Clinical and Economic Impact of Remote Monitoring on the Follow-Up of Patients with Implantable Electronic Cardiovascular Devices: An Observational Study
Clinical and Economic Impact of Remote Monitoring on the Follow-Up of Patients with Implantable Electronic Cardiovascular Devices: An Observational Study
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DOI：
10.1089/tmj.2012.0064
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发表时间：
2013-02-01
影响因子：
4.7
通讯作者：
Rodrigues, Pedro P.
中科院分区：
文献类型：
--
作者：
Costa, Paulo Dias;Hipolito Reis, A.;Rodrigues, Pedro P.
传统的对心血管设备患者的随访仍然是一项活动，除了为日益增长的人口提供服务外，还需要相当多的时间和专门的人力和技术资源。我们的目的是评估CareLink(R)(明尼阿波利斯美敦力)远程监测系统作为在办公室就诊期间对植入设备患者进行随访的补充选项的适用性。评估结果包括临床(事件检测和诊断时间)和非临床(患者满意度和经济成本)两个方面。一项观察性的、纵向的前瞻性研究在一周内对葡萄牙一家中心医院的患者进行了抽样(43名患者)。数据是在四个时刻收集的：两次办公室访问和两次远程评估，再现了一年的临床随访。数据来源包括健康记录、植入物报告、初始人口统计数据收集、后续打印输出和调查问卷。在验证了选择标准后，纳入15名患者(11名男性[73%])，年龄63.4+/-10.8岁，再次出现14.0+/-6.3个种植月。临床上，检测到15起事件(9起通过远程监测，6起由患者启动)，其中只有9起是有症状的。我们验证了远程监测可以检测到症状和无症状事件，而患者发起的激活只检测到有症状的事件(p=0.028)。此外，有事件的患者的平均诊断预期约为58天(p<；0.001)。在非临床方面，我们观察到对使用远程监控技术的满意度很高或非常高(分别为67%和33%)，但仍有8名患者(53%)表示他们更喜欢在办公室就诊。最后，远程监护技术的引入有能力为患者降低25%的总随访成本。我们的结论是，在办公室就诊之间，使用该系统是对植入装置患者进行随访的一种可行的补充选择。
Traditional follow-up of patients with cardiovascular devices is still an activity that, in addition to serving an increasing population, requires a considerable amount of time and specialized human and technical resources. Our aim was to evaluate the applicability of the CareLink (R) (Medtronic, Minneapolis, MN) remote monitoring system as a complementary option to the follow-up of patients with implanted devices, between in-office visits. Evaluated outcomes included both clinical (event detection and time to diagnosis) and nonclinical (patient's satisfaction and economic costs) aspects. An observational, longitudinal, prospective study was conducted with patients from a Portuguese central hospital sampled by convenience during 1 week (43 patients). Data were collected in four moments: two in-office visits and two remote evaluations, reproducing 1 year of clinical follow-up. Data sources included health records, implant reports, initial demographic data collection, follow-up printouts, and a questionnaire. After selection criteria were verified, 15 patients (11 men [73%]) were included, 63.4 +/- 10.8 years old, re-presenting 14.0 +/- 6.3 implant months. Clinically, 15 events were detected (9 by remote monitoring and 6 by patient-initiated activation), of which only 9 were symptomatic. We verified that remote monitoring could detect both symptomatic and asymptomatic events, whereas patient-initiated activation only detected symptomatic ones (p = 0.028). Moreover, the mean diagnosis anticipation in patients with events was approximately 58 days (p < 0.001). In nonclinical terms, we observed high or very high satisfaction (67% and 33%, respectively) with using remote monitoring technology, but still 8 patients (53%) stated they preferred in-office visits. Finally, the introduction of remote monitoring technology has the ability to reduce total follow-up costs for patients by 25%. We conclude that the use of this system constitutes a viable complementary option to the follow-up of patients with implantable devices, between in-office visits.