EVALUATING THE INTEGRATION OF REMOTE MONITORING FOR CARDIOVASCULAR IMPLANTABLE ELECTRONIC DEVICE FOLLOW-UP

2014 ◽  
Vol 30 (10) ◽  
pp. S357-S358
Author(s):  
J. Forman ◽  
S. Flavelle ◽  
O. Van Breemen ◽  
E. Hahn ◽  
C. McIlroy ◽  
...  
Keyword(s):  
Remote Monitoring ◽  
Electronic Device ◽  
Cardiovascular Implantable Electronic Device

Canadian Registry of Electronic Device Outcomes: remote monitoring outcomes in the Abbott battery performance alert—a multicentre cohort

EP Europace ◽  
2021 ◽  
Author(s):  
Sharath Kumar ◽  
Jason Davis ◽  
Bernard Thibault ◽  
Iqwal Mangat ◽  
Benoit Coutu ◽  
...  
Keyword(s):  
Remote Monitoring ◽  
Primary Outcome ◽  
Electronic Device ◽  
Electronic Devices ◽  
Cardiac Resynchronization ◽  
Device Performance ◽  
Cardiac Implantable Electronic Devices ◽  
All Cause Mortality ◽  
Multicentre Cohort

Abstract Aims Cardiac implantable electronic devices with device advisories have the potential of device malfunction. Remote monitoring (RM) of devices has been suggested to allow the identification of abnormal device performance and permit early intervention. We sought to describe the outcomes of patients with and without RM in devices subject to the Abbott Premature Battery Depletion (PBD) advisory with data from a Canadian registry. Methods and results Patients with an Abbott device subject to the PBD advisory from nine implantable cardioverter defibrillator (ICD) implanting centres in Canada were included in the registry. The use of RM was identified from baseline and follow-up data in the registry. The primary outcome was detection of PBD and all-cause mortality. A total of 2666 patients were identified with a device subject to the advisory. In all, 1687 patients (63.2%) had RM at baseline. There were 487 deaths during follow-up. At a mean follow-up of 5.7 ± 0.7 years, mortality was higher in those without a remote monitor compared with RM at baseline (24.7% vs. 14.5%; P < 0.001). Pre-mature battery depletion was identified in 36 patients (2.1%) with RM vs. 7 (0.7%) without RM (P = 0.004). Time to battery replacement was significantly reduced in patients on RM (median 5 vs. 13 days, P = 0.001). Conclusion The use of RM in patients with ICD and cardiac resynchronization therapy under advisory improved detection of PBD, time to device replacement, and was associated with a reduction in all-cause mortality. The factors influencing the association with mortality are unknown and deserve further study.

Abstract 16099: Predictors of Cardiovascular Implantable Electronic Device-dependence at Long-term Follow-up After Alcohol Septal Ablation in Hypertrophic Cardiomyopathy Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Weeranun D Bode ◽  
Michael F Bode ◽  
Megan Zhao ◽  
Rahul Sakhuja ◽  
Michael A Fifer ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Electronic Device ◽  
Av Block ◽  
Ventricular Pacing ◽  
Alcohol Septal Ablation ◽  
Long Term Follow Up ◽  
Baseline Characteristics ◽  
Cardiovascular Implantable Electronic Device

Introduction: The most common complication of alcohol septal ablation (ASA) is periprocedural high grade AV block (HGAVB). No long-term follow-up of cardiovascular implantable electronic device (CIED) utilization after ASA has been reported. Hypothesis: Pacemaker dependence on long-term follow up can be predicted by ECG or procedural characteristics. Methods: We analyzed all patients with hypertrophic cardiomyopathy who underwent ASA from December 1998 to December 2019 at our institution and received their first CIED within 30 days after ASA for HGAVB. All available follow-up interrogations were reviewed. CIED dependence was defined as ventricular pacing of ≥5%. CIED programming was determined by the patients’ cardiologists' discretion. Results: A total of 103 patients with hypertrophic cardiomyopathy underwent ASA. The average follow up duration was 10.1 years. Within 30 days after ASA, a total 25 patients received a CIED for HGAVB. On long term follow-up 16 patients (64%) were found to be CIED-dependent. Baseline characteristics, including pre and post-ASA ECG, were not significantly different between dependent and non-dependent patients (Table). The only predictor for CIED dependence was >1 ml of alcohol injected during ASA (OR 6.0, p<0.046). Conclusions: CIED implantation after ASA is common. Almost two thirds of patients who received CIED for postprocedural HGAVB were CIED-dependent on long term follow up. CIED dependence can be predicted by amount of injected alcohol >1 ml during ASA.

