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Kratka A, Rotering TL, Raitt MH, Whooley MA, Dhruva SS. Informational letters or postcards to initiate remote monitoring among veterans with pacemakers and implantable cardioverter-defibrillators: A randomized, controlled trial. Pacing Clin Electrophysiol 2024; 47:642-649. [PMID: 38556540 DOI: 10.1111/pace.14912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/04/2023] [Accepted: 12/10/2023] [Indexed: 04/02/2024]
Abstract
BACKGROUND Remote monitoring (RM) of pacemakers and implantable cardioverter-defibrillators (ICDs) is a Class 1, Level of Evidence A recommendation because of its multitude of clinical benefits. However, RM adherence rates are suboptimal, precluding patients from achieving these benefits. There is a need for direct-to-patient efforts to improve adherence. METHODS In this national randomized, controlled trial conducted in the Veterans Health Administration (VHA), 2120 patients with a pacemaker or ICD who had not sent an RM transmission for ≥1 year (and usually ≥3 years) while under VHA care for their device were randomly assigned to be mailed a postcard (n = 1076) or a detailed letter (n = 1044). The postcard described what RM does and its key benefits (reduced mortality and fewer in-person visits). The letter provided a similar message but included more details about RM benefits and the process. The primary outcome was an RM transmission sent within 90 days of mailing, and a secondary outcome was an RM transmission sent within 365 days. RESULTS The primary outcome was achieved in 121 (11.3%) in the postcard and 96 patients (9.2%) in the letter group (p = .12). The secondary outcome was achieved in 266 (24.7%) and 239 (22.9%), respectively (p = .32). CONCLUSIONS This randomized trial showed no significant difference in the proportion of chronically non-adherent patients who sent an RM transmission after receiving a low-cost postcard or a detailed, higher-cost letter encouraging their participation in RM. However, as only a minority of patients responded to either, further work is needed to engage patients in the life-saving benefits of RM.
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Affiliation(s)
- Allison Kratka
- Section of Cardiology, Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Thomas L Rotering
- Section of Cardiology, Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco School of Medicine, San Francisco, United States
| | - Merritt H Raitt
- Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Knight Cardiovascular Institute, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Mary A Whooley
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco School of Medicine, San Francisco, United States
- Section of General Internal Medicine, Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Sanket S Dhruva
- Section of Cardiology, Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco School of Medicine, San Francisco, United States
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Seo J, Alhuarrat MAD, Krishnan S, Saralidze T, Lim H, Chen B, Flomenbaum D, Naser A, Kharawala A, Apple SJ, Ferrick N, Chudow J, Di Biase L, Fisher JD, Krumerman A, Ferrick KJ. Utilization of the remote monitoring of cardiac implantable electronic devices in a diverse demographic cohort: Insights from a single-center observation. Pacing Clin Electrophysiol 2024; 47:185-194. [PMID: 38010836 DOI: 10.1111/pace.14883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/29/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Despite its clinical benefits, patient compliance to remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) varies and remains under-studied in diverse populations. OBJECTIVE We sought to evaluate RM compliance, clinical outcomes, and identify demographic and socioeconomic factors affecting RM in a diverse urban population in New York. METHODS This retrospective cohort study included patients enrolled in CIED RM at Montefiore Medical Center between December 2017 and May 2022. RM compliance was defined as the percentage of days compliant to RM transmission divided by the total prescribed days of RM. Patients were censored when they were lost to follow-up or at the time of death. The cohorts were categorized into low (≤30%), intermediate (31-69%), and high (≥70%) RM compliance groups. Statistical analyses were conducted accordingly. RESULTS Among 853 patients, median RM compliance was 55%. Age inversely affected compliance (p < .001), and high compliance was associated with guideline-directed medical therapy (GDMT) usage and implantable cardioverter defibrillator (ICD)/cardiac resynchronization defibrillator (CRTD) devices. The low-compliance group had a higher mortality rate and fewer regular clinic visits (p < .001) than high-compliance group. Socioeconomic factors did not significantly impact compliance, while Asians showed higher compliance compared with Whites (OR 3.67; 95% CI 1.08-12.43; p = .04). Technical issues were the main reason for non-compliance. CONCLUSION We observed suboptimal compliance to RM, which occurred most frequently in older patients. Clinic visit compliance, optimal medical therapy, and lower mortality were associated with higher compliance, whereas insufficient understanding of RM usage was the chief barrier to compliance.
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Affiliation(s)
- Jiyoung Seo
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Suraj Krishnan
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Tinatin Saralidze
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Hyomin Lim
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Brett Chen
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David Flomenbaum
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ahmad Naser
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amrin Kharawala
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Samuel J Apple
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Neal Ferrick
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jay Chudow
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - John D Fisher
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrew Krumerman
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kevin J Ferrick
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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McLaughlin MM, Raitt MH, Tarasovsky G, Whooley MA, Dhruva SS. Informational Postcards Increase Engagement with Remote Monitoring Among Veterans with Pacemakers and Implantable Cardioverter-Defibrillators: a Stepped-Wedge Randomized Controlled Trial. J Gen Intern Med 2024; 39:87-96. [PMID: 38252247 PMCID: PMC10937872 DOI: 10.1007/s11606-023-08478-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 10/12/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Remote monitoring (RM) of pacemakers and implantable cardioverter-defibrillators (ICDs) reduces morbidity and mortality. However, many patients are not adherent to RM. OBJECTIVE To test the effect of informational postcards on RM adherence. DESIGN/PATIENTS Stepped-wedge randomized controlled trial among Veterans with pacemakers and ICDs. INTERVENTION In wave 1, Veterans who had sent at least 1 transmission within the past 2 years but had become non-adherent were randomly assigned to receive a postcard or no postcard. Those receiving postcards were randomized to 1 of 2 messages: (1) a"warning" postcard describing risks of non-adherence or (2) an "encouraging" postcard describing benefits of adherence. In wave 2, Veterans who had either not received a postcard in wave 1 or had since become non-adherent were mailed a postcard (again, randomized to 1 of 2 messages). Patients who did not send an RM transmission within 1 month were mailed a second, identical postcard. MAIN MEASURES Transmission within 70 days. KEY RESULTS Overall, 6351 Veterans were included. In waves 1 and 2, postcards were mailed to 5657 Veterans (2821 "warning" messages and 2836 "encouraging" messages). Wave 1 included 2178 Veterans as controls (i.e., not mailed a postcard), some of whom received a postcard in wave 2 if they remained non-adherent. In wave 2, 3473 postcards were sent. Of the 5657 patients mailed a postcard, 2756 (48.7%) sent an RM transmission within 70 days, compared to 530 (24.3%) of 2178 controls (absolute difference 24.4%, 95% confidence interval [CI] 22.2%, 26.6%). Of those who sent a transmission, 71.8% did so after the first postcard. Transmission rates at 70 days did not significantly differ between "warning" and "encouraging" messages (odds ratio 1.04, 95% CI 0.92, 1.18). CONCLUSIONS Informational postcards led to a 24.4% absolute increase in adherence at 70 days among Veterans with pacemakers and ICDs who were non-adherent to RM.
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Affiliation(s)
- Megan M McLaughlin
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Merritt H Raitt
- Portland Veterans Affairs Health Care System, Portland, OR, USA
| | - Gary Tarasovsky
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Mary A Whooley
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Sanket S Dhruva
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA.
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Rotering TL, Hysong SJ, Williams KE, Raitt MH, Whooley MA, Dhruva SS. Strategies to enhance remote monitoring adherence among patients with cardiovascular implantable electronic devices. Heart Rhythm O2 2023; 4:794-804. [PMID: 38204458 PMCID: PMC10774668 DOI: 10.1016/j.hroo.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
Background Remote monitoring (RM) of patients with cardiovascular implantable electronic devices (CIEDs) (pacemakers and implantable cardioverter-defibrillators) has a Class 1, Level of Evidence A Heart Rhythm Society recommendation. Yet RM adherence varies widely across settings, and factors associated with variation are not understood. Objective The purpose of this study was to identify strategies for supporting RM across Veterans Health Administration (VHA) facilities. Methods In a national evaluation, we surveyed and interviewed 27 nurses, medical instrument technicians, and advanced practice providers across 26 VHA facilities (following approximately 15,000 CIED patients). Participants were selected based on overall patient adherence by facility, which ranged from 46%-96%. Questions covered RM adherence strategies, manufacturer resources, organizational characteristics, and workflows for optimizing adherence. Results All clinicians reported that RM adherence was extremely important (53.8%), very important (34.6%), or important (11.5%) for improving patient outcomes. High performing facilities prioritized consistent patient education about RM and evaluated nonadherence using dashboards and manufacturer web sites. High performing facilities instituted clear standard operating procedures that defined staff responsibilities and facilitated efficient contact with nonadherent patients and then family members by phone and then mail. Clinicians based at high performing facilities spent twice as many hours per week (9.1) on average managing RM adherence compared to other facilities (4.5). Effective communication (internally and with non-VHA care partners) and use of CIED manufacturer resources were essential. Facilities that were not high performing rarely used these strategies. Conclusion Clinicians can support high RM adherence by emphasizing patient education, regularly assessing and addressing nonadherence using staff protocols, and engaging CIED manufacturers.
