Diagnostic and Cost Effectiveness of Telemonitoring the Pediatric Pacemaker Patient

Abstract

Although recommended as part of a comprehensive pacemaker follow-up protocol, the diagnostic and cost-effectiveness of routine telephone monitoring (TM) in children in the United States is largely unknown. Patient age and size with inherent age-related problems and potential inability to correlate symptoms with pacemaker performance places the pediatric patient in a unique category, different from that of the adult. A total of 96 patients, ages 0.2-32.0 years (mean 12.0 years) were followed for 3 years after pacemaker implant with both routine monthly and anytime emergency TM. A total of 1372 routine transmissions were performed of a recommended 3456 (40% patient compliance). Of these, 99% showed normal rhythm or pacemaker function. The remaining 1% demonstrated asymptomatic pacemaker dysfunction requiring intervention or new-onset dysrhythmias. A total of 75 emergency transmissions were undertaken for patient/parent-perceived problems, only 8% of which showed pacemaker dysfunction or dysrhythmias. The sensitivity of patient/parent capacity to detect pacemaker problems or dysrhythmias based on clinical findings was 29%, with a positive predictive value of 8%. The specificity of routine monthly TM to screen for asymptomatic pacemaker dysfunction or new-onset dysrhythmias was 95%, with a negative predictive value of 99%. TM was effective (p < 0.001) for correlating the presence or absence of pacemaker problems with subjective complaints at any patient age. Financial charges for use of TM were significantly less (p < 0.01) than comparable outpatient visits.

Revisión sistemática de evaluaciones económicas de los sistemas de telemonitorización en los marcapasos

“…Despué s de revisar a texto completo 108 estudios potencialmente relevantes, siete artículos [10][11][12][13][14][15][16] cumplían los criterios de selecció n (figura) y se incluyeron en la posterior síntesis de la evidencia. Las referencias de los 101 artículos excluidos se pueden consultar en el material suplementario.…”

“…Se incluyeron tres estudios experimentales y cuatro de diseñ o descriptivo/observacional, con el objetivo de evaluar los resultados en calidad de vida, eficacia, seguridad, fiabilidad y costes de la TM de marcapasos en comparació n con la MH [10][11][12][13][14][15][16] . [12][13][14][15][16] .…”

The Dilemma of Falciparum Malaria and Telecommunications in Northeastern Nigeria

“…With respect to medical care, patient data can be transmitted to health specialists in an urban setting, where medical personnel can examine the patient, make the relevant diagnosis, and prescribe treatments without having to physically travel to the rural areas to see the patient (Whitcare, 2007;Vincent et al, 2007). Telemedicine has been applied to the field diagnosis of malaria.…”

Towards an Intelligent Monitoring System for Patients with Obstrusive Sleep Apnea

“…They agreed to participate in the 6-month study, signing the informed consent 3 . However, 9 of them were excluded due to: the CPAP machine stopped working before the 6th month (3 patients); they did not go to the final visit at month 6 (5 patients); and 1 patient died during the study.…”

“…Thanks to the new and inexpensive technologies it is now possible and affordable to get information and realize medical tasks remotely, thus reducing the corresponding overall costs [2] [3]. Telemedecine is now a reality and can be applied to several fields of the health practice to assist patients in selfcare and adherence to treatments [4].…”