P6546Canadian Registry of Electronic Device Outcomes (CREDO): remote monitoring outcomes in the abbott battery performance alert, a multicentre cohort

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Davis ◽  
B Thibault ◽  
I Mangat ◽  
B Coutu ◽  
M Bennett ◽  
...  
Keyword(s):  
Remote Monitoring ◽  
Primary Outcome ◽  
Electronic Device ◽  
Electronic Devices ◽  
Device Performance ◽  
Remote Monitor ◽  
Cardiac Implantable Electronic Devices ◽  
All Cause Mortality ◽  
Multicentre Cohort

Abstract Background Cardiac implantable electronic devices have been known to have lead and device malfunctions leading to advisories. Increased use of remote monitoring of devices has been suggested to allow the identification of abnormal device performance and allow early intervention. We sought to describe the outcomes of patients with and without remote monitoring of in devices in the Abbott Premature Battery Depletion advisory with data from a Canadian registry Methods Patients with an Abbott device subject to the Battery Performance Alert Advisory from nine ICD implanting centres in Canada were included in the registry. The use of remote monitoring was identified from baseline and followup data in the registry. The primary outcome was detection of premature battery depletion and all cause mortality. Results 2679 patents were identified with a device subject to the advisory. Devices were implanted between 2010 and 2017. 1716 patients (64%) had remote monitoring at baseline with this increasing to 83.7% at followup at 12 months. Premature battery depletion occurred in 43 patients (1.6%). Discovery of premature battery depletion was detected by remote monitoring in 70% of patients. There were 492 deaths during the follow up. Mortality was higher in those without a remote monitor compared to those with a remote monitor at follow-up and remote monitor at baseline and follow-up (11.3%, 2.6% versus 6.1% respectively; p=0.0186). There were no deaths attributed to premature battery depletion Conclusion The use of remote monitoring in patients with ICD and CRT under advisory reliably detected device failure and was associated with a reduction in all-cause mortality.

P2277Utility of cardiovascular implantable electronic device (CIED)-derived patient activity, a novel digital biomarker, to predict inappropriate therapy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Rosero ◽  
P Jones ◽  
I Goldenberg ◽  
W Zareba ◽  
K Stein ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Electronic Device ◽  
Cox Proportional Hazards ◽  
Inappropriate Therapy ◽  
Activity Data ◽  
Proportional Hazards Regression ◽  
Kaplan Meier ◽  
Cardiovascular Implantable Electronic Device

