title: Home Monitoring technology and integrated follow-up care of ICD patients.
abstract: OBJECTIVE
  Increasing utilization rates of implantable cardioverter-defibrillators (ICDs) tend to overburden follow-up resources at the implanting electrophysiological centres (ECs). Remote monitoring technology allows physicians from different institutions to simultaneously review ICD data of shared patients. We studied if an integrated follow-up care involving ECs and general cardiologists (GCs) may reduce the frequency of in-office follow-ups at ECs by using remote monitoring data to identify routine checks that may be conducted at GCs.
  
  
  RESULTS
  The analysis included 109 patients (aged 63 +/- 11 years, 84.4% male) followed for a cumulative study duration of 155 patient-years. The patients underwent 436 in-office controls after hospital discharge: 143 (33%) at two ECs and 293 (67%) at two GCs (each cooperating with one EC). The mean duration of in-office follow-up sessions was 13.7 min (EC) and 10.3 min (GC). The average distance between patients' homes and follow-up sites was 31.6 km (EC) vs. 16.2 km (GC). Investigators considered a follow-up to be of'high or medium'importance in 78% (EC) vs. 45% (GC) of all in-office follow-ups. At one EC, the integrated follow-up care concept appeared highly successful, with 97% of follow-ups transferred to the corresponding GC and, on average, 103.8 km shorter patient trips per follow-up.
  
  
  CONCLUSIONS
  Integrated follow-up care guided by remote monitoring allows to direct the more significant follow-ups towards ECs and routine follow-ups towards GCs.This concept may contribute to the needed adaptations of the health-care system to the rising numbers of patients with implanted devices.
authors.affiliation: Institute for Prevention and Sports Medicine, CardioCentrum Düsseldorf, Düsseldorf, Germany. stefan.perings@t-online.de
authors.forename: Stefan M
authors.initials: SM
authors.lastname: Perings
authors.forename: Christian
authors.initials: C
authors.lastname: Perings
authors.forename: Norbert
authors.initials: N
authors.lastname: Smetak
authors.forename: Christian
authors.initials: C
authors.lastname: Meyer
authors.forename: Dong-In
authors.initials: DI
authors.lastname: Shin
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.forename: Johannes
authors.initials: J
authors.lastname: Brachmann
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000191:economics; D017046:Cost Savings; D017147:Defibrillators, Implantable; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D015716:Electrocardiography, Ambulatory / Q000191:economics / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005260:Female; D005858:Germany; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008490:Medical Informatics / Q000458:organization & administration; D008875:Middle Aged; D011446:Prospective Studies; D019114:Remote Consultation