
- Yale University School of Medicine and Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; and on behalf of the NCDR
| | - Joseph G Akar
- Yale University School of Medicine and Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; and on behalf of the NCDR
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Impact of remote monitoring on clinical events and associated health care utilization: A nationwide assessment. Heart Rhythm 2016; 13:2279-2286. [DOI: 10.1016/j.hrthm.2016.08.024] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Indexed: 11/20/2022]
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13
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Use of remote monitoring in the management of ICD end-of-life: Data from the DECODE registry. Int J Cardiol 2016; 221:430-2. [DOI: 10.1016/j.ijcard.2016.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/03/2016] [Indexed: 12/29/2022]
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Mauf S, Jentzsch T, Laberke PJ, Thali MJ, Bartsch C. Why We Need Postmortem Analysis of Cardiac Implantable Electronic Devices. J Forensic Sci 2016; 61:988-92. [DOI: 10.1111/1556-4029.13075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 06/17/2015] [Accepted: 08/30/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Sabrina Mauf
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine (ZIFM); University of Zurich; Winterthurerstrasse 190/52 8057 Zürich Switzerland
| | - Thorsten Jentzsch
- Division of Trauma Surgery, Department of Surgery; University Hospital Zurich; Raemistrasse 100 8091 Zurich Switzerland
| | - Patrick J. Laberke
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine (ZIFM); University of Zurich; Winterthurerstrasse 190/52 8057 Zürich Switzerland
| | - Michael J. Thali
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine (ZIFM); University of Zurich; Winterthurerstrasse 190/52 8057 Zürich Switzerland
| | - Christine Bartsch
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine (ZIFM); University of Zurich; Winterthurerstrasse 190/52 8057 Zürich Switzerland
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VARMA NIRAJ, EPSTEIN ANDREWE, SCHWEIKERT ROBERT, MICHALSKI JUSTIN, LOVE CHARLESJ. Role of Automatic Wireless Remote Monitoring Immediately Following ICD Implant: The Lumos-T Reduces Routine Office Device Follow-Up Study (TRUST) Trial. J Cardiovasc Electrophysiol 2016; 27:321-6. [DOI: 10.1111/jce.12895] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/21/2015] [Accepted: 12/02/2015] [Indexed: 01/21/2023]
Affiliation(s)
- NIRAJ VARMA
- Heart and Vascular Institute; Cleveland Clinic; Cleveland Ohio USA
| | - ANDREW E. EPSTEIN
- Department of Cardiology; University of Pennsylvania; Pennsylvania USA
| | | | | | - CHARLES J. LOVE
- Department of Cardiology; New York University Langone Medical Center; New York New York USA
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VARMA NIRAJ, RICCI RENATOPIETRO. Impact of Remote Monitoring on Clinical Outcomes. J Cardiovasc Electrophysiol 2015; 26:1388-95. [DOI: 10.1111/jce.12829] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 08/14/2015] [Accepted: 08/16/2015] [Indexed: 11/29/2022]
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Varma N, Piccini JP, Snell J, Fischer A, Dalal N, Mittal S. The Relationship Between Level of Adherence to Automatic Wireless Remote Monitoring and Survival in Pacemaker and Defibrillator Patients. J Am Coll Cardiol 2015; 65:2601-2610. [DOI: 10.1016/j.jacc.2015.04.033] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/23/2015] [Accepted: 04/07/2015] [Indexed: 11/25/2022]
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HRS Expert Consensus Statement on remote interrogation and monitoring for cardiovascular implantable electronic devices. Heart Rhythm 2015; 12:e69-100. [PMID: 25981148 DOI: 10.1016/j.hrthm.2015.05.008] [Citation(s) in RCA: 364] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Indexed: 11/23/2022]
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Migowski A, Ribeiro AL, Carvalho MS, Azevedo VMP, Chaves RBM, Hashimoto LDA, Xavier CDA, Xavier RMDA. Seven years of use of implantable cardioverter-defibrillator therapies: a nationwide population-based assessment of their effectiveness in real clinical settings. BMC Cardiovasc Disord 2015; 15:22. [PMID: 25888219 PMCID: PMC4364497 DOI: 10.1186/s12872-015-0016-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 02/27/2015] [Indexed: 11/10/2022] Open
Abstract
