Organizational model and reactions to alerts in remote monitoring of cardiac implantable electronic devices: A survey from the Home Monitoring Expert Alliance project
Organizational model and reactions to alerts in remote monitoring of cardiac implantable electronic devices: A survey from the Home Monitoring Expert Alliance project
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DOI：
10.1002/clc.23108
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发表时间：
2019-01-01
影响因子：
2.7
通讯作者：
Ricci, Renato P.
中科院分区：
文献类型：
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作者：
Zanotto, Gabriele;D'Onofrio, Antonio;Ricci, Renato P.
背景本调查旨在描述心脏植入性电子设备(CIEDS)远程监测(RM)服务的组织工作流程。方法设计一份调查问卷，由49个参与意大利家庭监测专家联盟的站点填写。结果86%的中心建立了专门的RM组织模式。中位数RM组由2名医生(IQR：1-3)和1名护士(IQR：0-2)组成。接受心脏复律除颤器(ICD)和心脏再同步治疗(CRT)的患者的中位数百分比为100%(IQR：10%-100%)，接受心脏再同步治疗(CRT)的患者的中位数百分比为5%(IQR：0%-30%)。起搏器组和ICD/CRT组分别每12个月和6个月进行一次随访。超过90%的站点用于激活所有技术警报，在参数超出范围的情况下会立即做出反应。大多数病例的房颤(AF)每日负荷通知阈值范围为2.4至7.2小时。所有的室性心律失常警报通常都是打开的：不适当的治疗或不止一次适当的发作引发了紧急的医院就诊。对于心力衰竭，总是使用低CRT百分比起搏警报，而其他可用的通知不太频繁地打开。结论RM服务一般采用两名专科医生和一名护士的初级护理模式，主要面向ICD/CRT患者。技术性、房颤和室性心律失常警报会触发快速反应，而与心力衰竭相关的指标通常较少应用。
Background This survey aimed to describe the organizational workflow of cardiac implantable electronic devices (CIEDs) remote monitoring (RM) service in ordinary practice. Methods A questionnaire was designed for our purpose and completed by 49 sites participating to the Italian Home Monitoring Expert Alliance. Results A dedicated organizational model for RM was set up for 86% of centers. The median RM team consisted of 2 (Interquartile range [IQR]: 1-3) physicians and 1 (IQR: 0-2) nurse. RM service was available in working hours and the median percentage of patients included was 100% (IQR: 10%-100%) for implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) recipients and 5% (IQR:0%-30%) for pacemakers. In-office follow-up was performed every 12 and 6 months for pacemaker and ICD/CRT recipients, respectively. More than 90% of sites used to activate all technical alerts, with a prompt reaction in case of an out-of-range parameter. The threshold for atrial fibrillation (AF) daily burden notification in most cases ranged from 2.4 to 7.2 hours. All ventricular arrhythmias alerts were usually switched on: an inappropriate therapy or more than one appropriate episode triggered an urgent in-hospital visit. Concerning heart failure, low CRT percentage pacing alert was always used, while the other available notifications were less frequently switched on. Conclusions This survey showed that RM service was usually set up with a primary nursing model including on average two responsible physicians and one nurse and mainly offered to ICD/CRT patients. Technical, AF and ventricular arrhythmia alerts triggered prompt reactions, while heart failure related indexes were generally less applied.