Effectiveness of remote monitoring of CIEDs in detection and treatment of clinical and device-related cardiovascular events in daily practice: the HomeGuide Registry

Abstract

AimsThe HomeGuide Registry was a prospective study (NCT01459874), implementing a model for remote monitoring of cardiac implantable electronic devices (CIEDs) in daily clinical practice, to estimate effectiveness in major cardiovascular event detection and management.Methods and resultsThe workflow for remote monitoring [Biotronik Home Monitoring (HM)] was based on primary nursing: each patient was assigned to an expert nurse for management and to a responsible physician for medical decisions. In-person visits were scheduled once a year. Seventy-five Italian sites enrolled 1650 patients [27% pacemakers, 27% single-chamber implantable cardioverter defibrillators (ICDs), 22% dual-chamber ICDs, 24% ICDs with cardiac resynchronization therapy]. Population resembled the expected characteristics of CIED patients. During a 20 ± 13 month follow-up, 2471 independently adjudicated events were collected in 838 patients (51%): 2033 (82%) were detected during HM sessions; 438 (18%) during in-person visits. Sixty were classified as false-positive, with generalized estimating equation-adjusted sensitivity and positive predictive value of 84.3% [confidence interval (CI), 82.5–86.0%] and 97.4% (CI, 96.5–98.2%), respectively. Overall, 95% of asymptomatic and 73% of actionable events were detected during HM sessions. Median reaction time was 3 days [interquartile range (IQR), 1–14 days]. Generalized estimating equation-adjusted incremental utility, calculated according to four properties of major clinical interest, was in favour of the HM sessions: +0.56 (CI, 0.53–0.58%), P < 0.0001. Resource consumption: 3364 HM sessions performed (76% by nurses), median committed monthly manpower of 55.5 (IQR, 22.0–107.0) min × health personnel/100 patients.ConclusionHome Monitoring was highly effective in detecting and managing clinical events in CIED patients in daily practice with remarkably low manpower and resource consumption.

Remote monitoring of patients with cardiac implantable electronic devices: a Southeast Asian, single-centre pilot study

“…Remote monitoring permits an earlier reaction to events requiring physician intervention in comparison to regular in-office device checks, with 98.6% of transmissions being reviewed within two working days in our cohort. (3,4,6,(14)(15)(16)(17)(18)(19)(20)(21) Early detection allows prompt management of arrhythmias, early management of device malfunction and device reprogramming to reduce inappropriate defibrillator shocks. (18,22,23) Compliance to remote monitoring was good, with an overall missed transmission rate of 11.8%.…”

The Unresolved Issues and Modern View on Atrial Fibrillation Patients Management

“…Пожалуй, наиболее позитивный факт об этих устройствах состоит в том, что они предостав-ляют достаточно точную информацию о частоте, дли-тельности эпизодов ФП и общем времени, в течение которого у пациента была ФП (особенно касается аппаратов длительного подкожного мониторинга ЭКГ) [8]. Botto, et al показали, что частота инсульта у пациентов с кардиостимулятором и анамнезом ФП не зависит только от прогностических шкал, таких как шкала CHADS 2 , но также от реальной частоты, продолжительности и времени, в течение которого пациент находится в состоянии ФП, что можно уви-деть при опросе этих устройств.…”

Validation of an Organizational Management Model of Remote Implantable Cardioverter-Defibrillator Monitoring Alerts

“…During a mean follow-up of 16±7 and median of 17 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) months, 562 patients were enrolled. The baseline characteristics of the study population are shown in Table 1.…”

“…15 The shift from ambulatory visits to RM of ICD recipients represents a major change in the delivery of health care although limited information is available that pertains to the organizational aspects of this new means of follow-up. [16][17][18][19] We hypothesized that the development and application of decisional trees to manage telemedical alerts might save medical and paramedical time and lower the variability in the responses of caregivers. We sought to describe our experience with an optimized organization of RM to validate our decisional trees, using a qualitative methodology particularly well adapted to this subject matter.…”