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Affiliation(s)
- Thomas L. Rotering
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Section of Cardiology, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California
| | - Sylvia J. Hysong
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Katherine E. Williams
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Merritt H. Raitt
- Portland Veterans Affairs Health Care System, Portland, Oregon
- Knight Cardiovascular Institute, Oregon Health and Sciences University, Portland, Oregon
| | - Mary A. Whooley
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Sanket S. Dhruva
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Section of Cardiology, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California
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Dhruva SS, Raitt MH, Munson S, Moore HJ, Steele P, Rosman L, Whooley MA. Barriers and Facilitators Associated With Remote Monitoring Adherence Among Veterans With Pacemakers and Implantable Cardioverter-Defibrillators: Qualitative Cross-Sectional Study. JMIR Cardio 2023; 7:e50973. [PMID: 37988153 DOI: 10.2196/50973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/07/2023] [Accepted: 10/12/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The Heart Rhythm Society strongly recommends remote monitoring (RM) of cardiovascular implantable electronic devices (CIEDs) because of the clinical outcome benefits to patients. However, many patients do not adhere to RM and, thus, do not achieve these benefits. There has been limited study of patient-level barriers and facilitators to RM adherence; understanding patient perspectives is essential to developing solutions to improve adherence. OBJECTIVE We sought to identify barriers and facilitators associated with adherence to RM among veterans with CIEDs followed by the Veterans Health Administration. METHODS We interviewed 40 veterans with CIEDs regarding their experiences with RM. Veterans were stratified into 3 groups based on their adherence to scheduled RM transmissions over the past 2 years: 6 fully adherent (≥95%), 25 partially adherent (≥65% but <95%), and 9 nonadherent (<65%). As the focus was to understand challenges with RM adherence, partially adherent and nonadherent veterans were preferentially weighted for selection. Veterans were mailed a letter stating they would be called to understand their experiences and perspectives of RM and possible barriers, and then contacted beginning 1 week after the letter was mailed. Interviews were structured (some questions allowing for open-ended responses to dive deeper into themes) and focused on 4 predetermined domains: knowledge of RM, satisfaction with RM, reasons for nonadherence, and preferences for health care engagement. RESULTS Of the 44 veterans contacted, 40 (91%) agreed to participate. The mean veteran age was 75.3 (SD 7.6) years, and 98% (39/40) were men. Veterans had been implanted with their current CIED for an average of 4.4 (SD 2.8) years. A total of 58% (23/40) of veterans recalled a discussion of home monitoring, and 45% (18/40) reported a good understanding of RM; however, when asked to describe RM, their understanding was sometimes incomplete or not correct. Among the 31 fully or partially adherent veterans, nearly all were satisfied with RM. Approximately one-third recalled ever being told the results of a remote transmission. Among partially or nonadherent veterans, only one-fourth reported being contacted by a Department of Veterans Affairs health care professional regarding not having sent a remote transmission; among those who had troubleshooted to ensure they could send remote transmissions, they often relied on the CIED manufacturer for help (this experience was nearly always positive). Most nonadherent veterans felt more comfortable engaging in RM if they received more information or education. Most veterans were interested in being notified of a successful remote transmission and learning the results of their remote transmissions. CONCLUSIONS Veterans with CIEDs often had limited knowledge about RM and did not recall being contacted about nonadherence. When they were contacted and troubleshooted, the experience was positive. These findings provide opportunities to optimize strategies for educating and engaging patients in RM.
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Affiliation(s)
- Sanket S Dhruva
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Merritt H Raitt
- Division of Cardiology, Department of Specialty Care, Portland Veterans Affairs Health Care System, Portland, OR, United States
| | - Scott Munson
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Hans J Moore
- Cardiology Section, Medical Service, Washington DC Veterans Affairs Medical Center, Washington, DC, United States
| | - Pamela Steele
- Cardiology Section, Medical Service, Washington DC Veterans Affairs Medical Center, Washington, DC, United States
| | - Lindsey Rosman
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mary A Whooley
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Sánchez-González JL, Almenar-Bonet L, Moreno-Segura N, Gurdiel-Álvarez F, Atef H, Sillero-Sillero A, López-Vilella R, Santolalla-Arnedo I, Juárez-Vela R, Tejada-Garrido CI, Marques-Sule E. Effects of COVID-19 Lockdown on Heart Failure Patients: A Quasi-Experimental Study. J Clin Med 2023; 12:7090. [PMID: 38002701 PMCID: PMC10672384 DOI: 10.3390/jcm12227090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION The COVID-19 lockdown has been associated with reduced levels of physical activity, quality of life, and sleep quality, but limited evidence exists for its impact on heart failure patients. This study examined the influence of the COVID-19 lockdown on these aspects in heart failure patients, with specific comparisons by age and sex. METHODS A quasi-experimental cross-sectional study of patients with heart failure was conducted. The assessment involved two time points: during the COVID-19 lockdown (March to June 2020) and post-lockdown (July to October 2020). A total of 107 HF patients participated, with assessments of overall PA (using the International Physical Activity Questionnaire), QoL (employing the Cantril Ladder of Life), and sleep quality (utilizing the Minimal Insomnia Symptom Scale) conducted during and after the COVID-19 lockdown. RESULTS HF patients reported lower levels of total PA (p = 0.001) and walking PA (p < 0.0001) during lockdown than after lockdown, whilst no differences were observed in QoL nor sleep quality. In addition, both younger and older patients reported lower walking PA and total PA during lockdown than after lockdown, while older patients reported lower QoL during lockdown than after lockdown. Moreover, both men and women reported lower walking PA and total PA during lockdown than after lockdown, whilst women reported lower QoL. CONCLUSIONS HF patients need improved PA programs during lockdowns, as these programs can elevate PA levels and enhance QoL, especially when faced with the risk of decompensation during health crises.
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Affiliation(s)
| | - Luis Almenar-Bonet
- Heart Failure and Transplantation Unit, Department of Cardiology, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain; (L.A.-B.); (R.L.-V.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28933 Madrid, Spain
- Department of Medicine, Universidad de Valencia, 46010 Valencia, Spain
| | - Noemí Moreno-Segura
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain;
| | - Francisco Gurdiel-Álvarez
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Reha-Bilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain
| | - Hady Atef
- School of Allied Health Professions (SAHP), Keele University, Keele, Staffordshire ST5 5BG, UK;
| | - Amalia Sillero-Sillero
- University School of Nursing and Physiotherapy “Gimbernat”, Autonomous University of Barcelona, Avd de la Generalitat, 202-206, Sant Cugat del Vallès, 08174 Barcelona, Spain;
- ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra Affiliated, 08018 Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Raquel López-Vilella
- Heart Failure and Transplantation Unit, Department of Cardiology, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain; (L.A.-B.); (R.L.-V.)
| | - Iván Santolalla-Arnedo
- Nursing Department, Faculty of Health Sciences, Research Group GRUPAC, University of La Rioja, 26004 Logroño, Spain; (R.J.-V.); (C.I.T.-G.)
| | - Raúl Juárez-Vela
- Nursing Department, Faculty of Health Sciences, Research Group GRUPAC, University of La Rioja, 26004 Logroño, Spain; (R.J.-V.); (C.I.T.-G.)
| | - Clara Isabel Tejada-Garrido
- Nursing Department, Faculty of Health Sciences, Research Group GRUPAC, University of La Rioja, 26004 Logroño, Spain; (R.J.-V.); (C.I.T.-G.)
| | - Elena Marques-Sule
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
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Hillmann HAK, Hansen C, Przibille O, Duncker D. The patient perspective on remote monitoring of implantable cardiac devices. Front Cardiovasc Med 2023; 10:1123848. [PMID: 36937908 PMCID: PMC10017432 DOI: 10.3389/fcvm.2023.1123848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/31/2023] [Indexed: 03/06/2023] Open
Abstract
Aims Remote monitoring for patients with cardiac implantable electronic devices (CIEDs) is well established in clinical routine and recommended by current guidelines. Nevertheless, data regarding patients' perceptions are limited. Therefore, this study aims to analyze the patient perspectives on the remote monitoring of cardiac devices in Germany. Methods and results Patients with CIEDs and remote monitoring of all current manufacturers from three German centers were asked to participate. The questionnaire consisted of 37 questions regarding the patients' individual use and perspectives on remote monitoring. Survey participation was anonymous and on a voluntary basis. A total of 617 patients (71.6% men) participated. Most patients reported feeling well informed (69.3%) and reported having unchanged or improved coping (98.8%) since the start of remote monitoring. At least 39.7% of patients experienced technical problems regarding the transmitter, whereas most patients (60.3%) reported that they never noted technical issues. Older patients had significantly less interest than younger patients in using their own smartphones for data transfer (p < 0.001). Conclusion Patients with remote follow-up of CIED reported that they felt well informed about the remote monitoring approach. Remote monitoring can support coping with their disease. With remote monitoring, patients experienced a prolongation of intervals of in-person follow-up visits, and especially younger patients would appreciate smartphone-based data transfer of their CIEDs.
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Affiliation(s)
- Henrike A. K. Hillmann
- 1Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Claudius Hansen
- 2Heart and Vascular Center, Hospital Neu-Bethlehem, Göttingen, Germany
| | - Oliver Przibille
- 3Cardioangiologisches Centrum Bethanien (CCB), Device Clinic, Frankfurt, Germany
| | - David Duncker
- 1Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
- *Correspondence: David Duncker,
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Remote versus in-office monitoring for implantable cardioverter defibrillators: Results from a randomized pragmatic controlled study in Portugal. Rev Port Cardiol 2022; 41:987-997. [PMID: 36229282 DOI: 10.1016/j.repc.2021.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/22/2021] [Accepted: 08/13/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Remote monitoring (RM) is a safe and effective alternative to in-office conventional follow-up. OBJECTIVE We aimed to evaluate patient satisfaction with RM and its impact on healthcare resources in a population with cardiac implantable electronic devices. METHODS Randomized, pragmatic, open-label controlled trial, with adult wearers of implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy with ICD (CRT-D), eligible for the CareLink® system. Patients newly implanted or with previous conventional follow-up were randomized to RM or conventional follow-up (control), and followed for 12 months, according to the centers' practice. The number of in-office visits and adverse events were compared between groups. Patient and healthcare professionals' satisfaction with RM were described. RESULTS Of the 134 randomized patients (69 RM; 65 control, aged 60±13 years), 80% were male, 23% employed, 72% ICD wearers and 54% newly implanted. Most patients (70%) reported travel costs less than 15€/visit, and 46% daily routine interference with in-office visits. Median physician/technician time with patient was 15 min/15 min, per in-office visit. Excluding baseline and final visits, control patients had more in-office visits in total: median 1 vs. 0, p<0.001. In 81% of the in-office visits, no clinical measures were taken. There were 10 adverse events, with no differences between groups. At the final visit, 95% of RM patients considered RM easy/very easy to use, and would all prefer to maintain RM and recommend it to others. All professionals found the CareLink website easy/very easy to use and were satisfied with transmission data. CONCLUSIONS In a Portuguese population with ICD and CRT-D, RM safely reduced the burden of in-office visits, with high levels of satisfaction among patients and healthcare professionals.
