Delivering remote monitoring data to patients with implantable cardioverter‐defibrillators: Does medium matter?

Mirro, Michael J.; Daley, Carly; Wagner, Shauna; Ghahari, Romisa Rohani; Drouin, Michelle; Toscos, Tammy

doi:10.1111/pace.13505

Cited by 16 publications

(19 citation statements)

References 24 publications

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“…In one study of seven patients with CRT devices, patients with CRT were asked their preferences and similar to our study stated that they wanted to know about battery life, events, and abnormal pacing when creating a visual dashboard that patients could access . In another study similar to our cohort, the authors found that patients with CIEDs wanted to have information from their devices in electronic or paper form, and having that information did not increase the physician's work load . In a third paper from the same group, they found participants “expressed consistent questions about their CIED and related physical conditions.” Our study differs in the fact that we directly tested patients with basic multiple choice questions that electrophysiologists would expect their patients to know the answers for.…”

Section: Discussionsupporting

confidence: 50%

The gap between what patients know and desire to learn about their cardiac implantable electronic devices

Patel

Hilow

et al. 2019

Pacing Clinical Electrophis

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Background: Advancement of digital technology now allows patients to have access to data from their cardiac implantable electronic devices (CIEDs). However, patients' understanding regarding CIED data and perceived personal usability remain unclear. The present study is a prospective survey to examine patients' understanding of their CIEDs and their perception of what is important. Methods: We screened 400 patients between July and December 2018 who presented to our outpatient clinic for a CIED interrogation. Patients received a one-page questionnaire asking baseline demographics, their perception about their own knowledge about their device, and multiple-choice questions in seven basic categories: type of CIED, original indication, functionality, manufacturer, number of active leads, estimated battery life, and number of shocks received.We compared these answers to their interrogation reports to assess accuracy. We also asked participants what they would like to be aware of regarding their CIED.Results: From this cohort, 344 of 400 (86%) (62.9 ± 12.8 years and 64 % males) agreed to take the survey and were included in the analysis. At baseline, 63.2% agreed or strongly agreed that they were knowledgeable about their devices. The overwhelming majority of patients demonstrated CIED knowledge deficits in at least one content area (n = 294, 86%), or more than two content areas (n = 176, 51%). Patients agreed or strongly agreed that they had a desire to have information regarding each of the following: battery life (84%), activity level (79%), heart rate trend (75%), and ventricular arrhythmias (74%). Conclusion:There is a large discrepancy in patients' level of knowledge regarding their CIEDs and their wish to know more details. Future technologies should satisfy providers' goals to educate their patients with basic information and fulfill patients' desire to obtain more data from their CIEDs.

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Section: Discussionsupporting

confidence: 50%

The gap between what patients know and desire to learn about their cardiac implantable electronic devices

Patel

Hilow

et al. 2019

Pacing Clinical Electrophis

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“…At the end of the study, two-thirds of patients were satisfied with the amount of information received through the electronic or paper ICD data summary. Further, providing patients with their device data did not increase ICD-specific clinical workload [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Patients' and Nurses’ Experiences and Perceptions of Remote Monitoring of Implantable Cardiac Defibrillators in Heart Failure: Cross-Sectional, Descriptive, Mixed Methods Study

