title: Diagnostic and cost effectiveness of telemonitoring the pediatric pacemaker patient.
abstract: Although recommended as part of a comprehensive pacemaker follow-up protocol, the diagnostic and cost-effectiveness of routine telephone monitoring (TM) in children in the United States is largely unknown. Patient age and size with inherent age-related problems and potential inability to correlate symptoms with pacemaker performance places the pediatric patient in a unique category, different from that of the adult. A total of 96 patients, ages 0.2-32.0 years (mean 12.0 years) were followed for 3 years after pacemaker implant with both routine monthly and anytime emergency TM. A total of 1372 routine transmissions were performed of a recommended 3456 (40% patient compliance). Of these, 99% showed normal rhythm or pacemaker function. The remaining 1% demonstrated asymptomatic pacemaker dysfunction requiring intervention or new-onset dysrhythmias. A total of 75 emergency transmissions were undertaken for patient/parent-perceived problems, only 8% of which showed pacemaker dysfunction or dysrhythmias. The sensitivity of patient/parent capacity to detect pacemaker problems or dysrhythmias based on clinical findings was 29%, with a positive predictive value of 8%. The specificity of routine monthly TM to screen for asymptomatic pacemaker dysfunction or new-onset dysrhythmias was 95%, with a negative predictive value of 99%. TM was effective (p < 0.001) for correlating the presence or absence of pacemaker problems with subjective complaints at any patient age. Financial charges for use of TM were significantly less (p < 0.01) than comparable outpatient visits.
authors.affiliation: Section of Cardiology, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Boulevard, Detroit, MI 48201, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Vincent
authors.forename: D L
authors.initials: DL
authors.lastname: Cavitt
authors.forename: P P
authors.initials: PP
authors.lastname: Karpawich
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D004562:Electrocardiography; D006801:Humans; D007223:Infant; D008991:Monitoring, Physiologic / Q000191:economics / Q000379:methods*; D010138:Pacemaker, Artificial; D017216:Telemedicine / Q000191:economics; D013689:Telephone