Information and Technology Based Therapeutic Remote Monitoring of Patient after Assist Device Implantation: A Conceptual Study and Preliminary Results

Abstract

Objectives: Left ventricular assist device (LVAD) implantation are increasing in prevalence to treat end stage heart failure. Post-implantation follow-up is important for monitoring device function and patient condition to avoid anticoagulation related life-threatening side effects or VAD malfunction. However, practise is inconsistent, and according to physician preference.Thus, in this study we evaluated and described an intelligent e-health platform for wireless remote monitoring of cardiac performance and anticoagulation status in VAD patients to identify salient problems rapidly. Methods: We designed and established a project pathway to conceptualise the deployment of this e-health service. Using insights of technical and conceptual needs (status-quo process) and a patient survey (capture of willingness to apply modern information technology and demands related to e-health) were combined to develop step by step a full scope-telemonitoring platform in VAD population. Results: Cardiac implantable electronic devices (ICD) and anticoagulation management (CoaguCheck®) are identified as potential enabler for health care process optimization and data flow. Using our e-health platform all data coming from the ICD or CoaguCheck® are recorded, evaluated and stored in a electronic health record and periodically analyzed for 50 consecutive patients. For data transmission no additional action is required. Potentially impaired health status, arrhythmias, disturbances or differences to define ranges of INR levels are highlighted automatically as alerts. Consequently, both the patient and the stakeholder are informed for further action. Most of the patient are appreciate e-health technology, but they have concerns about the security of data transmission and data confidentiality. Conclusions: A profound IT-support with continuous date exchange using implantable devices for monitoring VAD patients could impact the health care positively by avoiding life-threatening situations on a short reaction time along the care pathway. Additionally, such an e-health monitoring will help to reduce hospitalisation periods and rates and, therefore, decrease health insurance costs.