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Muniyappa AN, Raitt MH, Judson GL, Shen H, Tarasovsky G, Whooley MA, Dhruva SS. Factors associated with remote monitoring adherence for cardiovascular implantable electronic devices. Heart Rhythm 2022; 19:1499-1507. [PMID: 35500792 DOI: 10.1016/j.hrthm.2022.04.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/11/2022] [Accepted: 04/22/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Professional societies strongly recommend remote monitoring (RM) of all cardiac implantable electronic devices, and higher RM adherence is associated with improved patient outcomes. However, adherence with RM is suboptimal. OBJECTIVE The purpose of this study was to better understand factors associated with RM adherence. METHODS We linked RM data from the Veterans Affairs National Cardiac Device Surveillance Program to clinical data for patients monitored between October 25, 2018, and October 24, 2020. RM adherence was defined as the percentage of days covered by an RM transmission during the study period. Patients were classified into 3 categories: complete (100% of days covered by an RM transmission), intermediate (above median in patients with <100% adherence), and low (below median in patients with <100% adherence) adherence. We used multivariable logistic regression to examine patient, device, and facility characteristics associated with adherence. RESULTS In 52,574 patients, average RM adherence was 71.9%. Only 30.9% (16,224) of patients had complete RM adherence. Black or African American patients had a lower odds of complete RM adherence than white patients (odds ratio 0.88; 95% confidence interval 0.82-0.94), and Hispanic or Latino patients had a lower odds of complete RM adherence (odds ratio 0.79; 95% confidence interval 0.70-0.89) than non-Hispanic or Latino patients. Dementia, depression, and posttraumatic stress disorder were associated with a lower odds of RM adherence. CONCLUSION There are significant disparities in RM adherence by race, ethnicity, and neuropsychiatric comorbidities. These findings can inform strategies to improve health equity and ensure that all patients with cardiac implantable electronic devices receive the evidence-based clinical benefits of RM.
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Affiliation(s)
- Anoop N Muniyappa
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Merritt H Raitt
- Knight Cardiovascular Institute, Oregon Health and Sciences University, Portland, Oregon; Portland Veterans Affairs Health Care System, Portland, Oregon
| | - Gregory L Judson
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Hui Shen
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Gary Tarasovsky
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Mary A Whooley
- Department of Medicine, University of California, San Francisco, San Francisco, California; San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Sanket S Dhruva
- Department of Medicine, University of California, San Francisco, San Francisco, California; San Francisco Veterans Affairs Health Care System, San Francisco, California.
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10
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A mobile app for improving the compliance with remote management of patients with cardiac implantable devices: a multicenter evaluation in clinical practice. J Interv Card Electrophysiol 2022; 64:257-264. [PMID: 35412167 PMCID: PMC9002029 DOI: 10.1007/s10840-022-01207-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/29/2022] [Indexed: 12/04/2022]
Abstract
Background The remote device management (RM) is recommended for patients with cardiac implantable electronic devices (CIEDs). RM underutilization is frequently driven by the lack of correct system activation. The MyLATITUDE Patient App (Boston Scientific) has been developed to encourage patient compliance with RM by providing information on communicator setup, troubleshooting, and connection status of the communicator. Methods At 14 centers, patients with CIEDs were invited to download and install the App on a mobile device. After 3 months, patients were asked to complete an ad hoc questionnaire to evaluate their experience. Results The App was proposed to 242 consecutive patients: 81 before RM activation, and 161 during follow-up. The App was successfully installed by 177 (73%) patients. The time required for activation of the communicator and the need for additional support were similar between patients who followed the indications provided by the App and those who underwent standard in-clinic training. During follow-up, notifications of lack of connection were received by 20 (11%) patients and missed transmission by 22 (12%). The median time from notification to resolution was 2 days. After 3 months, 175 (99%) communicators of the 177 patients who installed the App were in “Monitored” status versus 113 (94%) of 120 patients without the App installed (p=0.033). The use of the app made 84% of patients feel reassured. Conclusions The App was well accepted by CIED patients and offered support for communicator management and installation. Its use enabled patients to remain connected with greater continuity during follow-up.
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11
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Kramer DB, Parasidis E. Informed consent and compulsory medical device registries: ethics and opportunities. JOURNAL OF MEDICAL ETHICS 2022; 48:79-82. [PMID: 33608445 DOI: 10.1136/medethics-2020-107031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 06/12/2023]
Abstract
Many high-risk medical devices earn US marketing approval based on limited premarket clinical evaluation that leaves important questions unanswered. Rigorous postmarket surveillance includes registries that actively collect and maintain information defined by individual patient exposures to particular devices. Several prominent registries for cardiovascular devices require enrolment as a condition of reimbursement for the implant procedure, without informed consent. In this article, we focus on whether these registries, separate from their legal requirements, have an ethical obligation to obtain informed consent from enrolees, what is lost in not doing so, and the ways in which seeking and obtaining consent might strengthen postmarket surveillance in the USA.
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Affiliation(s)
- Daniel B Kramer
- Harvard Medical School, Boston, Massachusetts, USA
- Richard A. and Susan F. Smith Center in Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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12
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Variations in cardiac implantable electronic device surveillance and ancillary testing in the paediatric and congenital heart disease population: an international multi-centre survey from the Paediatric and Congenital Electrophysiology Society. Cardiol Young 2022; 32:101-105. [PMID: 34709146 DOI: 10.1017/s104795112100425x] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Expert guidance from scientific societies and regulatory agencies recommend a framework of principles for frequency of in-person evaluations and remote monitoring for patients with cardiac implantable electronic devices. However, there are limited data regarding adherence to recommendations among paediatric electrophysiologists, and there are no data regarding cardiac implantable electronic device-related ancillary testing. METHODS To assess current clinical practices for cardiac implantable electronic device in-person evaluation, remote monitoring, and cardiac implantable electronic device-related ancillary testing, the Paediatric and Congenital Electrophysiology Society members were surveyed. The main outcome measures were variations in frequency of in person evaluation, frequency of remote monitoring, and cardiac implantable electronic device-related ancillary testing. RESULTS All respondents performed in-person evaluation at least once a year, but <50% of respondents performed an in-person evaluation within 2 weeks of cardiac implantable electronic device implantation. Remote monitoring was performed every 3 months for pacemakers and implantable cardioverter defibrillators by 71 and 75% respondents, respectively. Follow-up echocardiography was performed every 2-3 years by 53% respondents for patients with >50% ventricular pacing. Majority of respondents (75%) did not perform either an exercise stress test or ambulatory Holter monitoring or chest X-ray (65%) after cardiac implantable electronic device implantation. CONCLUSION This survey identified significant practice variations in cardiac implantable electronic device in- person evaluation, remote monitoring, and ancillary testing practices among paediatric electrophysiologists. Cardiac implantable electronic device management may be optimised by development of a paediatric-specific guidelines for follow-up and ancillary testing.
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13
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Evaluation of Medicare Claims for the Development of Heart Failure Diagnostics. J Card Fail 2021; 28:756-764. [PMID: 34775112 DOI: 10.1016/j.cardfail.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although claims data provide a large and efficient source of clinical events, validation is needed prior to use in heart failure (HF) diagnostic development. METHODS AND RESULTS Data from the Multisensor Chronic Evaluations in Ambulatory Heart Failure Patients (MultiSENSE) study, used to create the HeartLogic HF diagnostic, were linked with fee-for-service (FFS) Medicare claims. Events were matched by patient ID and date, and agreement was calculated between claims primary HF diagnosis codes and study event adjudication. HF events (HFEs) were defined as inpatient visits, or outpatient visits with intravenous decongestive therapy. Diagnostic performance was measured as HFE-detection sensitivity and false-positive rate (FPR). Linkage of 791 MultiSENSE subjects returned 320 FFS patients with an average follow-up duration of 0.94 years. Although study and claims deaths matched exactly (n = 14), matching was imperfect between study hospitalizations and acute inpatient claims events. Of 239 total events, 165 study hospitalizations (69%) matched inpatient claims events, 28 hospitalizations matched outpatient claims events (12%), 14 hospitalizations were study-unique (6%), and 32 inpatient events were claims-unique (13%). Inpatient HF classification had substantial agreement with study adjudication (κ = 0.823). Diagnostic performance was not different between claims and study events (sensitivity = 75.6% vs 77.6% and FPR = 1.539 vs 1.528 alerts/patient-year). HeartLogic-detected events contributed to > 90% of the HFE costs used for evaluation. CONCLUSIONS Acceptable event matching, good agreement of claims diagnostic codes with adjudication, and equivalent diagnostic performance support the validity of using claims for HF diagnostic development.
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14
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Cunha PS, Laranjo S, Lourenço A, Rodrigues L, Cardoso I, Portugal G, Valente B, Delgado AS, Ferreira RC, Abreu A, Oliveira MM. Lockdown measures for COVID-19 outbreak and variation in physical activity in patients with heart failure and cardiac implantable devices. IJC HEART & VASCULATURE 2021; 37:100906. [PMID: 34725644 PMCID: PMC8552563 DOI: 10.1016/j.ijcha.2021.100906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/16/2021] [Accepted: 10/24/2021] [Indexed: 10/27/2022]
Abstract
Aims The present study analysed the patterns of physical activity pre-, during and post-lockdown measures for COVID-19 pandemic in patients with chronic heart failure (CHF) and cardiac implantable electronic devices (CIED) under remote monitoring (RM), and assessed the physical activity patterns during these periods. Methods The raw data from 95 patients with CHF (age 67,7 ± 15,1 years, 71,5% male) corresponding to 2238 RM transmissions of the Medtronic Carelink™ network platform was obtained. The physical exercise profiles and the impact of the lockdown measures on the physical behaviour during and after the measures were analysed. According to the level of activity duration in the pre-lockdown, lockdown and post-lockdown periods, the patterns of behaviour were identified (non-recoverees, incomplete recoverees, recoverees and full-recoverees). Conclusion RM of CHF patients with CIED using the Carelink™ network is useful for close follow-up and identification of heart failure risk status variations. After relieving the confinement measures there were two groups of patients that did not recover the previous physical activity levels. Physical inactivity in patients with CHF can have a significant impact on outcomes.
