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Organizational model and reactions to alerts in remote monitoring of cardiac implantable electronic devices: A survey from the Home Monitoring Expert Alliance project
Author(s) -
Zanotto Gabriele,
D'Onofrio Antonio,
Della Bella Paolo,
Solimene Francesco,
Pisanò Ennio C.,
Iacopino Saverio,
Dondina Cristina,
Giacopelli Daniele,
Gargaro Alessio,
Ricci Renato P.
Publication year - 2019
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.23108
Subject(s) - medicine , interquartile range , cardiac resynchronization therapy , implantable cardioverter defibrillator , atrial fibrillation , medical emergency , alliance , emergency medicine , heart failure , cardiology , ejection fraction , political science , law
Background This survey aimed to describe the organizational workflow of cardiac implantable electronic devices (CIEDs) remote monitoring (RM) service in ordinary practice. Methods A questionnaire was designed for our purpose and completed by 49 sites participating to the Italian Home Monitoring Expert Alliance. Results A dedicated organizational model for RM was set up for 86% of centers. The median RM team consisted of 2 (Interquartile range [IQR]: 1‐3) physicians and 1 (IQR: 0‐2) nurse. RM service was available in working hours and the median percentage of patients included was 100% (IQR: 10%‐100%) for implantable cardioverter‐defibrillator (ICD) and cardiac resynchronization therapy (CRT) recipients and 5% (IQR:0%‐30%) for pacemakers. In‐office follow‐up was performed every 12 and 6 months for pacemaker and ICD/CRT recipients, respectively. More than 90% of sites used to activate all technical alerts, with a prompt reaction in case of an out‐of‐range parameter. The threshold for atrial fibrillation (AF) daily burden notification in most cases ranged from 2.4 to 7.2 hours. All ventricular arrhythmias alerts were usually switched on: an inappropriate therapy or more than one appropriate episode triggered an urgent in‐hospital visit. Concerning heart failure, low CRT percentage pacing alert was always used, while the other available notifications were less frequently switched on. Conclusions This survey showed that RM service was usually set up with a primary nursing model including on average two responsible physicians and one nurse and mainly offered to ICD/CRT patients. Technical, AF and ventricular arrhythmia alerts triggered prompt reactions, while heart failure related indexes were generally less applied.

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