A remote monitoring program evaluation: a retrospective study

2016 ◽  
Vol 22 (6) ◽  
pp. 982-988 ◽  
Author(s):  
Cynthia Williams ◽  
Thomas T. H. Wan
10.2196/31044 ◽  
2021 ◽  
Vol 23 (6) ◽  
pp. e31044
Author(s):  
Celia Violet Laur ◽  
Payal Agarwal ◽  
Geetha Mukerji ◽  
Elaine Goulbourne ◽  
Hayley Baranek ◽  
...  


Author(s):  
Dorien Lanssens ◽  
Sharona Vonck ◽  
Valerie Storms ◽  
Inge M. Thijs ◽  
Lars Grieten ◽  
...  

2021 ◽  
Author(s):  
Celia Violet Laur ◽  
Payal Agarwal ◽  
Geetha Mukerji ◽  
Elaine Goulbourne ◽  
Hayley Baranek ◽  
...  

UNSTRUCTURED REMOVE


2019 ◽  
Vol 25 (8) ◽  
pp. 686-692 ◽  
Author(s):  
Dorien Lanssens ◽  
Sharona Vonck ◽  
Thijs Vandenberk ◽  
Cédric Schraepen ◽  
Valerie Storms ◽  
...  

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Briosa E Gala ◽  
M Pope ◽  
M Leo ◽  
T R Betts

Abstract Introduction Atrial fibrillation (AF) is conventionally divided in paroxysmal AF (PAF) and persistent AF (PersAF) according to episode duration, with a perceived inevitable progression of the arrhythmia in most patients: "AF begets AF". This dichotomous classification of AF is currently being challenged by continuous monitoring with implantable cardiac monitors and pacemakers which suggest different patterns of AF with considerable variation in AF burden.  Purpose This study sought to examine the long-term progression of AF burden in patients with complex cardiac devices (implantable cardiac defibrillators [ICD] and cardiac resynchronisation therapy-defibrillators [CRT-D]). Methods This retrospective study examined the weekly AF burden in patients with ICDs and CRT-Ds and on remote monitoring between January 2010 and July 2019.  All transmissions and electrograms were assessed for the presence of AF lasting more than 6 minutes.  The first episode of AF determined was considered follow-up year 0.  PersAF was defined as a weekly AF burden of 100%. Medical records were reviewed for baseline characteristics at the time of the first episode of AF and interventions that may affect burden such as direct current cardioversion (DCCV) and catheter ablations. Results Of 331 patients on remote monitoring, 106 (32%) had evidence of AF. Of these, 89% were male, age 64 ± 12 years, BMI 30 ± 6 kg/m2, LA diameter 4.5 ± 0.8 cm, 58% had an ICD, 10% had previous AF ablation and 27% had antiarrhythmic medication. Forty-six (43%) had PersAF and 60 (57%) had PAF over a total follow-up of 393 patient years (mean follow-up 4.6. ±2.1).  The mean AF burden  was 1.2 ± 4.4% in PAF and 66.4 ± 35.3% in PersAF at the end of the first year of follow-up. When compared to year 1, the mean annual AF burden did not increase in the PAF and PersAF groups. Moreover, the PersAF patients had a significant reduction in the mean annual AF burden up to year 7 of follow-up. In year 8, the mean annual AF burden remained below year 1; however, due to a low number of patients (5) it did not reach statistical significance (mean difference 15.1%, p = 0.06) . To further assess individual progression in PersAF patients, the annual AF burden was subdivided in 4 categories (<25%, 25%-50%, 50%-75% and >75%). In 30 (65%) patients it remained unchanged, in 5(11%) it worsened and in 11 (24%) it improved (Figure ). Moreover, 35 (76%) patients reverted to sinus rhythm following their first episode of PersAF (5 following DCCV and 2 after catheter ablation).  Conclusions In this cohort,  the mean AF burden did not increase; in fact, we observed a significant reduction in patients with PersAF despite a low rate of interventions. These findings reinforce the emerging concept of AF as a heterogenous disease with various phenotypes that challenge the current simplistic binary classification. Abstract Figure


2020 ◽  
Author(s):  
Daniel J. Amante ◽  
David M. Harlan ◽  
Stephenie C. Lemon ◽  
David D. McManus ◽  
Oladapo O. Olaitan ◽  
...  

BACKGROUND Patients with poorly-controlled type 2 diabetes (T2D) experience increased morbidity, mortality and higher cost of care. Self-monitoring of blood glucose (SMBG) is a critical component of diabetes self-management with established diabetes outcome benefits. Technological advancements in blood glucose meters, including cellular-connected devices that automatically upload SMBG data to secure cloud-based databases, allow for improved sharing and monitoring of SMBG data. Real-time monitoring of SMBG data presents opportunities to provide timely support to patients responsive to abnormal SMBG recordings. Such diabetes remote monitoring programs can provide patients with poorly-controlled T2D additional support needed to improve critical outcomes. OBJECTIVE To evaluate six months of a diabetes remote monitoring program facilitated by cellular-connected glucose meter, access to a diabetes coach and support responsive to abnormal blood glucose recordings greater than 400 mg/dL or below 50 mg/dL in adults with poorly controlled T2D. METHODS Patients (n=120) receiving care at a diabetes center of excellence participated in a two-arm, 12-month randomized crossover study. The intervention included a cellular-connected glucose meter and phone-based diabetes coaching provided by Livongo Health. The coach answered questions, assisted in goal setting, and provided support in response to abnormal glucose levels. One group received the intervention for six months before returning to usual care (IV/UC). The other group received usual care before enrolling in the intervention (UC/IV) for six months. Change in hemoglobin A1c (HbA1c) was the primary outcome and change in treatment satisfaction was the secondary outcome. RESULTS Improvements in mean HbA1c were seen in both groups during the first six months (IV/UC -1.1% (SD 1.5) vs. UC/IV -0.8% (1.5), p < 0.001). After crossover, there was no significant change in HbA1c in IV/UC (mean HbA1c change +0.2 (1.7), p=0.41); however, those in UC/IV showed further improvement (mean (SD) HbA1c change -0.4% (1.0), p < 0.01). A mixed-effects model showed no significant treatment effect (IV vs. UC) over 12 months (p=0.06). However, participants with higher baseline HbA1c and those in first time period experienced greater improvements in HbA1c. Both groups reported similar improvements in treatment satisfaction throughout the study. CONCLUSIONS Patients enrolled in the diabetes remote monitoring program intervention experienced improvements in HbA1c and treatment satisfaction similar to usual care at a specialty diabetes center. Future studies on diabetes remote monitoring program should incorporate scheduled coaching components and involve family members and caregivers. CLINICALTRIAL Study details can be found at clinicaltrials.gov with the study identifier number: NCT03124043.


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