Personalized Remote Monitoring of the Atrial Fibrillation Patients with Electronic Implant Devices

Abstract

Cardiovascular Implantable Electronic Devices (CIED) are gaining popularity in treating patients with heart disease. Remote monitoring through care management systems enables continuous surveillance of such patients by checking device functions and clinical events. These care management systems include decision support capabilities based on clinical guidelines. Data input to such systems are from different information sources including medical devices and Electronic Health Records (EHRs). Although evidence-based clinical guidelines provides numerous benefits such as standardized care, reduced costs, efficient and effective care management, they are currently underutilized in clinical practice due to interoperability problems among different healthcare data sources. In this paper, we introduce the iCARDEA care management system for atrial fibrillation patients with implant devices and describe how the iCARDEA care plan engine executes the clinical guidelines by seamlessly accessing the EHR systems and the CIED data through standard interfaces.

Guideline-driven telemonitoring and follow-up of cardiovascular implantable electronic devices using IEEE 11073, HL7 & IHE profiles

“…The details are described more in [4] and on the official project pages (www.srdc.com.tr/icardea/). CIED follow-up through telemonitoring that is offered today by most CIED vendors, is gradually being adopted in the practice of cardiovascular medicine.…”

“…The adaptive care planner however, requires only the guidelinerelated information as noted in the definition of the personalized care plan. In the case of ventricular tachycardia (VT) alert [4], the care plan related data mainly refer to patient physiological and cardiologic measurements or device settings, but may also include other data items, such as technical data from the device such as its pacing details (Fig. 3), VT/VF therapy summary (Fig.…”

“…3 shows the extract of the CIED telemonitoring report that indicates the details of ICD pacing configuration. As this fragment shows, the pacing amplitude for right ventricle (RV) is 2.00 V and the pacing polarity of RV is bipolar information that is used by the adaptive care planner to assess a possible noise case in the VT care plan [4]: If there are other occurrences of such noise cases in the past week, then the adaptive care planner presents the recently retrieved lead impedance alerts, lead impedance trend report, and the value of the amplitude of the signal to the health professional, so that s/he can decide whether there is an abnormality. Fig.…”

“…The adaptive care planner by examining the CIED report data above, checks the total number of shocks and aborted shocks. In case of ventricular tachycardia (VT), if there are frequent shocks over a specified time period, the care plan recommends an urgent patient referral to the clinic to check his/her health status and treatment would be optimized [4]. Table I.…”

“…Clinical guidelines endorsed by cardiology societies as [1], [2], [3] provide the basis on which cardiology departments can develop their care pathways incorporating clinical data from the hospital EHR and lifestyle data from the patient's PHR, with alerts and full telemonitoring reports from the CIED. The iCARDEA project has designed and implemented the framework for capturing and maintaining personalized care plans [4].…”