This Telemedicine study assists patients in adopting self-care behaviors and is designed for early recognition and treatment of cardiac arrythmias. Telemedicine allows health care professionals to evaluate, diagnose and treat patients within their own home [1] by connecting via video or telephone visits. The arrhythmia care with such visits is aimed at increasing the subject's self-efficacy of arrhythmia care and increasing behaviors to manage the arrhythmias [1,2]. The goal of the study is to utilize telemedicine to provide earlier diagnosis of arrhythmias and increased patient involvement in one's own self-care.
Telemedicine and video patient care visits have been present within the medical and nursing community for over twenty years. These visits serve an alternative purpose to in person face to face visits allowing continued care for those who may be too elderly to leave their home, those who cannot afford the high cost of traveling several hundred miles to a specialty center, or for those who have very busy lives, who need to compress the appointment into a short video or telephone visit. The electrophysiology department within theUniversity of Michigan has adopted a research Telemedicine study to determine if video or phone visits can decrease the time needed to recognize, diagnose, and treat any change in arrhythmias. The study aims to improve the subject's self-efficacy of medication knowledge and use, activity, and understanding of the arrhythmia. This ongoing study has enrolled 31 subjects as of this date with 17 subjects in the telemedicine arm of the study and 14 subjects enrolled in the standard arm of the study. The telemedicine subjects receive monthly visits for three consecutive months compared with standard visit subjects who have face to face visits every six months. The two goals of the study are to improve or shorten the time to diagnosis of any new arrhythmia and treatment and to improve the subject's self-efficacy of medication knowledge and use, activity, and arrhythmia knowledge.
These AAD medications are use throughout our country by both electro physiologists and general cardiologists. The challenge remains- how to conduct serial monitoring and required testing while maintaining adequate logs and documentation of such testing?
In the cardiology and electrophysiology clinic there are several diagnoses which challenge the provider to determine the specific arrhythmia. These challenges include consideration of the best way to capture tracings or evidence of the arrhythmia. Patient complaints may include a fluttering sensation and palpitations in one's chest, a history of cryptogenic stroke, passing out, a history of atrial fibrillation which occurs very infrequently, and history of seizure with suspected arrhythmia trigger [1]. The provider determines the best monitoring device which can capture the underlying rhythm for such complaints. Monitoring devices are externally worn devices which detect changes in heart rhythms [2]. There are several monitors which have specialized indications. There are two week monitors which are placed externally and data is sent for interpretation (such as a brand called the Ziopatch [3]. These monitors can be minimally affected by showering or a plastic barrier used to protect the monitor from water [4]. Another type of monitor is a two-day monitor which is ordered when a patient has a frequently occurring arrhythmia and the overall percentage of the arrhythmia is needed. These monitors are called Holter monitors and are excellent in giving an overall ventricular arrhythmia burden or premature ventricular burden [5]. There are also externally worn event monitors designed to be a real time system to directly alert the provider of an adverse cardiac event. This type of monitoring system relies upon focused and intense monitoring which gives timely and current communication to the provider, rather than a historic encapsulation of the heart rhythm events. Such real time event monitors are offered by such companies, such as the Biotel monitor [3].Unfortunately, some arrhythmias occur so infrequently that an externally worn device with a preset time such as a few days or 2-4 weeks may not capture the arrhythmia. There are special circumstances in which a long-term monitoring device is indicated. Such a device is a loop recorder (implanted loop recorder-ILR) that is implanted subcutaneously and transmits the arrhythmias to a remote monitor. These devices capture the abnormal heart rhythm and transmit the data which may be uploaded and evaluated later. Dangerous, but infrequently occurring arrhythmias such as nonsustained ventricular tachycardia and prolonged pauses or short episodes of asystole which later require pacemaker insertion have become indications for ILR as the ILRs are able to capture these infrequently occurring arrhythmias given the ongoing monitoring capability [3]. Loop recorders are implanted devices which can track any arrhythmia which the patient experiences. These devices last over ARTICLE INFO ABSTRACT
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