Background The efficacy of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D) therapy has already been established in clinical trials but their effectiveness in several clinical settings remains undetermined. This study aimed to assess the effectiveness of ICD and CRT-D therapies within the Brazilian National Health System (SUS). Methods All patients who underwent ICD or CRT-D implantation within the SUS from 2001 to 2007 were included in the study. We compared estimated Kaplan-Meier survival curves using the Peto’s test. Prognostic factors were selected using Cox’s models. Results There were included 3,295 patients in the ICD group and 681 patients in the CRT-D group. Cardiac causes accounted for 79% of all deaths in both groups and Chagas’ heart disease accounted for 31% of these deaths. In the CRT-D group, survival significantly decreased around the fourth year of follow-up, with a decrease from 59.5% to 38.3% in 5.5 months. Transvenous implantation technique was used in 62% of CRT-D patients. In-hospital case-fatality rates were higher in those undergoing surgical implantation (5.3%) than those undergoing transvenous implantation (1.6%) (p = 0.02). Conclusions The results show that short-term, medium-term and long-term effectiveness of ICD therapy appears to be similar to that evidenced in clinical trials. In the CRT-D group, in-hospital case-fatality and 30-day case-fatality were higher than those reported in other studies. Surgical epicardial implantation technique was performed in this group at a higher frequency than that reported in the literature and was associated with poorer short-term prognosis.
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Affiliation(s)
- Arn Migowski
- Instituto Nacional de Cardiologia - INC (National Institute of Cardiology, Ministry of Health), Coordenação de Ensino e Pesquisa, Divisão de Saúde Coletiva, rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil.
| | - Antonio Luiz Ribeiro
- University Hospital and School of Medicine, Federal University of Minas Gerais (UFMG), Minas Gerais, Brazil.
| | | | - Vitor Manuel Pereira Azevedo
- Instituto Nacional de Cardiologia - INC (National Institute of Cardiology, Ministry of Health), Coordenação de Ensino e Pesquisa, Divisão de Saúde Coletiva, rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil.
| | - Rogério Brant Martins Chaves
- Instituto Nacional de Cardiologia - INC (National Institute of Cardiology, Ministry of Health), Coordenação de Ensino e Pesquisa, Divisão de Saúde Coletiva, rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil.
| | | | | | - Regina Maria de Aquino Xavier
- Instituto Nacional de Cardiologia - INC (National Institute of Cardiology, Ministry of Health), Coordenação de Ensino e Pesquisa, Divisão de Saúde Coletiva, rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil.
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Abstract
Cardiac implantable electronic devices (CIEDs) store clinically valuable, time-sensitive information regarding system integrity, arrhythmias, and heart failure parameters. Remote monitoring has impacted clinical practice by reducing scheduled office visits, providing protocols for device recalls and advisories, and facilitating the management of unscheduled encounters. The successful implementation of remote monitoring into clinical practice requires a new work flow and additional staff; the use of the electronic medical record to manage the data emanating from CIEDs poses an additional challenge. Solutions to these issues are discussed, and projections are made regarding the management of CIEDs in a modern electrophysiology practice.
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Similarities and differences in patient characteristics between heart failure registries versus clinical trials. Curr Heart Fail Rep 2014; 10:373-9. [PMID: 23943315 DOI: 10.1007/s11897-013-0152-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Acute and chronic heart failure results in significant morbidity and mortality to patients and is a major concern for the healthcare systems. Various randomized controlled trials have demonstrated an improvement in morbidity and mortality for patients with heart failure. However, the findings of these trials are often applicable to a limited population. Several large-scale registries are now shedding insight as to the treatment, outcomes, and follow-up of patients in a real-life clinical setting. The objective of this review is to examine some of the heart failure therapies, such as cardiac resynchronization therapy, implantable cardioverter defibrillators and medications, in the context of randomized trials versus clinical registries. This review will also identify how registries are improving patient outcomes and how they are uncovering differences and gaps in treatment in non-randomized trial settings.