Abstract Background The role of cardiovascular implantable electronic device (CIED)-derived activity to predict inappropriate implantable cardioverter-defibrillator (ICD) therapy is not known. The Multicenter Automatic Defibrillator Implantation Trial – Reduce Inappropriate Therapy (MADIT-RIT) enrolled 1500 patients with contemporary indication for an ICD or a CRT-D. We aimed to identify whether activity, as a digital biomarker, predicted inappropriate therapy. Methods In 1500 patients enrolled in MADIT-RIT, CIED-derived patient activity was acquired daily. CIED-derived activity was averaged for the first 30 days following randomization and utilized in this study to predict inappropriate therapy post- 30-day. Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression models were used to evaluate first inappropriate therapy by 30-day CIED-derived patient activity quintiles, and by 30-day device derived patient activity as a continuous measurement. Results There were a total of 1463 patients with activity data available (90%), 135 patients received at least one inappropriate therapy during the post-30 day follow-up period. Patients in the highest quintile (Q5) of CIED-derived activity (more active) were younger, more often males and more likely to have had a prior ablation of an atrial arrhythmia. Patients in the highest quintile of 30-day CIED-derived median activity had the highest risk of receiving inappropriate therapy, 21% at 2 years as compared 7–11% in the other four quintiles (Figure, p<0.001 for the overall duration). Patients with the highest level of 30-day median patient activity (Q5) had 1.75 times higher risk of any inappropriate therapy as compared with lower levels of activity, Q1-Q4 (HR=1.75, 95% CI: 1.23–2.50, p<0.002). Each 10% increase in CIED-derived 30-day median patient activity was associated with a significant, 73% increase in risk of receiving inappropriate therapy (HR=1.73, 95% CI: 1.17–2.54, p=0.005). Patients in the highest quintile for activity had a 68% increase in the risk of SVT excluding atrial fibrillation, atrial flutter or atrial tachycardia (HR=1.69, 95% CI: 1.26–2.25, p=0.004), despite 96% receiving beta-blocker medications. Inappropriate ICD Therapies by Activity Conclusions CIED-derived 30-day median patient activity predicted subsequent inappropriate therapy in ICD and CRT-D patients enrolled in MADIT-RIT. Patients with high levels of 30-day CIED-derived median patient activity were at a significantly higher risk of receiving inappropriate therapy. Activity, as a digital biomarker, may have utility in predicting and managing the risk of inappropriate therapy in this population. Acknowledgement/Funding Boston Scientific

Variations in cardiac implantable electronic device surveillance and ancillary testing in the paediatric and congenital heart disease population: an international multi-centre survey from the Paediatric and Congenital Electrophysiology Society

2021 ◽  
pp. 1-5
Author(s):  
Melissa M. Olen ◽  
Brynn E. Dechert ◽  
Anne Foster ◽  
Ronald J. Kanter ◽  
Michael J. Silka ◽  
...  
Keyword(s):  
Remote Monitoring ◽  
Electronic Device ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Implantable Cardioverter Defibrillators ◽  
Cardiac Implantable Electronic Device ◽  
Clinical Practices ◽  
Device Implantation

Abstract Background: Expert guidance from scientific societies and regulatory agencies recommend a framework of principles for frequency of in-person evaluations and remote monitoring for patients with cardiac implantable electronic devices. However, there are limited data regarding adherence to recommendations among paediatric electrophysiologists, and there are no data regarding cardiac implantable electronic device-related ancillary testing. Methods: To assess current clinical practices for cardiac implantable electronic device in-person evaluation, remote monitoring, and cardiac implantable electronic device-related ancillary testing, the Paediatric and Congenital Electrophysiology Society members were surveyed. The main outcome measures were variations in frequency of in person evaluation, frequency of remote monitoring, and cardiac implantable electronic device-related ancillary testing. Results: All respondents performed in-person evaluation at least once a year, but <50% of respondents performed an in-person evaluation within 2 weeks of cardiac implantable electronic device implantation. Remote monitoring was performed every 3 months for pacemakers and implantable cardioverter defibrillators by 71 and 75% respondents, respectively. Follow-up echocardiography was performed every 2–3 years by 53% respondents for patients with >50% ventricular pacing. Majority of respondents (75%) did not perform either an exercise stress test or ambulatory Holter monitoring or chest X-ray (65%) after cardiac implantable electronic device implantation. Conclusion: This survey identified significant practice variations in cardiac implantable electronic device in- person evaluation, remote monitoring, and ancillary testing practices among paediatric electrophysiologists. Cardiac implantable electronic device management may be optimised by development of a paediatric-specific guidelines for follow-up and ancillary testing.

scholarly journals Clinic time required to manage cardiac implantable electronic device patients: a time and motion workflow evaluation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Biundo ◽  
A Burke ◽  
S Rosemas ◽  
D Lanctin ◽  
E Nicolle
Keyword(s):  
Remote Monitoring ◽  
Electronic Device ◽  
Future Research ◽  
Funding Source ◽  
Staff Time ◽  
Private Company ◽  
Remote Transmission ◽  
Time And Motion ◽  
Time Required

