title: Potential role of telemedical service centers in managing remote monitoring data transmitted daily by cardiac implantable electronic devices: results of the early detection of cardiovascular events in device patients with heart failure (detecT-Pilot) study.
abstract: OBJECTIVE
  Implantable cardioverter-defibrillators (ICDs) alone or combined with cardiac resynchronization therapy (CRT-Ds) featuring automatic home monitoring (HM) function can be monitored remotely on a daily basis. Different ways of implementing HM into clinical routines are possible, with efficient patient management being the main objective. In this study, a concept using a telemedical service center (TmSC) to manage HM data was developed and investigated regarding patients' satisfaction, physicians' satisfaction, and alert filtering.
  
  
  METHODS
  Fifty-five ICD or CRT-D patients with symptomatic heart failure were enrolled. The TmSC received HM data, identified "actionable parameters" (APs) by following protocol-defined procedures, conducted structured patient interviews, and forwarded selected APs to the respective follow-up clinic. Satisfaction of patients and physicians with the TmSC was evaluated at the end of the study by purpose-designed questionnaires.
  
  
  RESULTS
  During a mean follow-up of 402±200 days, 3,831 APs were identified and analyzed at the TmSC (5.28 per patient-month). Most APs were triggered by a pilot detection algorithm for worsening heart failure (2.80 per patient-month), followed by atrial tachyarrhythmia episodes (1.10 per patient-month) and ventricular pacing issues (0.87 per patient-month). The TmSC forwarded 682 APs (18% of all APs) to 10 study sites. Approximately 65% of physicians and patients deemed the TmSC improved patient care.
  
  
  CONCLUSIONS
  The TmSC-based management concept was well accepted and appreciated by the majority of physicians and patients. It may be helpful in gaining symptomatic information on top of automatic HM data and in supporting smaller clinics in the follow-up of their device patients.
authors.affiliation: Clinic of Internal Medicine I, Chemnitz Hospital, 09113 Chemnitz, Germany. axel.mueller@skc.de
authors.forename: Axel
authors.initials: A
authors.lastname: Müller
authors.forename: Andreas
authors.initials: A
authors.lastname: Goette
authors.forename: Christian
authors.initials: C
authors.lastname: Perings
authors.forename: Herbert
authors.initials: H
authors.lastname: Nägele
authors.forename: Thomas
authors.initials: T
authors.lastname: Konorza
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Spitzer
authors.forename: Sabine-Susan
authors.initials: SS
authors.lastname: Schulz
authors.forename: Christian
authors.initials: C
authors.lastname: von Bary
authors.forename: Matthias
authors.initials: M
authors.lastname: Hoffmann
authors.forename: Marco
authors.initials: M
authors.lastname: Albani
authors.forename: Stefan
authors.initials: S
authors.lastname: Sack
authors.forename: Annegret
authors.initials: A
authors.lastname: Niederlöhner
authors.forename: Thorsten
authors.initials: T
authors.lastname: Lewalter
mesh_terms: D000368:Aged; D003226:Congresses as Topic; D003258:Consumer Behavior; D017147:Defibrillators, Implantable; D042241:Early Diagnosis; D005260:Female; D005858:Germany; D063025:Health Information Management; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D007253:Information Centers; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D010865:Pilot Projects; D013686:Telemetry