Findings of an observational investigation of pure remote follow-up of pacemaker patients: is the in-clinic device check still needed?

Facchin, Domenico; Baccillieri, S.; Gasparini, G.; Zoppo, Franco; Allocca, Giuseppe; Brieda, Marco; Verlato, Roberto; Proclemer, Alessandro

doi:10.1016/j.ijcard.2016.06.162

Cited by 16 publications

(17 citation statements)

References 20 publications

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“…The frequency of prioritized events was relatively high compared with the 8.2% presented by Cronin et al; [14] but a direct comparison is challenging because of different approaches depending on the target population and, above all, because different variables, for example learning curve, need to be taken into consideration when a third party is involved in the monitoring pathway. Once referred to the hospital staff, 15.5% of escalated transmissions led to a clinical action, in line with the 15.4% reported by Facchin et al, [1] showing the ERMC is a precious tool to triage patients implanted with a CIED and to screen relevant events requiring clinical intervention. 84.5% of escalated events didn't lead to medical action but were nevertheless essential to hospital staff to monitor the evolution of patient clinical condition with respect to their ongoing treatment and medical history, in line with the definition of prioritized events in the protocol.…”

Section: Safety and Practicability Of Ermcsupporting

confidence: 75%

“…Remote monitoring (RM) management of patients implanted with cardiac implantable electronic devices (CIED) enables early detection of clinically relevant events and complications while partially replacing routine follow-up [1][2][3][4][5]. A number of studies have recently demonstrated that RM reduces the total number of in-office visits, [4,6] without negative effects on patient outcome; [7,8] some studies have also shown the positive clinical impact of RM.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12] Although RM can reduce clinical staff time compared to standard in-office follow-up, [13][14][15] organizational workflow changes and a new definition of roles and responsibilities may be needed to review remote transmissions in an effective, efficient and timely manner. [16] Considering that most RM data does not require any clinical escalation, [1,14] it has been hypothesized that the remote triage may be outsourced and that this would optimize the time allocation of highly skilled healthcare professionals. [17] Efficient allocation of healthcare professional times is crucial due to the limited resources available for RM activities today and prospectively in the future, given the patient population growth and accompanying follow-up burden.…”

Section: Introductionmentioning

confidence: 99%

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Outsourcing the Remote Management of Cardiac Implantable Electronic Devices: Medical Care Quality Improvement Project (Preprint)

Giannola¹,

Torcivia²,

Farulla³

et al. 2018

Preprint

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Strucured Abstract Background:Remote management is partially replacing routine follow-up in patients implanted with cardiac implantable electronic devices. While it reduces clinical staff time compared to standard in-office follow-up, new definition of roles and responsibilities may be needed to review remote transmissions in an effective, efficient and timely manner. If the remote triage may be outsourced is still unclear. Objectives:The aim of this healthcare quality improvememt project was to assess if outsourcing the triage of cardiac implantable devices (CIEDs) remote follow-up is safe, effective and efficient to manage clinical and technical events and can improve resource utilization. Methods:Patients (N=153) with implanted CIEDs were followed up for 8 months. An external remote monitoring center (ERMC) composed of nurses and physicians reviewed remote transmissions daily following a specific remote monitoring (RM) protocol. A benchmarking phase with the standard RM management, where patients transmissions were managed directly by the hospital staff, was performed as a term of comparison. Results:A total of 654 transmissions were recorded in the RM system and managed by the ERMC team within 2 working days, showing a significant time reduction compared with standard RM management (100% vs 11% respectively within 2 days, p<0.001). 84% of the transmissions did not include a prioritized event and did not require escalation to the hospital clinician. Highpriority was assigned to 15 (2.3%) transmissions, which were communicated to the hospital team by email within 1 working day. Non-urgent device status events occurred in 88 cases and were communicated to the hospital within 2 working days. Overall, 10 (9.7%) transmissions were followed by a hospitalization. Conclusions:The outsourcing of RM management to an ERMC safely provides efficacy and efficiency gains in patients care compared with a standard in hospital management. Moreover the externalization of RM management could be a key tool to save dedicated staff and facility time with possible positive economic impact.