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Varma N, Michalski J, Stambler B, Pavri BB. Superiority of automatic remote monitoring compared with in-person evaluation for scheduled ICD follow-up in the TRUST trial - testing execution of the recommendations. Eur Heart J 2014; 35:1345-52. [PMID: 24595864 PMCID: PMC4028610 DOI: 10.1093/eurheartj/ehu066] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Aims To test recommended implantable cardioverter defibrillator (ICD) follow-up methods by ‘in-person evaluations’ (IPE) vs. ‘remote Home Monitoring’ (HM). Methods and results ICD patients were randomized 2:1 to automatic HM or to Conventional monitoring, with follow-up checks scheduled at 3, 6, 9, 12, and 15 months post-implant. Conventional patients were evaluated with IPE only. Home Monitoring patients were assessed remotely only for 1 year between 3 and 15 month evaluations. Adherence to follow-up was measured. HM and Conventional patients were similar (age 63 years, 72% male, left ventricular ejection fraction 29%, primary prevention 73%, DDD 57%). Conventional management suffered greater patient attrition during the trial (20.1 vs. 14.2% in HM, P = 0.007). Three month follow-up occurred in 84% in both groups. There was 100% adherence (5 of 5 checks) in 47.3% Conventional vs. 59.7% HM (P < 0.001). Between 3 and 15 months, HM exhibited superior (2.2×) adherence to scheduled follow-up [incidence of failed follow up was 146 of 2421 (6.0%) in HM vs. 145 of 1098 (13.2%) in Conventional, P < 0.001] and punctuality. In HM (daily transmission success rate median 91%), transmission loss caused only 22 of 2275 (0.97%) failed HM evaluations between 3 and 15 months; others resulted from clinic oversight. Overall IPE failure rate in Conventional [193 of 1841 (10.5%) exceeded that in HM [97 of 1484 (6.5%), P < 0.001] by 62%, i.e. HM patients remained more loyal to IPE when this was mandated. Conclusion Automatic remote monitoring better preserves patient retention and adherence to scheduled follow-up compared with IPE. Clinical trial registration NCT00336284.
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Affiliation(s)
- Niraj Varma
- J2-2 Cardiac Pacing and Electrophysiology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | | | - Bruce Stambler
- Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Behzad B Pavri
- Jefferson Hospital, 111 South 11th Street, Philadelphia, PA 19107, USA
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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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Follow-up of patients with new cardiovascular implantable electronic devices: is adherence to the experts' recommendations associated with improved outcomes? Heart Rhythm 2013; 10:1127-33. [PMID: 23773989 DOI: 10.1016/j.hrthm.2013.06.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND A 2008 expert consensus statement recommended an in-person follow-up visit between 2 and 12 weeks after the placement of a new cardiovascular implantable electronic device (CIED). OBJECTIVE To assess outcomes associated with adherence to the experts' recommendations. METHODS By using data from the National Cardiovascular Data Registry's (NCDR) ICD Registry linked to Medicare claims, we studied the association between follow-up within 2-12 weeks after CIED placement between January 1, 2005, and September 30, 2008, and all-cause mortality and risk of readmission within 1 year. RESULTS Compared with patients who did not receive the recommended follow-up (n = 43,060), those who did (n = 30,256) were more likely to be older, white, to have received a cardiac resynchronization therapy-defibrillator device, to have more advanced heart failure symptoms, and to have nonischemic dilated cardiomyopathy. In Cox proportional hazards models adjusted for patient demographic and clinical factors, mortality was lower (hazard ratio [HR] 0.93; 95% confidence interval [CI] 0.88-0.98; P = .005) but cardiovascular readmission was higher (HR 1.04; 95% CI 1.01-1.08; P = .012) among patients who received initial follow-up within 2-12 weeks after CIED placement compared with those who did not. There was no association between CIED follow-up and readmission for heart failure (HR 1.00; 95% CI 0.96-1.05; P = .878) or device-related infection (HR 1.22; 95% CI 0.98-1.51; P = .075). CONCLUSIONS Follow-up within 2-12 weeks after CIED placement was independently associated with improved survival but increased cardiovascular readmission. Quality improvement initiatives designed to increase adherence to experts' recommendations may be warranted.
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Slotwiner D, Wilkoff B. Cost efficiency and reimbursement of remote monitoring: a US perspective. Europace 2013; 15 Suppl 1:i54-i58. [DOI: 10.1093/europace/eut109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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