title: Remote follow-up of pacemakers in a selected population of debilitated elderly patients.
abstract: OBJECTIVE
  The majority of patients with pacemakers are very elderly, many being >85-years old. They often suffer from serious illnesses and have great difficulty in walking. The aim of our study was to compare remote pacemaker monitoring with in-home checks of pacemakers, in terms of applicability, efficacy, and cost in a selected population of debilitated elderly patients.
  
  
  RESULTS
  We selected 72 subjects (mean age 87 ± 8 years) among elderly debilitated patients with Medtronic pacemakers, compatible with the Carelink(®) remote monitoring system (13 patients with DDD pacemaker; 59 patients with single-lead VDD pacemaker). Remote follow-up was compared with in-home checks performed by nurses in 326 patients in similar clinical conditions. A total of 190 transmissions were received by remote monitoring (mean transmissions per month: 7.0; mean per patient: 2.6; range 1-6) during 27 months of follow-up. In this period, seven pacemakers were replaced owing to battery exhaustion, after a mean of 6.7 years from implantation. The occurrence of atrial or ventricular high-rate episodes was reported in 98 transmissions (53%). Nineteen patients died (annual mortality: 11.7%). On comparing the costs borne by the hospital for in-home checks, both for medical personnel and transportation, the estimated average saving was €32 per year per patient.
  
  
  CONCLUSIONS
  Our study shows that the remote follow-up of pacemakers is a reliable, effective, and cost-saving procedure in elderly, debilitated patients. Moreover, remote controls provided an accurate and early diagnosis of arrhythmia occurrence.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani, 2, Padova 35128, Italy. franco.folino@unipd.it
authors.forename: Antonio Franco
authors.initials: AF
authors.lastname: Folino
authors.forename: Roberto
authors.initials: R
authors.lastname: Breda
authors.forename: Patrizia
authors.initials: P
authors.lastname: Calzavara
authors.forename: Francesca
authors.initials: F
authors.lastname: Borghetti
authors.forename: Jennifer
authors.initials: J
authors.lastname: Comisso
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Buja
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000191:economics; D016009:Chi-Square Distribution; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D011211:Electric Power Supplies; D004562:Electrocardiography / Q000191:economics; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D017721:Hospital Costs; D006792:House Calls / Q000191:economics; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D010138:Pacemaker, Artificial / Q000191:economics; D011237:Predictive Value of Tests; D012815:Signal Processing, Computer-Assisted; D017216:Telemedicine / Q000191:economics / Q000379:methods*; D013686:Telemetry / Q000191:economics; D013997:Time Factors