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心脏装置的后续护理。目前，美国有超过65万人依靠植入的心脏设备进行除颤和/或起搏，而且这一数字还在呈指数级增长。由于这些设备在安装后需要大量的后续护理，许多医生无法或很快就无法应对这种爆炸性的数量。远程监测技术可以减少对耗时的办公室访问的需要，从而减轻患者和提供者的后续负担。然而，临床医生不被允许远程控制这些设备，并且从远程随访中获得的信息不像他们从办公室访问中获得的那么多。此外，远程监控还会生成大量数据，从而增加提供商的负担，这些数据必须进行审查，并可能及时采取行动，在这种劳动力受限的环境中，这可能非常困难。研究方法是建立和严格分析新的数学决策模型。预期结果包括临床医生在确定对一组患者进行远程和办公室内随访的频率时使用的决策规则，其中可能包括使用制造商发布的建议下的设备的患者和生命即将结束时使用起搏器依赖电池的患者。通过这项研究建立的结果将通过告知临床实践、减少医疗保健支出和提高患者安全性而显著影响社会。传播将包括多份期刊出版物以及应邀在大学和国际会议上向学术受众发表演讲。这项建议的教育影响将由研究生和本科生以及医学研究人员通过在不同级别教授的课程、指导和直接参与研究来体验。

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.