Home MonitoringTM technology and integrated follow-up care of ICD patients

Abstract

Objective Increasing utilization rates of implantable cardioverter-defi brillators (ICDs) tend to overburden follow-up resources at the implanting electrophysiological centres (ECs). Remote monitoring technology allows physicians from diff erent institutions to simultaneously review ICD data of shared patients. We studied if an integrated follow-up care involving ECs and general cardiologists (GCs) may reduce the frequency of in-offi ce follow-ups at ECs by using remote monitoring data to identify routine checks that may be conducted at GCs.Methods and results The analysis included 109 patients (aged 63 ± 11 years, 84.4% male) followed for a cumulative study duration of 155 patient-years. The patients underwent 436 in-offi ce controls after hospital discharge: 143 (33%) at two ECs and 293 (67%) at two GCs (each cooperating with one EC). The mean duration of in-offi ce follow-up sessions was 13.7 min (EC) and 10.3 min (GC). The average distance between patients’ homes and follow-up sites was 31.6 km (EC) vs. 16.2 km (GC). Investigators considered a follow-up to be of ‘high or medium’ importance in 78% (EC) vs. 45% (GC) of all in-offi ce follow-ups. At one EC, the integrated follow-up care concept appeared highly successful, with 97% of follow-ups transferred to the corresponding GC and, on average, 103.8 km shorter patient trips per follow-up.Conclusions Integrated follow-up care guided by remote monitoring allows to direct the more signifi cant follow-ups towards ECs and routine follow-ups towards GCs. This concept may contribute to the needed adaptations of the health-care system to the rising numbers of patients with implanted devices.