The HomeGuide Registry was a prospective study (NCT01459874), implementing a model for remote monitoring of cardiac implantable electronic devices (CIEDs) in daily clinical practice, to estimate effectiveness in major cardiovascular event detection and management.The workflow for remote monitoring [Biotronik Home Monitoring (HM)] was based on primary nursing: each patient was assigned to an expert nurse for management and to a responsible physician for medical decisions. In-person visits were scheduled once a year. Seventy-five Italian sites enrolled 1650 patients [27 pacemakers, 27 single-chamber implantable cardioverter defibrillators (ICDs), 22 dual-chamber ICDs, 24 ICDs with cardiac resynchronization therapy]. Population resembled the expected characteristics of CIED patients. During a 20 13 month follow-up, 2471 independently adjudicated events were collected in 838 patients (51): 2033 (82) were detected during HM sessions; 438 (18) during in-person visits. Sixty were classified as false-positive, with generalized estimating equation-adjusted sensitivity and positive predictive value of 84.3 [confidence interval (CI), 82.586.0] and 97.4 (CI, 96.598.2), respectively. Overall, 95 of asymptomatic and 73 of actionable events were detected during HM sessions. Median reaction time was 3 days [interquartile range (IQR), 114 days]. Generalized estimating equation-adjusted incremental utility, calculated according to four properties of major clinical interest, was in favour of the HM sessions: 0.56 (CI, 0.530.58), P 0.0001. Resource consumption: 3364 HM sessions performed (76 by nurses), median committed monthly manpower of 55.5 (IQR, 22.0107.0) min health personnel/100 patients.Home Monitoring was highly effective in detecting and managing clinical events in CIED patients in daily practice with remarkably low manpower and resource consumption.
Effectiveness of remote monitoring of {CIEDs} in detection and treatment of clinical and device-related cardiovascular events in daily practice: the {HomeGuide} Registry
S. Favale;E. Santobuono
2013-01-01
Abstract
The HomeGuide Registry was a prospective study (NCT01459874), implementing a model for remote monitoring of cardiac implantable electronic devices (CIEDs) in daily clinical practice, to estimate effectiveness in major cardiovascular event detection and management.The workflow for remote monitoring [Biotronik Home Monitoring (HM)] was based on primary nursing: each patient was assigned to an expert nurse for management and to a responsible physician for medical decisions. In-person visits were scheduled once a year. Seventy-five Italian sites enrolled 1650 patients [27 pacemakers, 27 single-chamber implantable cardioverter defibrillators (ICDs), 22 dual-chamber ICDs, 24 ICDs with cardiac resynchronization therapy]. Population resembled the expected characteristics of CIED patients. During a 20 13 month follow-up, 2471 independently adjudicated events were collected in 838 patients (51): 2033 (82) were detected during HM sessions; 438 (18) during in-person visits. Sixty were classified as false-positive, with generalized estimating equation-adjusted sensitivity and positive predictive value of 84.3 [confidence interval (CI), 82.586.0] and 97.4 (CI, 96.598.2), respectively. Overall, 95 of asymptomatic and 73 of actionable events were detected during HM sessions. Median reaction time was 3 days [interquartile range (IQR), 114 days]. Generalized estimating equation-adjusted incremental utility, calculated according to four properties of major clinical interest, was in favour of the HM sessions: 0.56 (CI, 0.530.58), P 0.0001. Resource consumption: 3364 HM sessions performed (76 by nurses), median committed monthly manpower of 55.5 (IQR, 22.0107.0) min health personnel/100 patients.Home Monitoring was highly effective in detecting and managing clinical events in CIED patients in daily practice with remarkably low manpower and resource consumption.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.