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Affiliation(s)
- Pedro Silva Cunha
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Centre, Portugal
| | - Sérgio Laranjo
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Centre, Portugal.,Cardiovascular Rehabilitation Center, Faculty of Medicine, University of Lisbon, Portugal
| | - André Lourenço
- ISEL, Instituto Superior de Engenharia de Lisboa, Portugal
| | | | - Isabel Cardoso
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Centre, Portugal
| | - Guilherme Portugal
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Centre, Portugal
| | - Bruno Valente
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Centre, Portugal
| | - Ana Sofia Delgado
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Centre, Portugal
| | - Rui Cruz Ferreira
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Centre, Portugal
| | - Ana Abreu
- Cardiovascular Rehabilitation Center, Faculty of Medicine, University of Lisbon, Portugal
| | - Mário Martins Oliveira
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Centre, Portugal.,Cardiovascular Rehabilitation Center, Faculty of Medicine, University of Lisbon, Portugal
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15
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Thomas EE, Taylor ML, Banbury A, Snoswell CL, Haydon HM, Gallegos Rejas VM, Smith AC, Caffery LJ. Factors influencing the effectiveness of remote patient monitoring interventions: a realist review. BMJ Open 2021; 11:e051844. [PMID: 34433611 PMCID: PMC8388293 DOI: 10.1136/bmjopen-2021-051844] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Our recent systematic review determined that remote patient monitoring (RPM) interventions can reduce acute care use. However, effectiveness varied within and between populations. Clinicians, researchers, and policymakers require more than evidence of effect; they need guidance on how best to design and implement RPM interventions. Therefore, this study aimed to explore these results further to (1) identify factors of RPM interventions that relate to increased and decreased acute care use and (2) develop recommendations for future RPM interventions. DESIGN Realist review-a qualitative systematic review method which aims to identify and explain why intervention results vary in different situations. We analysed secondarily 91 studies included in our previous systematic review that reported on RPM interventions and the impact on acute care use. Online databases PubMed, EMBASE and CINAHL were searched in October 2020. Included studies were published in English during 2015-2020 and used RPM to monitor an individual's biometric data (eg, heart rate, blood pressure) from a distance. PRIMARY AND SECONDARY OUTCOME MEASURES Contextual factors and potential mechanisms that led to variation in acute care use (hospitalisations, length of stay or emergency department presentations). RESULTS Across a range of RPM interventions 31 factors emerged that impact the effectiveness of RPM innovations on acute care use. These were synthesised into six theories of intervention success: (1) targeting populations at high risk; (2) accurately detecting a decline in health; (3) providing responsive and timely care; (4) personalising care; (5) enhancing self-management, and (6) ensuring collaborative and coordinated care. CONCLUSION While RPM interventions are complex, if they are designed with patients, providers and the implementation setting in mind and incorporate the key variables identified within this review, it is more likely that they will be effective at reducing acute hospital events. PROSPERO REGISTRATION NUMBER CRD42020142523.
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Affiliation(s)
- Emma E Thomas
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Monica L Taylor
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Annie Banbury
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Helen M Haydon
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Victor M Gallegos Rejas
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Innovative Technology, University of Southern Denmark, Odense, Denmark
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
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16
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Heidbuchel H, Arbelo E, D'Ascenzi F, Borjesson M, Boveda S, Castelletti S, Miljoen H, Mont L, Niebauer J, Papadakis M, Pelliccia A, Saenen J, Sanz de la Garza M, Schwartz PJ, Sharma S, Zeppenfeld K, Corrado D. Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. Part 2: ventricular arrhythmias, channelopathies, and implantable defibrillators. Europace 2021; 23:147-148. [PMID: 32596731 DOI: 10.1093/europace/euaa106] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This paper belongs to a series of recommendation documents for participation in leisure-time physical activity and competitive sports by the European Association of Preventive Cardiology (EAPC). Together with an accompanying paper on supraventricular arrhythmias, this second text deals specifically with those participants in whom some form of ventricular rhythm disorder is documented, who are diagnosed with an inherited arrhythmogenic condition, and/or who have an implanted pacemaker or cardioverter defibrillator. A companion text on recommendations in athletes with supraventricular arrhythmias is published in the European Journal of Preventive Cardiology. Since both texts focus on arrhythmias, they are the result of a collaboration between EAPC and the European Heart Rhythm Association (EHRA). The documents provide a framework for evaluating eligibility to perform sports, based on three elements, i.e. the prognostic risk of the arrhythmias when performing sports, the symptomatic impact of arrhythmias while performing sports, and the potential progression of underlying structural problems as the result of sports.
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Affiliation(s)
- Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp, University Antwerp, Wilrijkstraat 10, 2650 Antwerp, Belgium
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Mats Borjesson
- Centre for Health and Performance (CHP), Department of Food, Nutrition and Sport Sciences, Gothenburg University, Sweden.,Department of Neuroscience and Physiology, Gothenburg University, Gothenburg, Sweden
| | - Serge Boveda
- Cardiology Department, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France
| | - Silvia Castelletti
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Laboratory of Cardiovascular Genetics, Milan, Italy
| | - Hielko Miljoen
- Department of Cardiology, University Hospital Antwerp, University Antwerp, Wilrijkstraat 10, 2650 Antwerp, Belgium
| | - Lluis Mont
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St. George's University of London, London, UK.,St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Antonio Pelliccia
- National Institute of Sports Medicine, Italian National Olympic Committee, Via dei Campi Sportivi 46, Rome, Italy
| | - Johan Saenen
- Department of Cardiology, University Hospital Antwerp, University Antwerp, Wilrijkstraat 10, 2650 Antwerp, Belgium
| | | | - Peter J Schwartz
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Laboratory of Cardiovascular Genetics, Milan, Italy
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's University of London, London, UK.,St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Domenico Corrado
- Department of Cardiology, University of Padova, Padova, Italy.,Department of Pathology, University of Padova, Padova, Italy
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17
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Magnocavallo M, Bernardini A, Mariani MV, Piro A, Marini M, Nicosia A, Adduci C, Rapacciuolo A, Saporito D, Grossi S, Santarpia G, Vaccaro P, Rordorf R, Pentimalli F, Giunta G, Campari M, Valsecchi S, Lavalle C. Home delivery of the communicator for remote monitoring of cardiac implantable devices: A multicenter experience during the covid-19 lockdown. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:995-1003. [PMID: 33908052 PMCID: PMC8207054 DOI: 10.1111/pace.14251] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/25/2021] [Accepted: 04/18/2021] [Indexed: 12/20/2022]
Abstract
Background During the COVID‐19 pandemic in‐person visits for patients with cardiac implantable electronic devices should be replaced by remote monitoring (RM), in order to prevent viral transmission. A direct home‐delivery service of the RM communicator has been implemented at 49 Italian arrhythmia centers. Methods According to individual patient preference or the organizational decision of the center, patients were assigned to the home‐delivery group or the standard in‐clinic delivery group. In the former case, patients received telephone training on the activation process and use of the communicator. In June 2020, the centers were asked to reply to an ad hoc questionnaire to describe and evaluate their experience in the previous 3 months. Results RM was activated in 1324 patients: 821 (62%) received the communicator at home and the communicator was activated remotely. Activation required one additional call in 49% of cases, and the median time needed to complete the activation process was 15 min [25th‐75th percentile: 10–20]. 753 (92%) patients were able to complete the correct activation of the system. At the time when the questionnaire was completed, 743 (90%) communicators were regularly transmitting data. The service was generally deemed useful (96% of respondents) in facilitating the activation of RM during the COVID‐19 pandemic and possibly beyond. Conclusions Home delivery of the communicator proved to be a successful approach to system activation, and received positive feedback from clinicians. The increased use of a RM protocol will reduce risks for both providers and patients, while maintaining high‐quality care.
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Affiliation(s)
- Michele Magnocavallo
- Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessia Bernardini
- Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Marco Valerio Mariani
- Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Agostino Piro
- Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | | | | | - Carmen Adduci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, St. Andrea Hospital, Rome, Italy
| | - Antonio Rapacciuolo
- Cardiology Unit, Università degli Studi di Napoli Federico II, Naples, Italy
| | | | - Stefano Grossi
- Cardiology Department, Azienda Ospedaliera Ordine Mauriziano, Turin, Italy
| | - Giuseppe Santarpia
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Paola Vaccaro
- Cardiology Unit, Riuniti Hospital, P.O. Cervello, Palermo, Italy
| | - Roberto Rordorf
- Department of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | - Giuseppe Giunta
- Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | | | | | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
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18
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Duncker D, Ding WY, Etheridge S, Noseworthy PA, Veltmann C, Yao X, Bunch TJ, Gupta D. Smart Wearables for Cardiac Monitoring-Real-World Use beyond Atrial Fibrillation. SENSORS (BASEL, SWITZERLAND) 2021; 21:2539. [PMID: 33916371 PMCID: PMC8038592 DOI: 10.3390/s21072539] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 01/17/2023]
Abstract
The possibilities and implementation of wearable cardiac monitoring beyond atrial fibrillation are increasing continuously. This review focuses on the real-world use and evolution of these devices for other arrhythmias, cardiovascular diseases and some of their risk factors beyond atrial fibrillation. The management of nonatrial fibrillation arrhythmias represents a broad field of wearable technologies in cardiology using Holter, event recorder, electrocardiogram (ECG) patches, wristbands and textiles. Implementation in other patient cohorts, such as ST-elevation myocardial infarction (STEMI), heart failure or sleep apnea, is feasible and expanding. In addition to appropriate accuracy, clinical studies must address the validation of clinical pathways including the appropriate device and clinical decisions resulting from the surrogate assessed.
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Affiliation(s)
- David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, 30625 Hannover, Germany;
| | - Wern Yew Ding
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool L1 8JX, UK; (W.Y.D.); (D.G.)
| | - Susan Etheridge
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA;
| | - Peter A. Noseworthy
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55902, USA; (P.A.N.); (X.Y.)
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Christian Veltmann
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, 30625 Hannover, Germany;
| | - Xiaoxi Yao
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55902, USA; (P.A.N.); (X.Y.)
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - T. Jared Bunch
- Department of Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84108, USA;
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool L1 8JX, UK; (W.Y.D.); (D.G.)
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19
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Taylor ML, Thomas EE, Snoswell CL, Smith AC, Caffery LJ. Does remote patient monitoring reduce acute care use? A systematic review. BMJ Open 2021; 11:e040232. [PMID: 33653740 PMCID: PMC7929874 DOI: 10.1136/bmjopen-2020-040232] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 02/01/2021] [Accepted: 02/10/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Chronic diseases are associated with increased unplanned acute hospital use. Remote patient monitoring (RPM) can detect disease exacerbations and facilitate proactive management, possibly reducing expensive acute hospital usage. Current evidence examining RPM and acute care use mainly involves heart failure and omits automated invasive monitoring. This study aimed to determine if RPM reduces acute hospital use. METHODS A systematic literature review of PubMed, Embase and CINAHL electronic databases was undertaken in July 2019 and updated in October 2020 for studies published from January 2015 to October 2020 reporting RPM and effect on hospitalisations, length of stay or emergency department presentations. All populations and disease conditions were included. Two independent reviewers screened articles. Quality analysis was performed using the Joanna Briggs Institute checklist. Findings were stratified by outcome variable. Subgroup analysis was undertaken on disease condition and RPM technology. RESULTS From 2050 identified records, 91 studies were included. Studies were medium-to-high quality. RPM for all disease conditions was reported to reduce admissions, length of stay and emergency department presentations in 49% (n=44/90), 49% (n=23/47) and 41% (n=13/32) of studies reporting each measure, respectively. Remaining studies largely reported no change. Four studies reported RPM increased acute care use. RPM of chronic obstructive pulmonary disease (COPD) was more effective at reducing emergency presentation than RPM of other disease conditions. Similarly, invasive monitoring of cardiovascular disease was more effective at reducing hospital admissions versus other disease conditions and non-invasive monitoring. CONCLUSION RPM can reduce acute care use for patients with cardiovascular disease and COPD. However, effectiveness varies within and between populations. RPM's effect on other conditions is inconclusive due to limited studies. Further analysis is required to understand underlying mechanisms causing variation in RPM interventions. These findings should be considered alongside other benefits of RPM, including increased quality of life for patients. PROSPERO REGISTRATION NUMBER CRD42020142523.
