Optimizing Implanted Cardiac Device Follow-Up Care

该奖项的研究目标是为临床医生制定指南，为各种不同类别的患者提供植入式心脏器械随访护理。 目前，美国有超过65万人依靠植入式心脏设备进行除颤和/或起搏，并且这一数字正在呈指数级增长。由于这些设备在实施后需要大量的后续护理，许多医生无法或很快将无法科普这种爆炸性的数量。远程监测技术可以通过减少耗时的办公室访问来减轻患者和提供者的后续负担。然而，临床医生不允许远程控制设备，并且从远程随访中获得的信息不如从诊室访视中获得的信息多。此外，远程监控还可能通过生成大量必须被审查并可能及时采取行动的数据而增加提供商的负担，这在这种劳动力受限的环境中可能非常困难。研究方法是制定和严格分析新的数学决策模型。 预期结果包括临床医生用于确定对一组患者进行远程和办公室随访的频率的决策规则，其中可能包括使用制造商发布的许可证下的设备的患者和电池接近寿命终点的起搏器依赖患者。通过这项研究建立的结果将通过告知临床实践而对社会产生重大影响，减少医疗保健支出，提高患者安全性。 传播将包括多种期刊出版物，并应邀在大学和国际会议上向学术界听众发表演讲。研究生和本科生以及医学研究人员将通过各级教学课程，指导和直接参与研究来体验这项建议的教育影响。

The research objective of this award is to develop guidelines for clinicians providing implanted cardiac device follow-up care for a variety of diverse classes of patients. Over 650,000 people in the United States currently rely on an implanted cardiac device for defibrillation and/or pacing, and this number is growing exponentially. Because these devices require such considerable follow-up care after implementation, many physicians are, or soon will be, unable to cope with this explosive volume. Remote monitoring technologies can serve to alleviate the follow-up burden for both patients and providers by reducing the need for time consuming office visits. However, clinicians are not permitted to control the devices remotely and do not obtain as much information from a remote follow-up as they would from an in-office visit. Moreover, remote monitoring can also contribute to the provider's burden by generating vast amounts of data that must be reviewed and possibly acted upon in a timely fashion, which can be very difficult in this workforce constrained environment. The research approach is to formulate and rigorously analyze novel mathematical decision models. Expected outcomes include decision rules for clinicians to use in determining the frequency with which to perform remote and in-office follow-ups for a panel of patients, which may include patients with devices under manufacturer-issued advisories and pacer-dependent patients with batteries near their end of life.The results established through this research will significantly impact society by informing clinical practice, reducing health care expenditures and improving patient safety. Dissemination will include multiple journal publications and invited presentations to academic audiences at universities and international conferences. The educational impacts of this proposal will be experienced by graduate and undergraduate students as well as medical researchers through courses taught at various levels, mentoring and direct involvement in the research.