Home monitoring after ambulatory implanted primary cardiac implantable electronic devices: The home ambulance pilot study

Abstract

Background The Home Monitoring (HM) system of cardiac implantable electronic devices (CIEDs) permits early detection of arrhythmias or device system failures. The aim of this pilot study was to examine how the safety and efficacy of the HM system in patients after ambulatory implanted primary CIEDs compare to patients with a standard procedure and hospitalization. Hypothesis We hypothesized that HM and their modifications would be a useful extension of the present concepts for ambulatory implanted CIEDs. Methods This retrospective analysis evaluates telemetric data obtained from 364 patients in an ambulatory single center over 6 years. Patients were assigned to an active group (n = 217), consisting of those who were discharged early on the day of implantation of the primary CIED, or to a control group (n = 147), consisting of those discharged and followed up with the HM system according to usual medical practices. Results The mean duration of hospitalization was 73.2% shorter in the active group than in the control group, corresponding to 20.5 ± 13 fewer hours (95% confidence interval [CI]: 6.3‐29.5; P < 0.01) spent in the hospital (7.5 ± 1.5 vs 28 ± 4.5 h). This shorter mean hospital stay was attributable to a 78.8% shorter postoperative period in the active group. The proportion of patients with treatment‐related adverse events was 11% (n = 23) in the active group and 17% (n = 25) in the control group (95% CI: 5.5‐8.3; P = 0.061). This 6% absolute risk reduction (95% CI: 3.3‐9.1; P = 0.789) confirmed the noninferiority of the ambulatory implanted CIED when compared with standard management of these patients. Conclusions Early discharge with the HM system after ambulatory CIED implantation was safe and not inferior to the classic medical procedure. Thus, together with lower costs, HM and its modifications would be a useful extension of the present concepts for ambulatory implanted CIEDs.

eHealth Applications to Support Independent Living of Older Persons: Scoping Review of Costs and Benefits Identified in Economic Evaluations

“…The studies in English were geographically clustered, with 26 studies conducted in North America, among which 20 occurred in the United States [ 20 - 23 , 25 - 28 , 30 , 31 , 33 , 34 , 37 , 38 , 42 , 61 , 62 , 64 , 67 , 68 ] and 6 in Canada [ 29 , 40 , 49 , 51 , 63 , 66 ]. Among the 22 studies conducted in Europe, they were spread across countries, with 5 studies conducted in England and the United Kingdom [ 24 , 41 , 43 , 44 , 53 ]; 3 each in Denmark [ 50 , 52 , 58 ], Italy [ 32 , 45 , 55 ], the Netherlands [ 35 , 39 , 72 ]; 2 each in Austria [ 46 , 60 ] and Germany [ 47 , 54 ]; and 1 each in France [ 59 ], Spain (although not explicitly stated in the paper) [ 57 ], Norway [ 70 ], and Sweden [ 69 ]. Finally, 4 studies took place in Australia [ 36 , 56 , 71 , 73 ] and 3 in Asia, among which 2 were in Japan [ 13 , 65 ] and 1 in Taiwan [ 48 ].…”

“…In total, 18 studies reported CEAs [ 24 , 25 , 27 , 34 , 35 , 39 - 41 , 44 , 46 , 50 , 53 , 54 , 59 , 60 , 70 , 71 , 73 ], 2 studies combined CEAs with clinical or budget impact analyses [ 48 , 62 ], 2 studies reported CUAs [ 36 , 52 ], and 1 study reported a CBA [ 13 ]; 8 studies denoted the evaluation as cost analysis [ 26 , 45 , 61 , 63 , 67 - 69 , 72 ], the term cost minimization was used in 4 studies [ 29 , 49 , 51 , 65 ], and 1 study reported relying on cost consequence analysis [ 43 ]. The remaining 17 studies stated that they evaluated a range of cost and outcome measures [ 21 , 23 , 28 , 30 - 33 , 37 , 38 , 42 , 47 , 55 - 58 , 64 , 66 ], and 2 studies relied on case studies to outline benefits, saving, expenditures, and outcomes [ 20 , 22 ].…”

“…Only a few studies without Markov modeling explicitly stated the time frame of the economic evaluation, with 1 study capturing a period of multiple weeks [ 63 ] and 6 studies with a 1-year time frame [ 24 , 39 , 44 , 45 , 50 , 54 ]. The remaining 40 studies did not indicate the time frame explicitly, and the period of data collection was, if applicable, used as a proxy for the time frame: 1-6 months [ 22 , 25 , 36 - 38 , 42 , 51 , 56 , 57 , 60 , 66 ], 7-12 months [ 28 , 29 , 48 , 52 , 58 , 59 , 64 , 67 - 69 , 71 - 73 ], 13-18 months [ 20 , 21 , 31 , 53 ], 19-24 months [ 27 , 49 , 61 ], and beyond 24 months [ 26 , 30 , 32 , 33 , 46 , 47 , 55 , 70 ]. In 1 study, the period of data collection was insufficiently described [ 23 ].…”

“…The group of 28 studies on the left considered at least one implementation and one operating activity, in addition to the consequences of the eHealth intervention [ 13 , 24 , 29 , 31 , 34 - 41 , 44 , 50 , 51 , 53 , 55 , 56 , 59 , 61 , 63 , 65 , 66 , 69 - 73 ]. The middle group of 13 studies contains either implementation or operating activities, in addition to consequences [ 22 , 23 , 25 , 26 , 28 , 30 , 32 , 43 , 47 , 52 , 57 , 62 , 68 ]. Finally, the 14 studies on the right do not consider implementation and operating activities but only focus on the consequences [ 20 , 21 , 27 , 33 , 45 , 46 , 48 , 49 , 54 , 58 , 60 , 64 , 67 ].…”

“…Tables 1 - 3 also show that some components have received more attention than others. Concentrating on the different consequences, we observed the following: If patient outcomes are considered, the focus lies on physical outcomes [ 30 , 32 - 34 , 43 , 44 , 46 , 47 , 54 , 55 , 59 - 61 , 68 ] and quality of life or quality-adjusted life years [ 24 , 35 , 36 , 39 - 41 , 44 , 50 , 52 , 62 , 71 , 73 ]. Productivity loss because of time absent from work received less attention, with only 4% (2/55) of the studies incorporating it [ 44 , 62 ]; however, this outcome is understandable given that our review focused on the population of older persons, which predominantly no longer participates in the labor market.…”