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Affiliation(s)
- Monica L Taylor
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Emma E Thomas
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Centaine L Snoswell
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Anthony C Smith
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Liam J Caffery
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
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20
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Kumar S, Davis J, Thibault B, Mangat I, Coutu B, Bennett M, Philippon F, Sandhu R, Sterns L, Essebag V, Nery P, Wells G, Yee R, Exner D, Krahn A, Parkash R. Canadian Registry of Electronic Device Outcomes: remote monitoring outcomes in the Abbott battery performance alert-a multicentre cohort. Europace 2021; 23:1319-1323. [PMID: 33608700 DOI: 10.1093/europace/euab025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/19/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Cardiac implantable electronic devices with device advisories have the potential of device malfunction. Remote monitoring (RM) of devices has been suggested to allow the identification of abnormal device performance and permit early intervention. We sought to describe the outcomes of patients with and without RM in devices subject to the Abbott Premature Battery Depletion (PBD) advisory with data from a Canadian registry. METHODS AND RESULTS Patients with an Abbott device subject to the PBD advisory from nine implantable cardioverter defibrillator (ICD) implanting centres in Canada were included in the registry. The use of RM was identified from baseline and follow-up data in the registry. The primary outcome was detection of PBD and all-cause mortality. A total of 2666 patients were identified with a device subject to the advisory. In all, 1687 patients (63.2%) had RM at baseline. There were 487 deaths during follow-up. At a mean follow-up of 5.7 ± 0.7 years, mortality was higher in those without a remote monitor compared with RM at baseline (24.7% vs. 14.5%; P < 0.001). Pre-mature battery depletion was identified in 36 patients (2.1%) with RM vs. 7 (0.7%) without RM (P = 0.004). Time to battery replacement was significantly reduced in patients on RM (median 5 vs. 13 days, P = 0.001). CONCLUSION The use of RM in patients with ICD and cardiac resynchronization therapy under advisory improved detection of PBD, time to device replacement, and was associated with a reduction in all-cause mortality. The factors influencing the association with mortality are unknown and deserve further study.
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Affiliation(s)
- Sharath Kumar
- Department of Medicine, Division of Cardiology, QEII Health Sciences Center, Halifax Infirmary Site, 796 Summer Street, Room 2501D, Halifax NS B3H 3A7, Canada
| | - Jason Davis
- Department of Medicine, Division of Cardiology, QEII Health Sciences Center, Halifax Infirmary Site, 796 Summer Street, Room 2501D, Halifax NS B3H 3A7, Canada
| | - Bernard Thibault
- Division of Cardiology, Montreal Heart Institute, Montreal, QC, Canada
| | - Iqwal Mangat
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada
| | - Benoit Coutu
- Division of Cardiology, Centre Hospitalier Universitaire de Montreal, Montreal, QC, Canada
| | - Matthew Bennett
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | | | - Roopinder Sandhu
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Laurence Sterns
- Division of Cardiology, Royal Jubilee Hospital, Victoria, BC, Canada
| | - Vidal Essebag
- Division of Cardiology, McGill University, Montreal, QC, Canada
| | - Pablo Nery
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - George Wells
- Division of Cardiology, University Health Network, Toronto, ON, Canada.,Cardiovascular Research Methods Center, University of Ottawa Heart Institute, Ottawa, ON, Canada a
| | - Raymond Yee
- Division of Cardiology, London Health Sciences Center, London, ON, Canada
| | - Derek Exner
- Division of Cardiology, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Andrew Krahn
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Ratika Parkash
- Department of Medicine, Division of Cardiology, QEII Health Sciences Center, Halifax Infirmary Site, 796 Summer Street, Room 2501D, Halifax NS B3H 3A7, Canada
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21
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Daniolou S, Rapp A, Haase C, Ruppert A, Wittwer M, Scoccia Pappagallo A, Pandis N, Kressig RW, Ienca M. Digital Predictors of Morbidity, Hospitalization, and Mortality Among Older Adults: A Systematic Review and Meta-Analysis. Front Digit Health 2021; 2:602093. [PMID: 34713066 PMCID: PMC8521803 DOI: 10.3389/fdgth.2020.602093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/17/2020] [Indexed: 12/17/2022] Open
Abstract
The widespread adoption of digital health technologies such as smartphone-based mobile applications, wearable activity trackers and Internet of Things systems has rapidly enabled new opportunities for predictive health monitoring. Leveraging digital health tools to track parameters relevant to human health is particularly important for the older segments of the population as old age is associated with multimorbidity and higher care needs. In order to assess the potential of these digital health technologies to improve health outcomes, it is paramount to investigate which digitally measurable parameters can effectively improve health outcomes among the elderly population. Currently, there is a lack of systematic evidence on this topic due to the inherent heterogeneity of the digital health domain and the lack of clinical validation of both novel prototypes and marketed devices. For this reason, the aim of the current study is to synthesize and systematically analyse which digitally measurable data may be effectively collected through digital health devices to improve health outcomes for older people. Using a modified PICO process and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework, we provide the results of a systematic review and subsequent meta-analysis of digitally measurable predictors of morbidity, hospitalization, and mortality among older adults aged 65 or older. These findings can inform both technology developers and clinicians involved in the design, development and clinical implementation of digital health technologies for elderly citizens.
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Affiliation(s)
- Sofia Daniolou
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | | | | | | | | | | | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, School of Dentistry, University of Bern, Bern, Switzerland
| | - Reto W. Kressig
- University Department of Geriatric Medicine FELIX PLATTER, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Marcello Ienca
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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22
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Abstract
PURPOSE OF REVIEW Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is recommended as part of the individualized multidisciplinary follow-up of heart failure (HF) patients. Aim of this article is to critically review recent findings on RM, highlighting potential benefits and barriers to its implementation. RECENT FINDINGS Device-based RM is useful in the early detection of CIEDs technical issues and cardiac arrhythmias. Moreover, RM allows the continuous monitoring of several patients' clinical parameters associated with impending HF decompensation, but there is still uncertainty regarding its effectiveness in reducing mortality and hospitalizations. Implementation of RM strategies, together with a proactive physicians' attitude towards clinical actions in response to RM data reception, will make RM a more valuable tool, potentially leading to better outcomes.
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23
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Gruska M, Aigner G, Altenberger J, Burkart-Küttner D, Fiedler L, Gwechenberger M, Lercher P, Martinek M, Nürnberg M, Pölzl G, Porenta G, Sauermann S, Schukro C, Scherr D, Steinwender C, Stühlinger M, Teubl A. Recommendations on the utilization of telemedicine in cardiology. Wien Klin Wochenschr 2020; 132:782-800. [PMID: 33259003 DOI: 10.1007/s00508-020-01762-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/19/2020] [Indexed: 01/08/2023]
Abstract
The enormous progress made in recent years in the field of information and communication technology and also in sensor and computer technology has affected numerous fields of medicine and is capable of inducing even radical changes in diagnostic and therapeutic processes. This is particularly true for cardiology, where, for example, telemetric monitoring of cardiac and circulatory functions has been in use for many years. Nevertheless, broad application of newer telemedical processes has not yet been achieved to the extent one would expect from the encouraging results of numerous clinical studies in this field and the state of the art of the underlying technology. In the present paper, the Working Group on Rhythmology of the Austrian Cardiological Society aims to provoke a critical discussion of the digital change in cardiology and to make recommendations for the implementation of those telemedical processes that have been shown to exert positive effects on a wide variety of medical and economic parameters. The greatest benefit of telecardiological applications is certainly to be found in the long-term care of patients with chronic cardiovascular diseases. Accordingly, follow-up care of patients with cardiological rhythm implants, management of chronic heart failure and secondary prevention following an acute cardiac event during rehabilitation are currently the most important fields of application. Telemedicine is intended to enable high-quality and cost-efficient care for an increasing number of patients, whose care poses one of the greatest challenges to our healthcare system. Not least of all, telemedicine should make a decisive contribution to improving the quality of life of this segment of the population by favorably influencing mortality, morbidity and hospitalization as well as the patient's contribution to treatment.
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Affiliation(s)
- Michael Gruska
- Hauptstelle-Abt. Forschung, Innovation, Leistungsentwicklung, Pensionsversicherungsanstalt, Friedrich Hillegeist-Straße 1, 1021, Vienna, Austria.
| | - Gerhard Aigner
- Institut für Ethik und Recht in der Medizin, Universität Wien, Spitalgasse 2-4, Hof 2.8, 1090, Vienna, Austria
| | - Johann Altenberger
- SKA-Rehabilitationszentrum Großgmain, Salzburger Straße 520, 5084, Großgmain, Austria
| | - Dagmar Burkart-Küttner
- 2. Med. Abteilung, Hanusch Krankenhaus, Heinrich-Collin-Straße 30, 1140, Vienna, Austria
| | - Lukas Fiedler
- 2. Interne Abteilung, Landesklinikum Wr. Neustadt, Corvinusring 3-5, 2700, Wiener Neustadt, Austria
| | - Marianne Gwechenberger
- Universitätsklinik für Innere Medizin II, Klinische Abteilung für Kardiologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Peter Lercher
- Klinische Abteilung für Kardiologie, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Martin Martinek
- 2. Interne Abteilung, Ordensklinikum Linz, Krankenhaus der Elisabethinen, Fadingerstraße 1, 4020, Linz, Austria
| | - Michael Nürnberg
- 3. Medizinische Abteilung, Wilheminenspital der Stadt Wien, Montleartstraße 37, 1160, Vienna, Austria
| | - Gerhard Pölzl
- Universitätsklinik für Innere Medizin III, Medizinische Universität Innsbruck, Anichstraße, 6020, Innsbruck, Austria
| | - Gerold Porenta
- Privatkrankenanstalt Rudolfinerhaus, Billrothstraße 78, 1190, Vienna, Austria
| | - Stefan Sauermann
- Medical Engineering & eHealth, FH Technikum Wien, Höchstädtplatz 6, 1200, Vienna, Austria
| | - Christoph Schukro
- Universitätsklinik für Innere Medizin II, Klinische Abteilung für Kardiologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Daniel Scherr
- Klinische Abteilung für Kardiologie, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Clemens Steinwender
- Klinik für Kardiologie und internistische Intensivmedizin, Med Campus III, Kepler Universitätsklinikum, Krankenhausstraße 9, 4021, Linz/Donau, Austria
| | - Markus Stühlinger
- Universitätsklinik für Innere Medizin III, Medizinische Universität Innsbruck, Anichstraße, 6020, Innsbruck, Austria
| | - Alexander Teubl
- 2. Interne Abteilung, Landesklinikum Wr. Neustadt, Corvinusring 3-5, 2700, Wiener Neustadt, Austria
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Abstract
PURPOSE OF REVIEW Despite the promise of remote patient monitoring (RPM), this technology remained underutilized secondary to a lack of data transparency and systems issues until the COVID-19 pandemic ushered in a new era of telehealth and virtual solutions out of necessity. This review will explore the data supporting the use of RPM via both implantable and wearable devices in the field of cardiology and the role of home monitoring using RPM in the era of COVID-19. RECENT FINDINGS RPM using implantable cardiac devices is a safe alternative to in-person only visits which leads to enhanced patient satisfaction and improved clinical outcomes. Consumer-grade wearable sensors have drastically expanded RPM capabilities from just the sickest cardiac patients to the entire population aiding in early diagnosis and real-time disease management. Home monitoring enabled by automated alert systems tailored specifically to the needs of the patient by the provider will be the cornerstone of a more continuous, patent-centric healthcare model.