Liljeroos¹,

Thylén²,

Strömberg³

2020

J Med Internet Res

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Background The new generation of implantable cardioverter-defibrillators (ICDs) supports wireless technology, which enables remote patient monitoring (RPM) of the device. In Sweden, it is mainly registered nurses with advanced education and training in ICD devices who handle the arrhythmias and technical issues of the remote transmissions. Previous studies have largely focused on the perceptions of physicians, and it has not been explored how the patients’ and nurses’ experiences of RPM correspond to each other. Objective Our objective is to describe, explore, and compare the experiences and perceptions, concerning RPM of ICD, of patients with heart failure (HF) and nurses performing ICD follow-up. Methods This study has a cross-sectional, descriptive, mixed methods design. All patients with HF and an ICD with RPM from one region in Sweden, who had transitioned from office-based visits to implementing RPM, and ICD nurses from all ICD clinics in Sweden were invited to complete a purpose-designed, 8-item questionnaire to assess experiences of RPM. The questionnaire started with a neutral question: “What are your experiences of RPM in general?” This was followed by one positive subscale with three questions (score range 3-12), with higher scores reflecting more positive experiences, and one negative subscale with three questions (score range 3-12), with lower scores reflecting more negative experiences. One open-ended question was analyzed with qualitative content analysis. Results The sample consisted of 175 patients (response rate 98.9%) and 30 ICD nurses (response rate 60%). The majority of patients (154/175, 88.0%) and nurses (23/30, 77%) experienced RPM as very good; however, the nurses noted more downsides than did the patients. The mean scores of the negative experiences subscale were 11.5 (SD 1.1) for the patients and 10.7 (SD 0.9) for the nurses (P=.08). The mean scores of the positive experiences subscale were 11.1 (SD 1.6) for the patients and 8.5 (SD 1.9) for the nurses (P=.04). A total of 11 out of 175 patients (6.3%) were worried or anxious about what the RPM entailed, while 15 out of 30 nurses (50%) felt distressed by the responsibility that accompanied their work with RPM (P=.04). Patients found that RPM increased their own (173/175, 98.9%) and their relatives’ (169/175, 96.6%) security, and all nurses (30/30, 100%) answered that they found RPM to be necessary from a safety perspective. Most patients found it to be an advantage with fewer office-based visits. Nurses found it difficult to handle different systems with different platforms, especially for smaller clinics with few patients. Another difficulty was to set the correct number of alarms for the individual patient. This caused a high number of transmissions and a risk to miss important information. Conclusions Both patients and nurses found that RPM increased assurance, reliance, and safety. Few patients were anxious about what the RPM entailed, while about half of the nurses felt distressed by the responsibility that accompanied their work with RPM. To increase nurses’ sense of security, it seems important to adjust organizational routines and reimbursement systems and to balance the workload.

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“…The remote monitoring feature of pill bottles paired with e-prescribing software offers an unprecedented opportunity to: (1) compare adherence measures across these technologies and (2) examine the extent to which patients are receptive and responsive to clinical feedback based on data from these technologies (ie, the feedback loop). Building on past work on engaging cardiology patients with their health data 30–33 and taking into consideration the known issues associated with technology-driven medication adherence approaches, we triangulated these adherence measures (smart pill bottle, medication refill information, and patient messages about missed doses). We also created a feedback loop whereby nurses would provide information to patients when they missed doses.…”

Section: Introductionmentioning

confidence: 99%

Medication adherence for atrial fibrillation patients: triangulating measures from a smart pill bottle, e-prescribing software, and patient communication through the electronic health record

et al. 2020

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Objective Our primary objectives were to examine adherence rates across two technologies (e-prescribing software and smart pill bottle) with cross-validation from alert-triggered messaging within the patient electronic health record (EHR) portal and to explore the benefits and challenges faced by atrial fibrillation (AF) patients in using a smart pill bottle. Materials and Methods We triangulated the rate of oral anticoagulant medication adherence among 160 AF patients over 6 months using an EHR in combination with data from the AdhereTech© Wireless Smart Pill Bottle and Surescripts©. In addition, we collected qualitative feedback on patients’ Smart Pill Bottle usage through structured interviews with 153 participants. Results Patients maintained an average adherence rate of 90.0% according to the smart pill bottle; however, when dose misses were calibrated based on patient or provider feedback, the adjusted adherence was 93.6%. Surescripts adherence rates for refills were 92.2%. Participants generally found the bottle easy to operate but suggested that its size and functionality did not fit seamlessly into their existing routine, as many used weekly pill organizers to manage multiple medications. Discussion Though each method of tracking adherence has positive and negative attributes, combining them and seeking patient feedback may help capture a more accurate adherence rate than any single technological intervention. Technologies may have different design considerations for research and consumer use. Conclusion Overall, these technologies provide useful but imperfect adherence data for research purposes, and smart pill bottles could be improved with patient-centered design.

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Delivering remote monitoring data to patients with implantable cardioverter‐defibrillators: Does medium matter?

Abstract: Providing patients with their ICD data (through paper or electronic means) might have the potential to improve patient satisfaction and enhance shared-decision making without adversely impacting clinical workload.

Cited by 16 publications

References 24 publications

The gap between what patients know and desire to learn about their cardiac implantable electronic devices

The gap between what patients know and desire to learn about their cardiac implantable electronic devices

Patients' and Nurses’ Experiences and Perceptions of Remote Monitoring of Implantable Cardiac Defibrillators in Heart Failure: Cross-Sectional, Descriptive, Mixed Methods Study

Medication adherence for atrial fibrillation patients: triangulating measures from a smart pill bottle, e-prescribing software, and patient communication through the electronic health record

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