Abstract Background The population with cardiac implantable electronic devices (CIEDs) is growing, creating workload for device clinics to manage these patients. However, the CIED follow-up workflow is poorly understood. This study sought to characterize the workflow and staff time for CIED patient management. Methods A time and motion workflow evaluation was performed in 6 U.S. CIED clinics, which manage an average of 4,217 patients. Each task involved in CIED management was repeatedly timed, including all manufacturers, during 1 business week at each clinic. Mean staff time for a remote transmission and an in-person visit were calculated, including all clinical and administrative (e.g: scheduling, documentation) activities related to the encounter. Annual staff time for follow-up of 1 patient was modeled using CIED transmission data for the 6 clinics, guidelines for CIED follow-up, and published literature. Results 124 clinic visits and 1,374 remote monitoring activities were observed. Staff time required per remote transmission ranged from 12.1–13.4 minutes (depending on the CIED type), and time per visit was 43.4–51.0 minutes. Including all remote and in-person follow-ups, the estimated total staff time per year to manage one pacemaker, ICD, CRT, and ICM patient was 2.3, 2.4, 2.4, and 9.3 hours, respectively (Table 1). Conclusion CIED clinic workflow is complex and requires significant staff time. Remote monitoring is an efficient complement to in-office visits, allowing for continuous follow-up of patients. Future research should examine heterogeneity in clinic processes to identify the most efficient workflow. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Medtronic

Abstract 286: Clinic Time Required To Manage Cardiac Implantable Electronic Device Patients: A Time And Motion Workflow Evaluation

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Eliana Biundo ◽  
Alan Burke ◽  
Sarah C Rosemas ◽  
David Lanctin ◽  
Emmanuelle Nicolle
Keyword(s):  
Remote Monitoring ◽  
Patient Management ◽  
Electronic Device ◽  
Future Research ◽  
Staff Time ◽  
Remote Transmission ◽  
Time And Motion ◽  
Number Of Patients ◽  
Time Required

Background: The number of patients with cardiac implantable electronic devices (CIEDs) is growing, creating workload for device clinics to manage this population. Remote monitoring of CIED patients is a guidelines-recommended method for optimizing treatment in CIED patients in combination with in-person follow-up. However, the specific steps involved in CIED management, as well as the HCP time required for these activities, are not well understood. The aim of this study was to quantify the clinic staff time requirements associated with the remote and in-person management of CIED patients. Methods: A time and motion workflow evaluation was performed in 6 U.S. CIED clinics. Participating clinics manage an average of 4,217 (range: 870-10,336) CIED patients. The duration of each task involved in CIED management was repeatedly timed, for all device models/manufacturers, during one business week (5 days) of observation at each clinic. Mean time for review of a remote transmission and for an in-person clinic visit were calculated, including all clinical and administrative (e.g., scheduling, documentation) activities related to the encounter. Annual staff time (inclusive of all clinical and administrative staff) for follow-up of 1 CIED patient was modeled using device transmission data for the 6 clinics, clinical guidelines for CIED follow-up, and published literature (Table 1). Results: During 6 total weeks of data collection, 124 in-person clinic visits and 1,374 remote transmission review activities were observed and measured. On average, the total staff time required per remote transmission ranged from 11.9-13.5 minutes (depending on the CIED type), and time per in-person visit ranged from 43.4-51.0 minutes. Including all remote and in-person follow-ups, the estimated total staff time per year to manage one Pacemaker, ICD, CRT, and ICM patient was 2.3, 2.4, 2.4, and 9.3 hours, respectively. Conclusion: CIED patient management workflow is complex and requires significant staff time in cardiac device clinics. Remote monitoring is an efficient complement for in-office visits, allowing for continuous follow-up of patients with reduced staff time required per device check. Future research should examine heterogeneity in patient management processes to identify the most efficient workflow.

Sign in / Sign up

Export Citation Format

Share Document