Authors (including presenting author) :
Chiu SH(1), Wu KY(1), Kwok YC(1), Chan WS(1), Tsang MY(1)
Affiliation :
(1)Cardiac Team, Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China
Introduction :
There has been a rapid growth in the number of patients with cardiac implantable electronic devices (CIEDs) in Hong Kong as well as in other countries. In our center, there were estimated 160 new cases and accounted for more than 2500 episodes of clinic follow-up per year. Remote monitoring (RM) has broken out as is a safe, feasible and efficient solution. A pilot RM program for CIEDs patients were started at Princess Margaret Hospital (PMH) from July 2018 to explore the clinical benefits.
Objectives :
1. Early identification of arrhythmias, clinical events to allow earlier intervention 2. Early detection of lead malfunction and device failure to improve clinical outcome 3. Replace unnecessary device clinic follow up to reduce doctors’ workload
Methodology :
Patients with cardiac implantable devices including permanent pacemakers (PPMs), implantable cardioverter defibrillators (ICDs), cardiac resynchronization therapy (CRT) devices, and implantable loop recorders (ILRs), who agreed to receive a monitoring system and allow the internet-based transmission of encrypted personal information were invited to join. After full coverage explanation by device-clinic nurse, a written consent was signed. Individualized alerts and scheduled transmission was set up according to the pre-approved protocol. The data would be transferred to the RM database automatically or initiated by patients according to different manufactures. The device-clinic nurse reviewed the alerts on every Monday. For the high-risk red alerts, email notifications would send to the clinic nurse & doctor in-charge for analysis and early intervention if required. According to patient’s clinical status, clinic doctor would consider to replace clinic follow-up by remote follow-up alternately.
Result & Outcome :
From July 2018 to June 2020, total 133 eligible patients were invited to join RM program with 92(69.2%) patients enrolled successfully. The main reasons to refuse including, did not believe the RM technology, felt frustration to set up the transmitter at home or initiate the data transmission by self. 5(0.4%) patients dropped out because of failure to connect the transmitter at home, lacking supported from family members, not allowed by proprietor or dissatisfaction with no reduction of clinic follow-up. Total 707 alerts were received and reviewed. 26(3.7%) alert notifications due to new onset or burden of arrhythmias including atrial fibrillation and ventricular tachycardia, lead problems, ICD shock, battery depletion or fluid congestion required early follow up or clinical admission for active intervention. The numbers of clinic follow-up of patients with RM diminished by 40% compared with conventional practice. Moreover, the risk of missing a clinical event requiring active intervention did not report.
It can be easily concluded that device patients can benefit from RM in terms of early adverse event diagnosis, early intervention and better clinical outcome. Whilst the device centers can profit from reducing doctors’ workload. RM should be considered in all eligible device patients.
