Current International State of Remote Monitoring Ventricular Assist Device Patients

Abstract

As ventricular assist device (VAD) survival rates improve, focus has shifted to decreasing adverse events. Remote monitoring (RM) is a tool to optimize care and VAD coordinators are often responsible for implementing RM. Currently, there is limited research on the clinical benefits of RM in VAD patients. The aim of this study was to examine how VAD coordinators utilize RM, the impact on their workflow, and their perceptions of this technology. An online survey was distributed via the Mechanical Circulatory Support Collaboration yahoo group and International Consortium of Circulatory Assist Clinicians email from July to August 2019. The survey included questions regarding- center demographics, workflow, feature utilization, and clinical impact. Basic statistical analysis was performed, and open response questions were analyzed for recurrent themes. A total of 34 surveys were received representing 28 centers in 4 countries. Regarding which RM platforms are utilized- 74.3% use Acelis Connected Health, 22.9% ActiCare Health, and 20% "other." An average of 12.5 hours per week (range 2-168) was dedicated to RM. The most followed data was: International Normalized Ratio (INR) (82.9%), weight (77.1%), VAD parameters (74.3%) and blood pressure (62.9%). For 82% the RM platform does not interface with the patient chart, and 60% do not bill for RM services. Patients are instructed to upload photos of their driveline exit site by 62.9% of respondents. A majority do not use RM to track VAD equipment (64.7%), ask questions to their patients (65.7%), or for video conferencing (94.3%). Three themes emerged: INR monitoring was the most useful (33%), coordinators found parameter trends beneficial (33%) and RM holds patients more accountable (23.8%). The potential improvements identified were: 40.9% found the platforms to not be user friendly, and 18.1% expressed frustration that not all patients were eligible due to insurance benefits. In regards to clinical outcomes, 82.8% do not have quality measures with RM. This survey shows RM is now part of the VAD coordinator daily workflow. Most use 3rd party vendors and have patients transmit daily. There is an increase in coordinator work in exchange for a perceived improvement in patient care. INR monitoring was the most followed parameter. An improvement in platform interfaces may increase utilization of this emerging tool.