title: Validation of an Organizational Management Model of Remote Implantable Cardioverter-Defibrillator Monitoring Alerts.
abstract: BACKGROUND
  Implantable cardioverter-defibrillators (ICDs) are a standard means of sudden cardiac death prevention. Compared with ambulatory visits, remote monitoring (RM) of ICD recipients has improved the quality of health care and spared its resources. Few studies have addressed the organization of RM. We optimized and validated our institutional model of RM organization for ICD recipients.
  
  
  RESULTS
  This observational study of 562 ICD recipients compared 2 RM periods consisting of iterative, qualitative, and quantitative (1) device diagnostic evaluations by nurses and cardiologists; and (2) selected decisional trees. The main study end points were the professional interventions prompted by, and times allocated to, RM alerts. During the first period, 1134 alerts occurred in 427 patients (286 patient-year), of which 376 (33%) were submitted to cardiologists' reviews, compared with, 1522 alerts in 562 patients (458 patient-year), of which 273 (18%) were submitted to cardiologists' reviews during the second period (P<0.001). An intervention was prompted by 73 of 376 (19.4%) alerts in the first versus 77 of 273 (28.2%) in the second period (P=0.009). The mean time to manage an alert was 4 minutes 31 s in the first versus 2 minutes 10 s in the second period (P<0.001). The annual numbers of alert-related hospitalizations were 10.8 versus 8.1 per 100-patient-year (P=0.230), and annual numbers of alert-related visits were 9.8 and 6.1 per 100-patient-year (P=0.081), respectively.
  
  
  CONCLUSIONS
  An optimized RM organization based on automated alerts and decisional trees enabled a focus on clinically relevant events and a decrease in the consumption of resources without compromising the quality of ICD recipients' care.
authors.affiliation: From the Lille Regional University Health Centre, Lille, France. laurence.guedon@chru-lille.fr.
authors.forename: Laurence
authors.initials: L
authors.lastname: Guédon-Moreau
authors.affiliation: From the Lille Regional University Health Centre, Lille, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Finat
authors.affiliation: From the Lille Regional University Health Centre, Lille, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Boulé
authors.affiliation: From the Lille Regional University Health Centre, Lille, France.
authors.forename: Ludivine
authors.initials: L
authors.lastname: Wissocque
authors.affiliation: From the Lille Regional University Health Centre, Lille, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Marquié
authors.affiliation: From the Lille Regional University Health Centre, Lille, France.
authors.forename: François
authors.initials: F
authors.lastname: Brigadeau
authors.affiliation: From the Lille Regional University Health Centre, Lille, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Kouakam
authors.affiliation: From the Lille Regional University Health Centre, Lille, France.
authors.forename: Blandine
authors.initials: B
authors.lastname: Mondésert
authors.affiliation: From the Lille Regional University Health Centre, Lille, France.
authors.forename: Salem
authors.initials: S
authors.lastname: Kacet
authors.affiliation: From the Lille Regional University Health Centre, Lille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Klug
authors.affiliation: From the Lille Regional University Health Centre, Lille, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Lacroix
mesh_terms: D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D008991:Monitoring, Physiologic / Q000379:methods*; D011788:Quality of Life; D015203:Reproducibility of Results; D012189:Retrospective Studies; D017216:Telemedicine / Q000379:methods*; D013997:Time Factors
keywords: death, sudden, cardiac; defibrillators, implantable; models, organizational; remote monitoring; telemedicine