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Affiliation(s)
- Jennifer C. Miller
- University of Southern California’s Center for Body Computing, 12015 E Waterfront Dr, Los Angeles, CA 90094 USA
| | - Devin Skoll
- University of Southern California’s Center for Body Computing, 12015 E Waterfront Dr, Los Angeles, CA 90094 USA
| | - Leslie A. Saxon
- University of Southern California’s Center for Body Computing, 12015 E Waterfront Dr, Los Angeles, CA 90094 USA
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25
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Rapid review: Identification of digital health interventions in atherosclerotic-related cardiovascular disease populations to address racial, ethnic, and socioeconomic health disparities. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2020; 1:139-148. [PMID: 35265886 PMCID: PMC8890337 DOI: 10.1016/j.cvdhj.2020.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Disparities in cardiovascular disease (CVD) and associated health and healthcare delivery outcomes have been partially attributed to differential risk factors, and to prevention and treatment inequities within racial and ethnic (including language) minority groups and low socioeconomic status (SES) populations in urban and rural settings. Digital health interventions (DHIs) show promise in promoting equitable access to high-quality care, optimal utilization, and improved outcomes; however, their potential role and impact has not been fully explored. The role of DHIs to mitigate drivers of the health disparities listed above in populations disproportionately affected by atherosclerotic-related CVD was systematically reviewed using published literature (January 2008–July 2020) from multiple databases. Study design, type and description of the technology, health disparities information, type of CVD, outcomes, and notable barriers and innovations associated with the technology utilized were abstracted. Study quality was assessed using the Oxford Levels of Evidence. Included studies described digital health technologies in a disparity population with CVD and reported outcomes. DHIs significantly improved health (eg, clinical, intermediate, and patient-reported) and healthcare delivery (eg, access, quality, and utilization of care) outcomes in populations disproportionately affected by CVD in 24 of 38 included studies identified from 2104 citations. Hypertension control was the most frequently improved clinical outcome. Telemedicine, mobile health, and clinical decision support systems were the most common types of DHIs identified. DHIs improved CVD-related health and healthcare delivery outcomes in racial/ethnic groups and low SES populations in both rural and urban geographies globally.
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26
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Braunschweig F, Anker SD, Proff J, Varma N. Remote monitoring of implantable cardioverter-defibrillators and resynchronization devices to improve patient outcomes: dead end or way ahead? Europace 2020; 21:846-855. [PMID: 30903152 PMCID: PMC6545502 DOI: 10.1093/europace/euz011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/24/2019] [Indexed: 12/11/2022] Open
Abstract
Remote monitoring (RM) has become a new standard of care in the follow-up of patients with implantable pacemakers and defibrillators. While it has been consistently shown that RM enables earlier detection of clinically actionable events compared with traditional in-patient evaluation, this advantage did not translate into improved patient outcomes in clinical trials of RM except one study using daily multiparameter telemonitoring in heart failure (HF) patients. Therefore, this review, focusing on RM studies of implantable cardioverter-defibrillators and cardiac resynchronization therapy defibrillators in patients with HF, discusses possible explanations for the differences in trial outcomes. Patient selection may play an important role as more severe HF and concomitant atrial fibrillation have been associated with improved outcomes by RM. Furthermore, the technical set-up of RM may have an important impact as a higher level of connectivity with more frequent data transmission can be linked to better outcomes. Finally, there is growing evidence as to the need of effective algorithms ensuring a fast and well-structured clinical response to the events detected by RM. These factors re-emphasize the potential of remote management of device patients with HF and call for continued clinical research and technical development in the field.
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Affiliation(s)
| | - Stefan D Anker
- Department of Cardiology and Pneumology, Innovative Clinical Trials, University Medical Centre Göttingen, Göttingen, Germany
| | | | - Niraj Varma
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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27
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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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28
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Abstract
PURPOSE OF REVIEW Recent evidence has demonstrated substantial benefits associated with remote monitoring of cardiac implantable electronic devices (CIEDs), and treatment guidelines have endorsed the use of remote monitoring. Familiarity with the features of remote monitoring systems and the data supporting its use are vital for physicians' care for patients with CEIDs. RECENT FINDINGS Remote monitoring remains underutilized, but its use is expanding including in new practice settings including emergency departments. Patient experience and outcomes are positive, with earlier detection of clinical events such as atrial fibrillation, reductions in inappropriate implantable cardioverter-defibrillator (ICD) shocks and potentially a decrease in mortality with frequent remote monitoring utilizaiton. Rates of hospitalization are reduced among remote monitoring users, and the replacement of outpatient follow-up visits with remote monitoring transmissions has been shown to be well tolerated. In addition, health resource utilization is lower and remote monitoring has been associated with considerable cost savings. A dose relationship exists between use of remote monitoring and patient outcomes, and those with early and high transmission rates have superior outcomes. SUMMARY Remote monitoring provides clinicians with the ability to provide comprehensive follow-up care for patients with CIEDs. Patient outcomes are improved, and resource utilization is decreased with appropriate use of remote monitoring. Future efforts must focus on improving the utilization and efficiency of remote monitoring.
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Hansen C, Loges C, Seidl K, Eberhardt F, Tröster H, Petrov K, Grönefeld G, Bramlage P, Birkenhauer F, Weiss C. INvestigation on Routine Follow-up in CONgestive HearT FAilure Patients with Remotely Monitored Implanted Cardioverter Defibrillators SysTems (InContact). BMC Cardiovasc Disord 2018; 18:131. [PMID: 29954340 PMCID: PMC6025705 DOI: 10.1186/s12872-018-0864-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 06/13/2018] [Indexed: 12/28/2022] Open
Abstract
Background In heart failure (HF) patients with implantable cardioverter defibrillators (ICD) or cardiac resynchronisation therapy defibrillators (CRT-D), remote monitoring has been shown to result in at least non-inferior outcomes relative to in-clinic visits. We aimed to provide further evidence for this effect, and to assess whether adding telephone follow-ups to remote follow-ups influenced outcomes. Methods InContact was a prospective, randomised, multicentre study. Subjects receiving quarterly automated follow-up only (telemetry group) were compared to those receiving personal physician contact. Personal contact patients were further divided into those receiving automated follow-up plus a telephone call (remote+phone subgroup) or in-clinic visits only. Results Two hundred and ten patients underwent randomisation (telemetry n = 102; personal contact n = 108 [remote+phone: n = 53; visit: n = 55]). Baseline characteristics were comparable between groups and subgroups. Over 12 months, 34.8% of patients experienced deterioration of their Packer Clinical Composite Response, with no significant difference between the telemetry group and personal care (p > 0.999), remote+phone (p = 0.937) or visit (p = 0.940) patients; predefined non-inferiority criteria were met. Mortality rates (5.2% overall) were comparable between groups and subgroups (p = 0.832/p = 0.645), as were HF-hospitalisation rates (11.0% overall; p = 0.605/p = 0.851). The proportion of patients requiring ≥1 unscheduled follow-up was nominally higher in telemetry and remote+phone groups (42.2 and 45.3%) compared to the visit group (29.1%). Overall, ≥ 1 ICD therapy was delivered to 15.2% of patients. Conclusion In HF patients with ICDs/CRT-Ds, quarterly remote follow-up only over 12 months was non-inferior to regular personal contact. Addition of quarterly telephone follow-ups to remote monitoring does not appear to offer any clinical advantage. Trial registration clinicaltrials.gov: NCT01200381 (retrospectively registered on September 13th 2010).
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Affiliation(s)
- Claudius Hansen
- Herz- und Gefäßzentrum am Krankenhaus Neu-Bethlehem, Humboldtallee 6, 37073, Göttingen, Germany.
| | - Christian Loges
- SLK-Kliniken Heilbronn Klinikum am Plattenwald, Bad Friedrichshall, Germany
| | | | | | | | - Krum Petrov
- Kreiskliniken Böblingen Standort Sindelfingen, Sindelfingen, Germany
| | | | - Peter Bramlage
- Institut für Pharmakologie und Präventive Medizin, Cloppenburg, Germany
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30
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Ono M, Varma N. Remote Monitoring for Chronic Disease Management: Atrial Fibrillation and Heart Failure. Card Electrophysiol Clin 2018; 10:43-58. [PMID: 29428141 DOI: 10.1016/j.ccep.2017.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This review aims to cover the latest evidence of remote monitoring of cardiac implantable electronic devices for the management of atrial fibrillation and heart failure. Remote monitoring is useful for early detection for device-detected atrial fibrillation, which increases the risk of thromboembolic events. Early anticoagulation based on remote monitoring potentially reduces the risk of stroke, but optimal alert setting needs to be clarified. Multiparameter monitoring with automatic transmission is useful for heart failure management. Improved adherence to remote monitoring and an optimal algorithm for transmitted alerts and their management are warranted in the management of heart failure.
