Giuseppe D'Ancona1,2, Erdal Safak3,4, Jochen Senges5, Matthias Hochadel5, Van Luyen Nguyen3,4, Christian Perings6, Werner Jung7, Stefan Spitzer8, Lars Eckardt9, Johannes Brachmann10, Karlheinz Seidl11, Hans Ulrich Hink12, Hüseyin Ince3,4, Jasmin Ortak3,4. 1. Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany. rgea@hotmail.com. 2. Rostock University Medical Center, Rostock, Germany. rgea@hotmail.com. 3. Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany. 4. Rostock University Medical Center, Rostock, Germany. 5. Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany. 6. Katholisches Klinikum Lünen, Lünen, Germany. 7. Schwarzwald-Baar Klinikum, Klinik für Innere Medizin III Kardiologie, Villingen-Schwenningen, Germany. 8. Praxisklinik Herz und Gefäße Dresden, Institute of Medical Technology Brandenburg University of Technology Cottbus, Senftenberg, Germany. 9. Division of Experimental and Clinical Electrophysiology, Department of Cardiology and Angiology, University of Muenster, Münster, Germany. 10. Klinikum Coburg, Coburg, Germany. 11. Klinikum Ingolstadt, Ingolstadt, Germany. 12. Klinikum Frankfurt Höchst, Frankfurt am Main, Germany.
Abstract
BACKGROUND: Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has been popularized as a precious patients' management tool. We have investigated RM within the premises of a multicenter, prospective, real-world registry, i.e., the German Device II. METHODS: We have focused on: (1) CIEDs with RM capabilities implantation rate and (2) actual rate of RM features activation. RESULTS: A cohort of 1223 CIEDs patients were treated from 04/11 to 02/14. Of these, 720 (58.8%) were implanted with RM-capable devices and were presenting significantly more often a clinical diagnosis of dilatative cardiomyopathy and an indication for cardiac resynchronization. At discharge, the RM feature was activated in only 12.6% (91/720) of the total number of patients implanted with RM-capable CIEDs. After adjusting for implanting center, there was no significant correlation between any of the patient clinical characteristics and RM activation. One-year estimated mortality was 9.0% in patients with activated RM, 5.6% in those with not activated RM, and 7.7% in those without RM capability (p = 0.3). The RM feature was still activated in 13.8% of the patients surviving at follow-up. Patients undergoing RM had a trend for higher re-hospitalization rate and less visits in the device outpatient clinic. CONCLUSIONS: Although RM in CIEDs may be a clinically valuable technological armamentarium, its activation does not reflect patients' clinical profile. In fact, RM is often not activated, most probably because it is still recognized as a source of increased workload in a reality where reimbursement plans for dedicated human resources are not yet optimized.
BACKGROUND: Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has been popularized as a precious patients' management tool. We have investigated RM within the premises of a multicenter, prospective, real-world registry, i.e., the German Device II. METHODS: We have focused on: (1) CIEDs with RM capabilities implantation rate and (2) actual rate of RM features activation. RESULTS: A cohort of 1223 CIEDs patients were treated from 04/11 to 02/14. Of these, 720 (58.8%) were implanted with RM-capable devices and were presenting significantly more often a clinical diagnosis of dilatative cardiomyopathy and an indication for cardiac resynchronization. At discharge, the RM feature was activated in only 12.6% (91/720) of the total number of patients implanted with RM-capable CIEDs. After adjusting for implanting center, there was no significant correlation between any of the patient clinical characteristics and RM activation. One-year estimated mortality was 9.0% in patients with activated RM, 5.6% in those with not activated RM, and 7.7% in those without RM capability (p = 0.3). The RM feature was still activated in 13.8% of the patients surviving at follow-up. Patients undergoing RM had a trend for higher re-hospitalization rate and less visits in the device outpatient clinic. CONCLUSIONS: Although RM in CIEDs may be a clinically valuable technological armamentarium, its activation does not reflect patients' clinical profile. In fact, RM is often not activated, most probably because it is still recognized as a source of increased workload in a reality where reimbursement plans for dedicated human resources are not yet optimized.
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