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Section: Safety and Practicability Of Ermcsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Outsourcing the Remote Management of Cardiac Implantable Electronic Devices: Medical Care Quality Improvement Project (Preprint)

Giannola¹,

Torcivia²,

Farulla³

et al. 2018

Preprint

View full text Add to dashboard Cite

show abstract

“…The incorporation of this technological innovation without the corresponding organizational change could lead to configuring it as an incremental service (with processes being added to a previous monitoring protocol) rather than as a substitute service with respect to conventional hospital-based monitoring, with no savings except if there were a notable increase in effectiveness (but the majority of studies with pacemakers-not with other CIEDs-tend to suggest equivalence in effectiveness, safety, and quality of life). A radical organizational change, however, could lead to significant reductions in costs, as suggested by some observational studies with remote monitoring follow-up practically replacing in-clinic device checks [58]. In this area, and while it is assumed that one of the main advantages of RM would be the reduction of travel and costs for patients and their families (especially in dispersed territories such as Nordland, in the Northern Norway region), the similarity of travel costs (and total costs for patients and families) between both alternatives in our study is surprising and reinforces the idea that the introduction of remote monitoring in this case was not accompanied by an organizational change so as to take advantage of this new technology.…”

Section: Discussionmentioning

confidence: 99%

Cost–utility analysis of telemonitoring versus conventional hospital-based follow-up of patients with pacemakers. The NORDLAND randomized clinical trial

et al. 2020

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The aim of our study was to perform an economic assessment in order to check whether or not telemonitoring of users with pacemakers offers a cost-effective alternative to traditional follow-up in outpatient clinics. Methods We used effectiveness and cost data from the NORDLAND trial, which is a controlled, randomized, non-masked clinical trial. Fifty patients were assigned to receive either telemonitoring (TM; n = 25) or conventional monitoring (CM; n = 25) and were followed up for 12 months after the implantation. A cost-utility analysis was performed in terms of additional costs per additional Quality-Adjusted Life Year (QALY) attained from the perspectives of the Norwegian National Healthcare System and patients and their caregivers. Results Effectiveness was similar between alternatives (TM: 0.7804 [CI: 0.6864 to 0.8745] vs. CM: 0.7465 [CI: 0.6543 to 0.8387]), while cost per patient was higher in the RM group, both from the Norwegian NHS perspective (TM: €2,079.84 [CI: 0.00 to 4,610.58] vs. €271.97 [CI: 158.18 to 385.76]; p = 0.147) and including the patient/family perspective (TM: €2,295.91 [CI: 0.00 to 4,843.28] vs. CM: €430.39 [CI: 0.00 to 4,841.48]), although these large differences-mainly due to a few patients being hospitalized in the TM group, as opposed to none in the CM group-did not reach statistical significance. The Incremental Cost-Effectiveness Ratio (ICER) from the Norwegian NHS perspective (€53,345.27/QALY) and

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“…The development of remote monitoring and remote interrogation technology, which can potentially allow for the replacement of all in-clinic device checks, has also allowed for the easy storage and review of arrhythmic events [[7], [8], [9]]; therefore, knowing the clinical significance of NSVT may be of even greater interest to manage PM patients properly.…”

Section: Introductionmentioning

confidence: 99%

Prognostic role of non-sustained ventricular tachycardia detected with remote interrogation in a pacemaker population

Poli

Facchin

Rizzetto

et al. 2019

IJC Heart & Vasculature

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BackgroundNon-sustained ventricular tachycardia (NSVT) can occur asymptomatically and can be incidentally detected in the internal records of pacemakers (PM). The clinical value of NSVT in the population of PM patients is still uncertain.Our aim was to assess the prevalence of NSVT detected by remote PM control, to describe the clinical and demographic characteristics of patients with NSVT, and to assess the prognostic significance of NSVT in terms of both overall and cardiovascular mortality.MethodsConsecutive patients followed with PM remote interrogations from September 2010 to December 2015 were included. The transmissions pertaining to the first 12 months of remote control were analysed and the patients were divided by those presenting NSVT and those without NSVT. The two groups were compared in terms of total mortality and cardiovascular mortality based on the administrative data provided by the regional administration of the Italian National Health System.ResultsThe prevalence of NSVT in 408 patients (62% males, mean age 75.6; SD 10.6 years old) was 21% in a year. During a mean follow-up duration of 44 months, NSVT did not emerge as independently associated with overall mortality, but was associated with cardiovascular mortality in a competing risk regression model with older age, male gender, diabetes, chronic renal insufficiency, ischemic cardiomyopathy and chronic obstructive pulmonary disease.ConclusionsWe show that NSVT episodes recorded by remote control in a PM population are independently associated with cardiovascular mortality with possible implications for risk stratification and therapeutic options.

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Findings of an observational investigation of pure remote follow-up of pacemaker patients: is the in-clinic device check still needed?

Cited by 16 publications

References 20 publications

Outsourcing the Remote Management of Cardiac Implantable Electronic Devices: Medical Care Quality Improvement Project (Preprint)

Outsourcing the Remote Management of Cardiac Implantable Electronic Devices: Medical Care Quality Improvement Project (Preprint)

Cost–utility analysis of telemonitoring versus conventional hospital-based follow-up of patients with pacemakers. The NORDLAND randomized clinical trial

Prognostic role of non-sustained ventricular tachycardia detected with remote interrogation in a pacemaker population

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