The patient perspective on remote monitoring of patients with an implantable cardioverter defibrillator: Narrative review and future directions

Timmermans, Ivy; Meine, Mathias; Zitron, Edgar; Widdershoven, Jos; Kimman, Geert P.; Prévôt, Sébastien; Rauwolf, Thomas; Anselme, Frédéric; Szendey, Istvan; Roldán, Javier Romero; Mabo, Philippe; Schaer, Beat; Denollet, Johan; Versteeg, Henneke

doi:10.1111/pace.13123

Cited by 12 publications

(13 citation statements)

References 60 publications

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“…Patients expressed that they could live a more normal life after receiving RPM. This confirms results in previous research showing that patients were content with RPM and did not feel like patients as much anymore [ 16 , 36 ]. This is probably related to the fact that patients felt that RPM increased security and safety for both themselves and their relatives.…”

Section: Discussionsupporting

confidence: 91%

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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Section: Discussionsupporting

confidence: 91%

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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“…To the best of our knowledge, this was the first study to examine longterm patient experiences with RPM, and to explore which sociodemographic, clinical, and psychological factors are associated with patients' preferences for ICD follow-up. The findings of this study are in line with the findings of the previous studies with smaller sample sizes, shorter follow-up periods, and different RPM systems, 22 and underline that most ICD and CRT-D patients are highly satisfied with RPM. Patients rated the LATITUDE RPM system with a median score of 9 out of 10.…”

Section: Discussionsupporting

confidence: 91%

“…At 2 years postimplantation, 79 (26%) patients did not answer the question on their preference for follow-up and were regarded as missing. These patients were more likely to have NYHA class III versus II (46% vs 28%; P = 0.005), to smoke (24% vs 13%, P = 0.03), and to perform worse self-care behavior (26 [24][25][26][27][28][29][30][31][32][33][34] vs 24 [18][19][20][21][22][23][24][25][26][27][28][29][30][31]; P = 0.008).…”

Section: Preference For Follow-upmentioning

confidence: 99%

“…However, nearly all studies measured RPM experiences using single‐item purpose‐designed questions, and do not report study refusals or dropouts due to patient preferences. Moreover, most studies had a 1 year of follow‐up, which seems to be too short as patients are still recovering in the first year after implantation, and generally only miss one in‐office visit compared to standard in‐clinic follow‐up …”

Section: Introductionmentioning

confidence: 99%

“…Moreover, most studies had a 1 year of follow-up, which seems to be too short as patients are still recovering in the first year after implantation, and generally only miss one in-office visit compared to standard in-clinic follow-up. 22 Better insight into patient experiences with RPM could support its implementation in standard practice, especially since patients' attitudes and perceptions of RPM may influence monitoring quality and outcomes. 23 Therefore, the European REMOTE-CIED study is the first to examine patient evaluations of RPM in the first 2 years after ICD implantation, using Boston Scientific's LATITUDE system (Boston Scientific, Marlborough, MA, USA), including blood pressure cuffs and weighing scale for heart failure monitoring.…”

Section: Introductionmentioning

confidence: 99%

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Remote monitoring of implantable cardioverter defibrillators: Patient experiences and preferences for follow‐up

Timmermans

Meine

Szendey

et al. 2019

Pacing Clinical Electrophis

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BackgroundPatient satisfaction with remote patient monitoring (RPM) of implantable cardioverter defibrillators (ICDs) seems to be high, yet knowledge on long‐term patient experiences is limited. The European REMOTE‐CIED study explored patients' experiences with RPM, examined patient's preferences for ICD follow‐up, and identified determinants of patient's preferences in the first 2 years postimplantation.MethodsEuropean heart failure patients (N = 300; median age = 66 years [interquartile range (IQR) = 59‐73], and 22% female) with a first‐time ICD received a Boston Scientific LATITUDE RPM system (Marlborough, MA, USA) and had scheduled in‐clinic follow‐ups once a year. Patients completed questionnaires at 1‐2 weeks and also at 3, 6, 12, and 24 months postimplantation and clinical data were obtained from their medical records. Patient evaluation data were analyzed descriptively, and Student's t‐tests/Man‐Whitney U tests or Chi‐square tests/Fisher's exact tests were performed to examine determinants of patient preferences.ResultsAt 2 years postimplantation, the median patient satisfaction score with the RPM system was 9 out of 10 (IQR = 8‐10), despite 53% of the patients experiencing issues (eg, failure to transmit data). Of the 221 patients who reported their follow‐up preferences, 43% preferred RPM and 19% preferred in‐clinic follow‐up. Patients with a preference for RPM were more likely to be higher educated (P = 0.04), employed (P = 0.04), and equipped with a new LATITUDE model (P = 0.04), but less likely to suffer from chronic obstructive pulmonary disease (P = 0.009).ConclusionIn general, patients were highly satisfied with RPM, but a subgroup preferred in‐clinic follow‐up. Therefore, physicians should include patients’ concerns and preferences in the decision‐making process, to tailor device follow‐up to individual patients’ needs and preferences.

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2023 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Practical Management of the Remote Device Clinic

Ferrick,

Raj,

Deneke

et al. 2023

Journal of Arrhythmia

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Developed in partnership with and endorsed by the European Heart Rhythm Association (EHRA), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS), and in collaboration with and endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), the International Society for Holter and Noninvasive Electrocardiology (ISHNE), and the Pediatric and Congenital Electrophysiology Society (PACES).

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The patient perspective on remote monitoring of patients with an implantable cardioverter defibrillator: Narrative review and future directions

Cited by 12 publications

References 60 publications

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

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

Remote monitoring of implantable cardioverter defibrillators: Patient experiences and preferences for follow‐up

2023 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Practical Management of the Remote Device Clinic

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