Home Monitoring Remote Control of Pacemaker and Implantable Cardioverter Defibrillator Patients in Clinical Practice: Impact on Medical Management and Health-Care Resource Utilization

Renato Pietro Ricci; Loredana Morichelli; Massimo Santini

Disclosures

Europace. 2008;10(2):164-170. 

In This Article

Abstract and Introduction

Aims: To evaluate the impact of Home Monitoring™(HM) remote control on patient medical treatment and on health-care resource utilization.
Methods and Results: One hundred and seventeen patients received HM pacemakers or defibrillators. A pacing expert nurse consulted daily the website and submitted critical cases to physician. During a mean follow-up of 227 ± 128 days, 25 210 messages were received (23 545 daily messages and 1665 alert events) resulting in 90.7% of HM supervised days. Fifty-nine minutes/week for the nurse and 12 min/week for the physician were spent for HM data analysis during 267 web-connections. The mean connection time per patient was 115 ± 60 s. The nurse submitted to the physician 133 critical cases in 56 patients. The diagnosis were atrial fibrillation (47%), ventricular tachyarrhythmias (9%), inappropriate implantable cardioverter defibrillator intervention (4%), unsustained ventricular tachycardia (7%), device suboptimal programming (23%), and impending heart failure (10%). Sixty-six unplanned follow-up in 43 patients led to drug therapy change (44%), device reprogramming (18%), diagnosis confirmation without further intervention (24%), no confirmation (6%), further diagnostic tests (9%).
Conclusion: HM technology allowed optimization of medical treatment and device programming with low consumption of health-care resource.

Pacemakers and implantable cardioverter defibrillators (ICDs) equipped with the wireless Home Monitoring™ function (HM, Biotronik GmbH & Co. KG, Berlin, Germany) are capable of providing on daily basis automatic information about the patient cardiac condition as well as the implant status.[1] Devices have an embedded antenna for wireless transmissions of diagnostic information to a Service Center where messages are decrypted, stored as well as loaded on a protected website accessible to the attending physician through identity codes and a personal password.

Several studies have demonstrated the feasibility of this remote monitoring system as well as its technical reliability.[2,3,4] Potential advantages of HM for patient management include early detection of device technical troubles, early reaction to changes in patient clinical status, such as atrial and ventricular arrhythmia development or heart failure progression, reduction of unnecessary out-patient visits and optimization of health-care resource allocation.[5,6,7]

In spite of so promising benefits of the system, little data is available about the optimal health-care organization as well as about changes induced in the therapeutical approach.

The aim of our study is to evaluate the impact of HM technology on patient medical treatment and on health care resource utilization in a high-volume pacemaker and ICD European clinic.

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