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Affiliation(s)
- Maki Ono
- Department of Cardiology, Kameda General Hospital, 929 Higashi-cho, Kamogawa City, Chiba 296-8602, Japan; Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, J2-2, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Niraj Varma
- Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, J2-2, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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31
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Al-Chekakie MO, Bao H, Jones PW, Stein KM, Marzec L, Varosy PD, Masoudi FA, Curtis JP, Akar JG. Addition of Blood Pressure and Weight Transmissions to Standard Remote Monitoring of Implantable Defibrillators and its Association with Mortality and Rehospitalization. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003087. [PMID: 28506978 DOI: 10.1161/circoutcomes.116.003087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 04/07/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Among patients with implantable defibrillators (ICD), use of remote patient monitoring (RPM) is associated with lower risk of death and rehospitalization. Standard ICD RPM can be supplemented with weight and blood pressure data. It is not known whether standard RPM plus routine weight and blood pressure transmission (RPM+) is associated with better outcomes. METHODS AND RESULTS RPM+ patients (n=4106) were compared with patients who only transmitted standard ICD RPM data (n=14 183). Logistic regression models identified patient, physician, and hospital characteristics associated with RPM+ utilization. Mortality and rehospitalization were examined using landmark analyses at 180 days after ICD implant in Medicare fee-for-service patients. In these analyses, we examined the independent association between RPM+ utilization and times to events up to 3 years after device implantation with Cox regression models. We further examined whether the association between RPM+ and outcomes varied by frequency or type of transmissions. Determinants of RPM+ utilization included impaired ejection fraction, cardiac resynchronization therapy, and institutional practice. The risk of mortality of RPM+ patients was similar to standard ICD RPM patients (hazard ratio, 1.06; 95% confidence interval, 0.94-1.19; P=0.34). RPM+ patients also had similar risks of all-cause hospitalization (subdistribution hazard ratio, 1.03; 95% confidence interval, 0.94-1.14; P=0.52), cardiovascular hospitalization (subdistribution hazard ratio, 0.92; 95% confidence interval, 0.83-1.02; P=0.15), or heart failure hospitalizations (subdistribution hazard ratio, 0.90; 95% confidence interval, 0.78-1.05; P=0.18). RPM+ transmission frequency was not associated with outcomes. CONCLUSIONS In patients using standard ICD RPM, the added transmission of weight and blood pressure data was not associated with improved outcomes.
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Affiliation(s)
- M Obadah Al-Chekakie
- From the Department of Medicine, Shawnee Mission Medical Center, Shawnee Mission, KS (M.O.A.-C.); Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine and Center of Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.B., J.P.C., J.G.A.); Boston Scientific Corporation, St. Paul, MN (P.W.J., K.M.S.); Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (L.M., P.D.V., F.A.M.); and VA Eastern Colorado Health Care System, Denver (P.D.V.)
| | - Haikun Bao
- From the Department of Medicine, Shawnee Mission Medical Center, Shawnee Mission, KS (M.O.A.-C.); Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine and Center of Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.B., J.P.C., J.G.A.); Boston Scientific Corporation, St. Paul, MN (P.W.J., K.M.S.); Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (L.M., P.D.V., F.A.M.); and VA Eastern Colorado Health Care System, Denver (P.D.V.)
| | - Paul W Jones
- From the Department of Medicine, Shawnee Mission Medical Center, Shawnee Mission, KS (M.O.A.-C.); Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine and Center of Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.B., J.P.C., J.G.A.); Boston Scientific Corporation, St. Paul, MN (P.W.J., K.M.S.); Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (L.M., P.D.V., F.A.M.); and VA Eastern Colorado Health Care System, Denver (P.D.V.)
| | - Kenneth M Stein
- From the Department of Medicine, Shawnee Mission Medical Center, Shawnee Mission, KS (M.O.A.-C.); Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine and Center of Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.B., J.P.C., J.G.A.); Boston Scientific Corporation, St. Paul, MN (P.W.J., K.M.S.); Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (L.M., P.D.V., F.A.M.); and VA Eastern Colorado Health Care System, Denver (P.D.V.)
| | - Lucas Marzec
- From the Department of Medicine, Shawnee Mission Medical Center, Shawnee Mission, KS (M.O.A.-C.); Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine and Center of Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.B., J.P.C., J.G.A.); Boston Scientific Corporation, St. Paul, MN (P.W.J., K.M.S.); Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (L.M., P.D.V., F.A.M.); and VA Eastern Colorado Health Care System, Denver (P.D.V.)
| | - Paul D Varosy
- From the Department of Medicine, Shawnee Mission Medical Center, Shawnee Mission, KS (M.O.A.-C.); Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine and Center of Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.B., J.P.C., J.G.A.); Boston Scientific Corporation, St. Paul, MN (P.W.J., K.M.S.); Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (L.M., P.D.V., F.A.M.); and VA Eastern Colorado Health Care System, Denver (P.D.V.)
| | - Frederick A Masoudi
- From the Department of Medicine, Shawnee Mission Medical Center, Shawnee Mission, KS (M.O.A.-C.); Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine and Center of Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.B., J.P.C., J.G.A.); Boston Scientific Corporation, St. Paul, MN (P.W.J., K.M.S.); Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (L.M., P.D.V., F.A.M.); and VA Eastern Colorado Health Care System, Denver (P.D.V.)
| | - Jeptha P Curtis
- From the Department of Medicine, Shawnee Mission Medical Center, Shawnee Mission, KS (M.O.A.-C.); Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine and Center of Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.B., J.P.C., J.G.A.); Boston Scientific Corporation, St. Paul, MN (P.W.J., K.M.S.); Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (L.M., P.D.V., F.A.M.); and VA Eastern Colorado Health Care System, Denver (P.D.V.)
| | - Joseph G Akar
- From the Department of Medicine, Shawnee Mission Medical Center, Shawnee Mission, KS (M.O.A.-C.); Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine and Center of Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.B., J.P.C., J.G.A.); Boston Scientific Corporation, St. Paul, MN (P.W.J., K.M.S.); Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (L.M., P.D.V., F.A.M.); and VA Eastern Colorado Health Care System, Denver (P.D.V.).
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Barraud J, Pinon P, Laine M, Cautela J, Orabona M, Koutbi L, Pinto J, Thuny F, Franceschi F, Paganelli F, Bonello L, Peyrol M. Ventricular Arrhythmia Occurrence and Compliance in Patients Treated With the Wearable Cardioverter Defibrillator Following Percutaneous Coronary Intervention. Heart Lung Circ 2017; 27:984-988. [PMID: 28969980 DOI: 10.1016/j.hlc.2017.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 07/26/2017] [Accepted: 08/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The wearable cardioverter defibrillator (WCD) is a life-saving therapy in patients with high risk of arrhythmic death. We aimed to evaluate ventricular arrhythmia (VA) occurrence rate and compliance with the WCD during the first 90 days following myocardial revascularisation with percutaneous coronary intervention (PCI) in patients with left ventricular ejection fraction (LVEF) <30%. METHODS From September 2015 to November 2016, clinical characteristics, WCD recordings and compliance data of the aforementioned subset of patients were prospectively collected. RESULTS Twenty-four patients (men=20, 80%) were included in this analysis. Mean age was 56±10 years and mean LVEF at enrolment was 26.6±4.3%. During a mean wearing period of 3.0±1.3 months, two episodes of VA occurred in two patients (8.3%): one successfully treated with WCD shock and one with spontaneous termination. The mean and median daily use of the WCD was 21.5hours and 23.5hours a day, respectively. Eighteen patients (75%) wore the WCD more than 22hours a day. CONCLUSIONS The rate of VA, during the WCD period use after myocardial revascularisation with PCI, was high in our study. Otherwise it underlined that patient compliance is critical during the WCD period use. Remote monitoring and patient education are keys to achieve good compliance.
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Affiliation(s)
- Jérémie Barraud
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Nord Hospital, France; Mediterranean Academic Association for Research and Studies in Cardiology (MARS Cardio), France
| | - Pauline Pinon
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Nord Hospital, France; Mediterranean Academic Association for Research and Studies in Cardiology (MARS Cardio), France
| | - Marc Laine
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Nord Hospital, France; Mediterranean Academic Association for Research and Studies in Cardiology (MARS Cardio), France
| | - Jennifer Cautela
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Nord Hospital, France; Mediterranean Academic Association for Research and Studies in Cardiology (MARS Cardio), France
| | - Morgane Orabona
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Nord Hospital, France; Mediterranean Academic Association for Research and Studies in Cardiology (MARS Cardio), France
| | - Linda Koutbi
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Hôpital Timone, Marseille, France
| | - Johan Pinto
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Nord Hospital, France; Mediterranean Academic Association for Research and Studies in Cardiology (MARS Cardio), France
| | - Franck Thuny
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Nord Hospital, France; Mediterranean Academic Association for Research and Studies in Cardiology (MARS Cardio), France
| | - Frederic Franceschi
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Hôpital Timone, Marseille, France
| | - Franck Paganelli
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Nord Hospital, France; Mediterranean Academic Association for Research and Studies in Cardiology (MARS Cardio), France
| | - Laurent Bonello
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Nord Hospital, France; Mediterranean Academic Association for Research and Studies in Cardiology (MARS Cardio), France
| | - Michaël Peyrol
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Nord Hospital, France; Mediterranean Academic Association for Research and Studies in Cardiology (MARS Cardio), France.
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Díaz-Infante E, Guerra JM, Jiménez-Candil J, Pérez-Castellanos N. Selection of the Best of 2016 in Implantable Defibrillators. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2017; 70:301-302. [PMID: 28347409 DOI: 10.1016/j.rec.2017.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/22/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Ernesto Díaz-Infante
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen Macarena, Sevilla, Spain.
| | - José M Guerra
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Javier Jiménez-Candil
- Sección de Arritmias, Servicio de Cardiología, IBSAL-Hospital Universitario de Salamanca, Salamanca, Spain
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Díaz-Infante E, Guerra JM, Jiménez-Candil J, Pérez-Castellanos N. Selección de lo mejor del año 2016 en desfibriladores implantables. Rev Esp Cardiol (Engl Ed) 2017. [DOI: 10.1016/j.recesp.2016.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ono M, Varma N. Remote monitoring to Improve long-term prognosis in heart failure patients with implantable cardioverter-defibrillators. Expert Rev Med Devices 2017; 14:335-342. [PMID: 28299956 DOI: 10.1080/17434440.2017.1306438] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Strong evidence exists for the utility of remote monitoring in cardiac implantable electronic devices for early detection of arrhythmias and evaluation of system performance. The application of remote monitoring for the management of chronic disease such as heart failure has been an active area of research. Areas covered: This review aims to cover the latest evidence of remote monitoring of implantable cardiac defibrillators in terms of heart failure prognosis. This article also updates the current technology relating to the method and discusses key factors to be addressed in order to better use the approach. PubMed and internet searches were conducted to acquire most recent data and technology information. Expert commentary: Multiparameter monitoring with automatic transmission is useful for heart failure management. Improved adherence to remote monitoring and an optimal algorithm for transmitted alerts and their management are warranted in the management of heart failure.
