Fig 18 - available via license: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
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Relationship between intracardiac pressure and intrathoracic impedance. (A) Example from one patient. Relationships between intrathoracic impedance, pulmonary capillary wedge pressure, and net fluid loss (I/O) during 4 days of intensive diuresis in the CCU. (B) Correlation between daily medians of ePAD and intrathoracic impedance. Examples are given for 2 patients with major HF events. Correlations are shown during the whole follow-up period (r ¼ À0.31 and À 0.51) (left) and within the 1-month period before a major HF event (r ¼ À0.77 and À 0.81) (right).
Source publication
Patients with cardiac implantable electronic devices (CIEDs) have been followed with periodic clinic visits. The number of patients with CIEDs has been increasing and CIEDs have become more complex. The workload of both medical staff and patients for CIED follow-up has also been increasing. Remote monitoring (RM) technology has undergone many devel...
Citations
... The design process is to add information fusion from multiple sensors to reduce repeated data transmission and reduce energy consumption [7]. Nishii N believes that traditional scheduling schemes often have various problems when applied to practical problems, because traditional scheduling schemes often ignore the complex constraints in practice, often leading to weak scheduling performance [8]. The requirements for intelligent air-conditioning control systems mainly include the ability to adjust the on/off time of the air-conditioning at any time, with diversified control methods, and the ability to perform emergency dispatch, to find faults in time and notify the maintenance personnel to repair them immediately, etc. [9][10]. ...
... The two main changes in RT practice: (1) increase in the RTP and (2) decrease in TT is significant because recent studies consistently document the efficacy of RM following CIED implantation across a range of outcomes, including a mortality benefit [3,5,19,20]. Unfortunately, current evidence also describes the underutilization of RM 15 . ...
Background
Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is standard of care. However, it is underutilized. In July 2012, our institution began providing cell phone adapters (CPAs) to patients free of charge following CIED implantation to improve remote transmission (RT) adherence.Methods
Patients in our institution’s RM database from January 1, 2010, thru June 30, 2015, were retrospectively reviewed. There were 2157 eligible patients. Remote transmission proportion (RTP) and time to transmission (TT) were compared pre- and post-implementation of free CPA. Chi-squared analysis and Kruskal-Wallis tests were performed to compare RTP and TT.ResultsThere was a significant increase in RTP (134 [18.4%] vs 99 [54.7%]; p < 0.001) and decrease in median TT in days (189[110–279] vs 58 [10–149]; p < 0.001) after CPAs were provided to patients. Caucasian patients were more likely than African Americans and Hispanics to use RM prior to CPAs (p = 0.04). After the implementation of CPAs, there was a significant increase in RTP for all racial groups (< 0.001) with no difference in RTP among racial groups (p = 0.18). The RTP for urban residents was significantly greater than non-urban residents with CPAs (p = 0.008). Patients greater than 70 years of age were significantly less likely to participate in RT before and after CPAs were provided (p = 0.03, p = 0.01, respectively).ConclusionsCPAs significantly improve RTP and reduce median TT for all patients regardless of race, geographic residence, and age (> 70 years old to lesser extent). Broad institution of CPAs following ICD implantation could potentially reduce disparity in RTP and deserves more study.
Background:
The number of patients with cardiac implantable electronic devices (CIEDs) is growing, creating substantial workload for device clinics.
Objective:
This study aimed to characterize the workflow and quantify clinic staff time requirements to manage CIED patients.
Methods:
A time and motion workflow evaluation was performed in 11 US and European CIED clinics. Workflow tasks were repeatedly timed during one business week of observation at each clinic. Observations were inclusive of all device models/manufacturers present. Mean cumulative staff time required to review a Remote device transmission and for an In-person clinic visit were calculated, including all necessary clinical and administrative tasks. Annual staff time for follow-up of 1 CIED patient was modeled using CIED transmission volumes, clinical guidelines, and published literature.
Results:
A total of 276 in-person clinic visits and 2,173 remote monitoring activities were observed. Mean staff time required per remote transmission ranged from 9.4-13.5 minutes for therapeutic devices (pacemaker, ICD, CRT) and 11.3-12.9 mins for diagnostic devices (insertable cardiac monitors (ICMs)). Mean staff time per in-person visit ranged from 37.8-51.0 mins and 39.9-45.8 mins, for therapeutic devices and ICMs respectively. Including all remote and in-person follow-ups, the estimated annual time to manage one CIED patient ranged from 1.6-2.4 hours for therapeutic devices and 7.7-9.3 hours for ICMs.
Conclusions:
CIED patient management workflow is complex and requires significant staff time. Understanding process steps and time requirements informs implementation of efficiency improvements, including remote solutions. Future research should examine the heterogeneity in patient management processes to identify the most efficient workflows.
Clinicaltrial:
Background:
Remote monitoring (RM) is an established technology integrated into routine follow-up of patients with implantable cardioverter-defibrillator (ICD). Current RM systems differ according to transmission frequency and alert definition.
Objective:
We aimed to compare time difference between detection and acknowledgement of clinically relevant events between four RM systems.
Methods:
We analyzed time delay between detection of ventricular arrhythmic and technical events by the ICD and acknowledgement by hospital staff in 1.802 consecutive patients followed with RM during September 2014 - August 2016. Devices from Biotronik (BIO, n=374), Boston Scientific (BSC, n=196), Medtronic (MDT, n=468) and St Jude Medical (SJM, n=764) were included. We identified all events from RM webpages and their acknowledgement with RM or at in-clinic follow-up. Events occurring during weekends were excluded.
Results:
We included 3.472 events. Proportion of events acknowledged within 24 hours was 72%, 23%, 18% and 65% with BIO, BSC, MDT and SJM, respectively, with median times of 13, 222, 163 and 18 hours from detection to acknowledgement (p<0.001 for both comparisons between manufacturers). Including only events transmitted as alerts by RM, 72%, 68%, 61% and 65% for BIO, BSC, MDT and SJM, respectively were acknowledged within 24 hours. Variation in time to acknowledgement of ventricular tachyarrhythmia episodes not treated with shock therapy was the primary cause for the difference between manufacturers.
Conclusion:
Significant and clinically relevant differences in time delay from event detection to acknowledgement exist between RM systems. Varying definitions of which events RM transmits as alerts are important for the differences observed.
