Home monitoring remote control of pacemaker and implantable cardioverter defibrillator patients in clinical practice: impact on medical management and health-care resource utilization.
OBJECTIVE
To evaluate the impact of Home Monitoringtrade mark(HM) remote control on patient medical treatment and on health-care resource utilization.


RESULTS
One hundred and seventeen patients received HM pacemakers or defibrillators. A pacing expert nurse consulted daily the website and submitted critical cases to physician. During a mean follow-up of 227 +/- 128 days, 25,210 messages were received (23,545 daily messages and 1665 alert events) resulting in 90.7% of HM supervised days. Fifty-nine minutes/week for the nurse and 12 min/week for the physician were spent for HM data analysis during 267 web-connections. The mean connection time per patient was 115 +/- 60 s. The nurse submitted to the physician 133 critical cases in 56 patients. The diagnosis were atrial fibrillation (47%), ventricular tachyarrhythmias (9%), inappropriate implantable cardioverter defibrillator intervention (4%), unsustained ventricular tachycardia (7%), device suboptimal programming (23%), and impending heart failure (10%). Sixty-six unplanned follow-up in 43 patients led to drug therapy change (44%), device reprogramming (18%), diagnosis confirmation without further intervention (24%), no confirmation (6%), further diagnostic tests (9%).


CONCLUSIONS
HM technology allowed optimization of medical treatment and device programming with low consumption of health-care resource.
Ricci
Renato Pietro
RP
Department of Cardiovascular Disease, San Filippo Neri Hospital, Via Martinotti 20, 00135 Rome, Italy. renatopietroricci@tin.it
Morichelli
Loredana
L
Santini
Massimo
M
D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000628:therapy*; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D005240:Feasibility Studies; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006699:Home Care Services; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D013686:Telemetry