Telemed J E Health - Potential role of telemedical service centers in managing remote monitoring data transmitted daily by cardiac implantable electronic devices: results of the early detection of cardiovascular events in device patients with heart failure (detecT-Pilot) study.

Tópicos

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Resumo

JECTIVE: Implantable cardioverter-defibrillators (ICDs) alone or combined with cardiac resynchronization therapy (CRT-Ds) featuring automatic home monitoring (HM) function can be monitored remotely on a daily basis. Different ways of implementing HM into clinical routines are possible, with efficient patient management being the main objective. In this study, a concept using a telemedical service center (TmSC) to manage HM data was developed and investigated regarding patients' satisfaction, physicians' satisfaction, and alert filtering.SUBJECTS AND METHODS: Fifty-five ICD or CRT-D patients with symptomatic heart failure were enrolled. The TmSC received HM data, identified "actionable parameters" (APs) by following protocol-defined procedures, conducted structured patient interviews, and forwarded selected APs to the respective follow-up clinic. Satisfaction of patients and physicians with the TmSC was evaluated at the end of the study by purpose-designed questionnaires.RESULTS: During a mean follow-up of 402?200 days, 3,831 APs were identified and analyzed at the TmSC (5.28 per patient-month). Most APs were triggered by a pilot detection algorithm for worsening heart failure (2.80 per patient-month), followed by atrial tachyarrhythmia episodes (1.10 per patient-month) and ventricular pacing issues (0.87 per patient-month). The TmSC forwarded 682 APs (18% of all APs) to 10 study sites. Approximately 65% of physicians and patients deemed the TmSC improved patient care.CONCLUSIONS: The TmSC-based management concept was well accepted and appreciated by the majority of physicians and patients. It may be helpful in gaining symptomatic information on top of automatic HM data and in supporting smaller clinics in the follow-up of their device patients.

Resumo Limpo

jectiv implant cardioverterdefibril icd alon combin cardiac resynchron therapi crtds featur automat home monitor hm function can monitor remot daili basi differ way implement hm clinic routin possibl effici patient manag main object studi concept use telemed servic center tmsc manag hm data develop investig regard patient satisfact physician satisfact alert filteringsubject method fiftyf icd crtd patient symptomat heart failur enrol tmsc receiv hm data identifi action paramet ap follow protocoldefin procedur conduct structur patient interview forward select ap respect followup clinic satisfact patient physician tmsc evalu end studi purposedesign questionnairesresult mean followup day ap identifi analyz tmsc per patientmonth ap trigger pilot detect algorithm worsen heart failur per patientmonth follow atrial tachyarrhythmia episod per patientmonth ventricular pace issu per patientmonth tmsc forward ap ap studi site approxim physician patient deem tmsc improv patient careconclus tmscbase manag concept well accept appreci major physician patient may help gain symptomat inform top automat hm data support smaller clinic followup devic patient

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