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Affiliation(s)
- Maki Ono
- a Department of Cardiology , Kameda General Hospital , Chiba , Japan
| | - Niraj Varma
- b Heart and Vascular Institute, J2-2 Cardiac Pacing and Electrophysiology, Cleveland Clinic , Cleveland , OH , USA
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A link to better care: The effect of remote monitoring on long-term adverse cardiac events in a propensity score-matched cohort. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Portugal G, Cunha P, Valente B, Feliciano J, Lousinha A, Alves S, Braz M, Pimenta R, Delgado AS, Oliveira M, Ferreira RC. A link to better care: The effect of remote monitoring on long-term adverse cardiac events in a propensity score-matched cohort. Rev Port Cardiol 2017; 36:189-195. [PMID: 28258782 DOI: 10.1016/j.repc.2016.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/18/2016] [Accepted: 08/29/2016] [Indexed: 11/30/2022] Open
Abstract
AIMS There are conflicting data regarding the clinical benefits of device-based remote monitoring (RM). We sought to assess the effect of device-based RM on long-term clinical outcomes in recipients of implantable cardioverter-defibrillators (ICDs). METHODS We assessed the incidence of adverse cardiac events, overall mortality and device therapy efficacy and safety in a propensity score-matched cohort of patients under RM compared to patients under conventional follow-up. Data on hospitalizations, mortality and cause of death were systematically assessed using a nationwide healthcare platform. The primary outcome was time to a composite outcome of first hospital admission for heart failure or cardiovascular death. RESULTS Of a total of 923 implantable device recipients, 164 matched patients were identified (84 under RM, 84 under conventional follow-up). The mean follow-up was 44 months (range 1-123). There were no significant differences regarding baseline characteristics in the matched cohorts. Patients under RM had a significantly lower incidence of the primary outcome (hazard ratio [HR] 0.42, confidence interval [CI] 0.20-0.88, p=0.022); there was a non-significant trend towards lower overall mortality (HR 0.53, CI 0.27-1.04, p=0.066). No significant differences between cohorts were found regarding appropriate therapies (RM vs. conventional follow-up, 8.1 vs. 8.2%, p=NS) or inappropriate therapies (6.8 vs. 5.0%, p=NS). CONCLUSION In a propensity score-matched cohort of ICD recipients with long-term follow-up, RM was associated with a lower rate of a combined endpoint of hospital admission for heart failure or cardiovascular death.
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Affiliation(s)
- Guilherme Portugal
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Portugal.
| | - Pedro Cunha
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Portugal
| | - Bruno Valente
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Portugal
| | - Joana Feliciano
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Portugal
| | - Ana Lousinha
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Portugal
| | - Sandra Alves
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Portugal
| | - Manuel Braz
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Portugal
| | - Ricardo Pimenta
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Portugal
| | - Ana Sofia Delgado
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Portugal
| | - Mário Oliveira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Portugal
| | - Rui C Ferreira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Portugal
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Economic analysis of remote monitoring of cardiac implantable electronic devices: Results of the Health Economics Evaluation Registry for Remote Follow-up (TARIFF) study. Heart Rhythm 2017; 14:50-57. [DOI: 10.1016/j.hrthm.2016.09.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Indexed: 11/22/2022]
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Ambrosino N, Vagheggini G, Mazzoleni S, Vitacca M. Telemedicine in chronic obstructive pulmonary disease. Breathe (Sheff) 2016; 12:350-356. [PMID: 28210321 PMCID: PMC5297949 DOI: 10.1183/20734735.014616] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Telemedicine is a medical application of advanced technology to disease management. This modality may provide benefits also to patients with chronic obstructive pulmonary disease (COPD). Different devices and systems are used. The legal problems associated with telemedicine are still controversial. Economic advantages for healthcare systems, though potentially high, are still poorly investigated. A European Respiratory Society Task Force has defined indications, follow-up, equipment, facilities, legal and economic issues of tele-monitoring of COPD patients including those undergoing home mechanical ventilation. We need much more evidence before telemedicine can be considered as real progress in the management of COPD patientshttp://ow.ly/Rko8305tpnJ
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Affiliation(s)
| | | | | | - Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS Lumezzane, Lumezzane, Italy
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Portugal G, Cunha P, Valente B, Feliciano J, Lousinha A, Alves S, Braz M, Pimenta R, Delgado AS, Oliveira M, Ferreira RC. Influence of remote monitoring on long-term cardiovascular outcomes after cardioverter-defibrillator implantation. Int J Cardiol 2016; 222:764-768. [DOI: 10.1016/j.ijcard.2016.07.157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
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Akar JG, Hummel JP. Editorial commentary: Virtual medicine-A better reality? Trends Cardiovasc Med 2016; 26:731-732. [PMID: 27737760 DOI: 10.1016/j.tcm.2016.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 06/27/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Joseph G Akar
- Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT.
| | - James P Hummel
- Division of Cardiology, University of North Carolina, Chapel Hill, NC
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Affiliation(s)
- Christine M Albert
- From Harvard Medical School, Center for Arrhythmia Prevention, Division of Cardiovascular and Preventive Medicine (C.M.A.), and Department of Medicine, Harvard Medical School, Cardiac Arrhythmia Program, Division of Cardiovascular Medicine (W.G.S.), Brigham and Women's Hospital, Boston, MA.
| | - William G Stevenson
- From Harvard Medical School, Center for Arrhythmia Prevention, Division of Cardiovascular and Preventive Medicine (C.M.A.), and Department of Medicine, Harvard Medical School, Cardiac Arrhythmia Program, Division of Cardiovascular Medicine (W.G.S.), Brigham and Women's Hospital, Boston, MA
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43
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Digital monitoring and care: Virtual medicine. Trends Cardiovasc Med 2016; 26:722-730. [PMID: 27373351 DOI: 10.1016/j.tcm.2016.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 05/13/2016] [Accepted: 05/19/2016] [Indexed: 01/29/2023]
Abstract
Remote digital health monitoring technologies can be synergistically organized to create a virtual medical system providing more continuous care centered on the patient rather than the bricks and mortar medical complex. Utilization of the digitalized patient health monitoring can facilitate diagnosis, treatment plans, physician-patient interaction, and accelerate the progress of medical research, education, and training. The field of cardiac electrophysiology has been an early adopter of this shift in care and serves as a paradigm applicable to all areas of medicine. The overall impact of this remote virtual care model on the quality of medical care and patient experience requires greater study, as well as vigilance as to the differences between technology and care in order to preserve the intangible and immeasurable factors that bring humanity to the art and science of medicine.
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Mittal S, Piccini JP, Snell J, Prillinger JB, Dalal N, Varma N. Improved survival in patients enrolled promptly into remote monitoring following cardiac implantable electronic device implantation. J Interv Card Electrophysiol 2016; 46:129-36. [PMID: 26860839 PMCID: PMC4923102 DOI: 10.1007/s10840-016-0112-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 02/01/2016] [Indexed: 12/02/2022]
Abstract
Purpose Guidelines advocate remote monitoring (RM) in patients with a cardiac implantable electronic device (CIED). However, it is not known when RM should be initiated. We hypothesized that prompt initiation of RM (within 91 days of implant) is associated with improved survival compared to delayed initiation. Methods This retrospective, national, observational cohort study evaluated patients receiving new implants of market-released St. Jude Medical™ pacemakers (PM), implantable cardioverter defibrillators (ICD), and cardiac resynchronization therapy (CRT) devices. Patients were assigned to one of two groups: an “RM Prompt” group, in which RM was initiated within 91 days of implant; and an “RM Delayed” group, in which RM was initiated >91 days but ≤365 days of implant. The primary endpoint was all-cause mortality. Results The cohort included 106,027 patients followed for a mean of 2.6 ± 0.9 years. Overall, 47,014 (44 %) patients had a PM, 31,889 (30 %) patients had an ICD, 24,005 (23 %) patients had a CRT-D, and 3119 (3 %) patients had a CRT-P. Remote monitoring was initiated promptly (median 4 weeks [IQR 2, 8 weeks]) in 66,070 (62 %) patients; in the other 39,957 (38 %) patients, RM initiation was delayed (median 24 weeks [IQR 18, 34 weeks]). In comparison to delayed initiation, prompt initiation of RM was associated with a lower mortality rate (4023 vs. 4679 per 100,000 patient-years, p < 0.001) and greater adjusted survival (HR 1.18 [95 % CI 1.13–1.22], p < 0.001). Conclusions Our data, for the first time, show improved survival in patients enrolled promptly into RM following CIED implantation. This advantage was observed across all CIED device types.
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Affiliation(s)
- Suneet Mittal
- Valley Health System of New York and New Jersey, 223 North Van Dien Avenue, Ridgewood, NJ, 07450, USA.
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Budts W, Roos-Hesselink J, Rädle-Hurst T, Eicken A, McDonagh TA, Lambrinou E, Crespo-Leiro MG, Walker F, Frogoudaki AA. Treatment of heart failure in adult congenital heart disease: a position paper of the Working Group of Grown-Up Congenital Heart Disease and the Heart Failure Association of the European Society of Cardiology. Eur Heart J 2016; 37:1419-27. [PMID: 26787434 DOI: 10.1093/eurheartj/ehv741] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/14/2015] [Indexed: 12/11/2022] Open
Affiliation(s)
- Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Jolien Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tanja Rädle-Hurst
- Department of Pediatric Cardiology, Saarland University Medical Center, Homburg, Germany
| | | | | | - Ekaterini Lambrinou
- Department of Nursing, School of Health Sciences Cyprus University of Technology, Limassol, Cyprus
| | - Maria G Crespo-Leiro
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Service, Hospital Universitario A Coruña, La Coruña, Spain
| | - Fiona Walker
- Centre for Grown-Up Congenital Heart Disease, St Bartholomews Hospital, London, UK
| | - Alexandra A Frogoudaki
- Adult Congenital Heart Clinic, Second Cardiology Department, ATTIKON University Hospital and Athens University, Athens, Greece
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KONECNY TOMAS, SAXON LESLIEA. Integration of Smartphone Based Monitoring: No Modality is an Island, Entire of Itself. J Cardiovasc Electrophysiol 2015; 27:58-9. [DOI: 10.1111/jce.12844] [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] [Indexed: 11/30/2022]
Affiliation(s)
- TOMAS KONECNY
- Division of Cardiovascular Medicine, Keck School of Medicine; University of Southern California; Los Angeles California USA
| | - LESLIE A. SAXON
- Division of Cardiovascular Medicine, Keck School of Medicine; University of Southern California; Los Angeles California USA
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Affiliation(s)
- Anne M. Gillis
- From the Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada
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