NURSING COUNSELING FOR THE OPTIMIZATION OF THE REMOTE MANAGEMENT OF PATIENTS WITH ILR AFTER CRYPTOGENIC STROKE

Abstract

Abstract Background ILR is a device used to diagnose and document cardiac rhythm disorders in various clinical contexts including syncope and CS. The ILRs can be remotely monitored through a dedicated system consisting of a fully automatic home monitor or, in the latest generation devices, throughan APP that can be downloaded by the patient on his mobile phone. ILR remote monitoring can be performed by the nurse after acquiring the necessary skills on system functioning and knowledge about heart rhythm disorders. Methods Since 2017, a collaboration between Cardiologists and Neurologists has been established at our hospital providing a shared protocol for the management of patients with CS implanted with an ILR to detect asymptomatic AF. All CS patients referred for ILR implantation at our center received a MEDTRONIC ILR and were equipped with a remote monitoring system. ILR management protocol includes a first phase after the implant, where the nurse carries out patient training and counseling; enters all data in the Medtronic Carelink website, provides the patient with the home monitor, clearly explaining its use at home and, finally, obtains patient informed. Second phase of the protocol includes patient FU management, where the nurse reviews all remote transmissions, identifies any arrhythmic events and contacts by phone the patient to evaluate symptoms and, in case,establish the date for FU. Results Since 2017, 70 pz with CS (mean age:65±9 years,67.24% with CHADS2–VASc Score >=4) underwent ILR implantation.ILR remote monitoring allowed the diagnosis of AF in 27% pz (asymptomatic in 72%), of bradyarrhythmia in 4% and VT in 2%. Patients with arrhythmic diagnoses were contacted for FU in H to set up appropriate intervention. In described care pathway, the training and counselling carried out by nurses after the implant was crucial to establish the relationship of trust between patient and nurse, which significantly improved patient compliance. Conclusions The use of ILR has allowed to detect arrhythmias, even when asymptomatic, in patients affected by CS. In our experience, remote monitoring managed by trained nurses was crucial for the early diagnosis of AF. However, since technology is rapidly evolving, training updates to nurse staff regarding remote monitoring systems are essential to improve the counselling. Teamwork and constant cardiologist–nurse communication proved to be fundamental in offering the best care to these patients.